5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation, then we can target our therapy and plan treatment that we know will work, instead of going through chemotherapies that are only partially effective or downright ineffective and then finding that the patient is resistant to treatment.

 

Are there side effects or drawbacks to targeted therapy?

A. Everything we do has side effects. The oral agent ibrutinib has been an effective first-line therapy for any type of CLL. Although the agent is specifically for patients with 17p deletion, it has also worked for patients without that genetic feature. While some cardiovascular and bleeding issues have been reported, ibrutinib overall is more tolerable than chemotherapy.

When we medically examine patients with CLL, we always look at a pattern of mutations to try to identify how to treat these people — not so much from an immediate therapeutic standpoint, but to gain knowledge of all these other cytogenetic abnormalities so that eventually, we will find other ways to target those different patterns.

What important points do you address with patients before they begin CLL therapy?

A. Many people with CLL don’t die of their disease, they die with their disease, so I tell patients not to be afraid of the disease itself. Many of the conversations we have with these people, however, revolve around the fact that they have this problem but may never need treatment. “We should follow you because you may need treatment down the line,” I tell them. “If you need treatment, we have many effective therapies.”

 

Do you foresee different therapies for CLL emerging within the next two to three years?

A. A number of medications are on the horizon that will be appropriate for any patient with CLL. For example, venetoclax, which gained FDA approval last year, is indicated for second-line treatment of CLL in patients with the 17p deletion, but I think that agent will be effective for all patients with CLL. As similarly versatile agents are developed, we will have many more treatment options.

What Role Do RNs Play in Oncology Treatment?

While all nurses are intimately involved in the challenges and rewards of patient care, this is perhaps most evident in the role that oncology nurses play in treating and caring for cancer patients. They are by the bedside offering encouragement and care as well as providing patient and family education.

What Does an Oncology Nurse Do?

An oncology nurse is a registered nurse who is typically the care coordinator for a patient who has cancer. Their duties vary by institution, but in the best cancer care facilities they typically include:

– Conducting a health history review
– Monitoring patients’ physical and emotional health
– Keeping track of necessary diagnostic tests and results
– Administering medications and treatments like chemotherapy
– Collaborating on patient care plans with other members of the healthcare team
– Educating patients and their families about their disease, methods for treatment, and side effects they may experience. This includes explaining complex medical terms and answering any questions that arise.
– Helping with symptom management throughout treatment

What Kind of Education Does an Oncology Nurse Receive?

Registered nurses must develop knowledge and clinical expertise in cancer care when becoming an oncology nurse. While this can sometimes be gained through direct experience, many oncology nurses undergo voluntary board certification in the area of cancer care through the Oncology Nursing Certification Corporation. For certification, an RN must meet state eligibility criteria and pass an exam. Some oncology nurses have advanced certification that includes a master’s degree or higher and a specified number of hours of supervised clinical practice.

What Should I Expect from an Oncology Nurse?

Patients undergoing cancer treatment will have an oncology nurse by their side throughout this challenging process. There are many details to remember when fighting this complex disease, and the nurse is responsible for keeping track of these details for his or her patients. That’s why some of the best cancer treatment centers refer to oncology nurses as “nurse navigators”—they are helping patients navigate these uncharted waters.

The role of the oncology nurse is more than just clinical. Oncology nurses are a much-needed source of compassion for patients and families, often forming meaningful relationships that extend long after treatment is completed.

Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

 

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

 

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

 

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

Think Cancer Prevention During Breast Cancer Awareness Month

American women have a 1 in 8 chance of getting breast cancer sometime during their life. Nearly a quarter million new, positive diagnoses of the disease will occur in the U.S. this year. The good news is breast cancer treatments and pharmaceuticals have dramatically improved in recent years, and new ones continue to emerge. Still, the basic guidance remains the same; early detection is key, as is knowing hereditary factors and warning signs that lead to a prompt diagnosis and successful treatment. During this October for Breast Cancer Awareness Month, consider these reminders for awareness and prevention.

