​How Immunotherapy Saved a Stage 4 Cancer Patient’s Life

​Diane Lucey has long hair. That's not noteworthy in itself — after all, so do lots of women. But long hair is significant for a woman who has just undergone cancer treatment, which Lucey has. A combination of precision medicine and immunotherapy not only saved her life, but spared her the difficult side effects that are common for cancer patients.

From Stage 1 to Stage 4

Lucey's cancer journey started in January of 2014, when she asked her dentist to check out a spot that had recently developed in her mouth. He sent her to an oral surgeon. A biopsy revealed a diagnosis of neuroendocrine carcinoma.

While there was some good news – it was stage one – she still had to undergo a stressful process of surgery to remove the spot, endure 30 sessions of radiation, and deal with weight loss and fatigue. However, it all seemed worth it as subsequent scans performed in 2014 and 2015 found no signs of cancer.

She said yes to a new job, moved to Leonardtown, Maryland, and moved forward with her life.  Life was going very well for Lucey. Unfortunately, that all changed abruptly in 2016. 

Lucey went in for a routine scan with Amir Khan, MD, an oncologist at MedStar St. Mary’s Hospital. Dr. Khan discovered that not only had Lucey's cancer come back, but it had metastasized and spread to other parts of her body – specifically in her lungs and liver. Her diagnosis? Stage four.

Lucey remembers her sister, who had accompanied her to her appointment, starting to cry. But she didn't allow herself to do the same. "I’m not going to cry about this," she remembered thinking. "This is what it is, and we just gotta go from here."

Finding Answers in New Treatments

Dr. Khan formed a treatment plan right away and sent Lucey to Louis Weiner, MD, director of MedStar Georgetown University Hospital’s Lombardi Comprehensive Cancer Center. Dr. Weiner was able to precisely analyze her cancer on a molecular level and found that it had mutated around 17 times.

Her body was fighting back.

While precision medicine and immunotherapy aren’t as widely known as treatment options like chemotherapy and radiation, Lucey had learned about them while researching her choices. She was hopeful that a combination of precision medicine and immunotherapy might work for her, and she was prepared to advocate for herself. 

As it turned out, she didn't need to fight for the treatment that she wanted. "When I met with Dr. Weiner, I was prepared to bring up precision medicine and immunotherapy — but he initiated the conversation," she recalled. 

She was relieved: "I wanted to hear something other than chemotherapy and radiation, which can really be devastating."

The Treatment Journey and Her Outcomes

In October, she began her immunotherapy treatment. Every two weeks, she would make the 10-minute drive from her home to MedStar St. Mary's, where she received injections of the immunotherapy nivolumab. Other than treatment days, she didn't have to miss any work. 

Having cancer never affected her daily routines, and she never suffered any major side effects except one small rash on her stomach.

As optimistic as Lucey was about the treatment, the results have exceeded even her expectations. Six weeks into the process, a scan revealed that the mass on her liver had shrunk by half, and the tumors on her lungs were shrinking too. After an additional six rounds of treatment, even better news: The lung tumors were gone, and the liver mass – while still present – had continued to shrink.

Lucey is incredibly grateful for the success of her treatment, and for the people who have cared for her and supported her along the way. "Everybody at MedStar has been wonderful. The doctors, the nurses, even the receptionist, Rachel — I love her!"

If she could say one thing to the staff at MedStar, it would be a simple message: "Thank you," she said. "Dr. Weiner and Dr. Khan especially, but the whole staff. I'd hug them all. And I probably have!"

We are here to help.

If you have questions about the MedStar Georgetown Cancer Network or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Lymphedema Risk Factors and Treatment Options for