Invaluable Role of Family and Personal History

Knowing if a relative had breast cancer is vital since family history plays such a significant role in incidence rate. Find out if at all possible. Knowledge of personal medical history also is crucial. For example, oncologists report women with cancer in one breast are at increased risk for the disease in the other. Dense breast tissue increases disease risk, as does not having children or bearing a first child after age 30. Oral contraceptive use, alcohol consumption, and becoming overweight after menopause may increase risk slightly. Finally, breast cancer susceptibility rises with age, with White women generally at higher risk than Black, Hispanic, Asian, and Native-American women.

Symptoms and Warning Signs

Thanks to regular screening mammography, radiologists and oncologists are spotting more breast cancer early before outward signs appear. Knowledgeable patients also play a fundamental role by paying attention to common warning signs and seeking medical help promptly. Signs and symptoms include:

  • A new lump or mass that appears on or near the breast, such as locations like armpits or the collarbone.
  • Swelling of part of or the entire breast.
  • Soreness or pain in the nipple or breast.
  • The nipple no longer protrudes but pulls back into the breast.
  • Any irritation, dimpling, scaling, redness, or thickening of breast skin.
  • A fluid discharging from the breast or nipple other than milk.

Make an appointment with your physician or nearby cancer center should any of these issues arise. Don’t delay.

Molecular Testing: Tailoring Treatment by Targeting Pathways

Phillip D. Reid, MD

 

What is molecular testing? How it is used in cancer care?

A.  As we learn how to treat specific subtypes of cancer more accurately, molecular testing, molecular medicine and molecular diagnostics are becoming more prominent in oncology.

In the past, once a cancer was diagnosed, we determined the organ where it started, how much cancer was in the body and where it was. We have since discovered many pathways through which a cancer develops. We now need to know not only the stage, type and origin of cancer, but also the pathway through which it developed and then target that pathway.

 

How does the pathway concept affect therapy selection?

A.  It enhances our ability to treat the cancer, but we now need extra testing on a patient’s particular cancer cells. The great thing about molecular testing is we get an answer specific for the individual, not just for everyone, for example, with lung cancer. But it does require more time for us to find the pathway. From the patient’s standpoint, diagnosis and stage are obtained, and then sometimes we have to send off the cancer cells for extra testing, which increases the time between diagnosis and treatment. But ultimately, a better sense is provided of what drug to use and when to use it, and there’s a much greater likelihood of devising specific, effective treatment.

 

For which types of cancer should molecular testing be used?

A.  Molecular testing has revolutionized every major cancer diagnosis. Patients with lung and breast cancer are the best candidates, but molecular testing also is useful in colon cancer, head-and-neck and bladder cancer, and some leukemias and myelomas.

 

What have been the main developments over the last two to three years with molecular testing?

A.  It’s becoming easier and more standardized to get molecular testing done. A patient receives a diagnosis and his or her cancer is sent off to a lab, which evaluates all known pathways for that cancer. A specific result is received. As the patient receives therapy, sometimes the cancer changes and he or she may need a second or third biopsy one to three years after the initial diagnosis to see what’s changed in the cancer, and then the treatment changes based on that result. We now see cancer as a moving target as it progresses, and we have to recalibrate every few years so that we’re shooting that target correctly.

 

What should patients know about molecular testing before proceeding?

A.  After a patient receives his or her staging diagnosis, the next question is, “What subtype of lung cancer do I have and what pathway did the cancer use to develop?” The patient needs to have patience, as that extra information may not arrive for two to four weeks, but that information can increase the chances of treatment success.

Also ask about clinical trials of cancer medications before beginning therapy, because we often know about upcoming medications that are effective and possibly better than what we have right now.

Determining If Clinical Trials Are Right For You

Cancer treatment is constantly evolving as new therapies emerge. This is thanks, in large part, to the volunteers and researchers who participate in clinical trials. The findings of these trials can help lead to new, effective treatment regimens. Clinical trials can be a great way for cancer patients to receive the treatment they need while advancing science and benefitting other cancer patients. These studies have their risks and benefits, but if you meet the eligibility criteria, they are worth considering and consulting your doctor about. The RCCA medical library provides resources for you to become more acquainted with the ins and outs of clinical trials and different types of cancer care.

Deciding if clinical trials are right for you should be up to you, your doctor, and your loved ones. Everyone has different circumstances, so it is important for you and your doctor to weigh the risks and benefits. For example, a study may have unknown results. However, the benefit of receiving potentially ground-breaking cancer treatment while monitoring your progress at all times may outweigh this risk. It is also worth noting that trial participants are not bound to the study in which they participated. They can leave at any time.

Eligibility Criteria

Different trials have different criteria for you to be eligible to volunteer for the study. This criterion may be based on age, gender, stage and type of cancer, previous treatment, and other medical conditions. Explore the various clinical trials available and determine if you are eligible to participate and potentially receive this cancer treatment.

Informed Consent

If you decide to take part in a clinical trial, it is necessary for you to be informed about the study and to provide consent that you are willing to participate. You should receive information detailing the purpose of the trial, eligibility criteria, potential risks and benefits, other treatments available, and trial design for you to review before deciding on the trial.

RCCA is committed to providing you with the best possible cancer care and new, personalized therapies by offering over 300 clinical trials at many convenient locations.

Colorectal Cancer Trends and Treatment

Ralph V. Boccia, MD, a cancer specialist at RCCA Maryland, provides some insight into recent colorectal cancer trends and treatments that are giving new hope to doctors, researchers and patients nationwide. Overall, Dr. Boccia finds much to be encouraged by, but also points to the need for awareness of a concerning development in the field of colorectal cancer.

 

How Far We’ve Come and Where We’re Going

As a whole, colorectal cancer rates have been dropping. According to the National Cancer Institute and Centers for Disease Control and Prevention, Maryland alone has seen a 2.6% decrease in the amount of new CRC patients diagnosed over a five-year period. Dr. Boccia believes this trend can be partly attributed to the following:

  • Widespread increase in colonoscopies and other CRC screening methods
  • Early detection and removal of polyps before they become cancerous
  • More cases being diagnosed at an early stage – when the cancer is more responsive to treatment

Despite the good news, it’s still projected that 2,358 Maryland residents will be diagnosed and that 927 people will die from the disease this year, says Dr. Boccia. Doctors have also been noticing an uncharacteristic increase in the amount of younger adults being diagnosed with CRC. Since it typically affects individuals above the age of 50, this emerging demographic has been cause for concern. But Dr. Boccia and his colleagues will continue to conduct research and make further strides in colorectal cancer care to better serve patients of all ages.

 

Current Treatment Options

Surgical innovations, targeted therapies, immunotherapies, chemotherapy and clinical trials are paving the way for more effective CRC solutions. Dr. Boccia explains, “We have a greater ability than ever before to individualize care, and to offer patients multi-modal treatment regimens that employ a variety of mechanisms of action to combat cancer by different means.”

 

Reducing Your Risk

Follow these tips to help reduce your risk for developing colorectal cancer:

  • Maintain a healthy weight
  • Stay physically active
  • Avoid smoking cigarettes and only drink alcohol in moderation
  • Get a CRC screening regularly
  • Consult a physician right away if you experience any CRC symptoms, such as blood in the stool and persistent abdominal pain
  • Manage other conditions that may increase your risk for CRC, like type 2 diabetes, inflammatory bowel disease and adenomatous polyps

 

If you or someone you love has been diagnosed with colorectal cancer, schedule an appointment at one of RCCA’s 29 locations in New Jersey, Maryland or Connecticut for personalized, professional care.

5 Common Types of Oncological Care That Cancer Doctors Recommend

The need for viable and effective cancer treatment options has spurred the research and development of multiple strategies for helping patients achieve favorable outcomes and potential remission. The most common types of treatments that medical oncology offers are surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. An oncologist will make a treatment recommendation depending on the type of cancer a patient has and its stage.

Surgery

A surgical operation can be used to diagnose, stage, prevent, and treat cancer. During a diagnosis, the doctor often carries out a biopsy to know what type of cancer the patient has and how far it has advanced. Surgery is most commonly used when cancer has not spread throughout the body. In this case, the surgeon has a higher success rate of removing or eliminating cancer. Working with the best oncologic team can assist in managing the condition well.

Chemotherapy

This treatment involves the use of drugs to treat cancer throughout the body. Chemo is prescribed for nearly all cancers—from solid tumors to hematologic malignancies. The doctor is responsible for determining what drugs or drug combinations to use. Factors to consider when choosing drugs include the type and stage of cancer, patient’s age and overall health, and any prior cancer treatments.

Radiation Therapy

Also known as radiotherapy, radiation therapy involves the use of high-energy particles to destroy or damage cancer cells. It can be used to slow cancer growth, cure it, or stop it from returning. There are two options for radiation—external beam radiation therapy and internal radiation therapy. It may take days or weeks to see the effects of radiation therapy. It can be recommended for different types of cancer such as breast cancer and prostate cancer. Consult the best oncologist to see if this type of treatment is right for you.

Targeted Therapy

Medical oncology researchers are continuing to find new changes in cancer cells that help them create more effective therapies for patients. In this treatment option, an oncologist targets specific vulnerabilities of cancer cells. First oncologists need to determine specific profiles of the cancer/tumor and whether there is a targeted agent that will work. Most therapies are either monoclonal antibodies, drugs that attach to the outer surface of the cells, or small-molecule drugs that can penetrate cells easily.

Immunotherapy

This type of cancer treatment supports the immune system to fight cancer. It works by marking cancer cells so that the immune system can find and destroy them. There are different types of immunotherapy including monoclonal antibodies, adoptive cell transfer, cytokines, treatment vaccines, and BCG treatment. Medical oncology professionals are still studying more options in clinical trials.

Medical Oncology Researchers have continually worked to develop more cancer treatments to reduce mortality rates, curb symptoms, and even cure cancer. Patients are always advised to work with the best oncologist to ensure the right treatment results, but it is important to note that all cases are different.

Targeting Treatments for Chronic Lymphocytic Leukemia

Dr. Joel Silver

 

How do myeloma and chronic lymphocytic leukemia (CLL) develop? What are some risk factors associated with those malignancies?

A. We don’t know what causes CLL. We do know that people in some occupations or with a certain exposure history might be at higher risk, and that CLL generally affects older people. Treatment fortunately is not needed in many cases, but even so our treatment options have evolved based on cytogenetics and next-generation sequencing. We have more ways to assess prognostic features and design more personalized and potentially more effective therapy for people with CLL.

 

What therapies have been successful in treating CLL over the last two to three years?

A. If you can identify a certain kind of CLL, such as IDH-mutated CLL, some of the patients with it can receive a standard chemotherapy regimen called FCR, and they sometimes go into remission indefinitely. It depends on whether the patient is young and healthy enough to tolerate the therapy. That’s a select group, though; you don’t see too many young people with CLL.

Years ago, an effective treatment did not exist for another group of patients with CLL, those with the genetic 17p deletion. In recent years, however, the oral agent ibrutinib has shown effectiveness for CLL in this group. Other therapies now are available for patients who don’t respond to ibrutinib.

 

Where does targeted therapy come into play?

A. In general, “targeted therapy” refers to a treatment based on a particular mutation or pattern. The presence of the genetic 17p deletion in CLL is one example, but this is a bad cytogenetic abnormality for which standard treatments such as chemotherapy haven’t worked. If we can identify a particular mutation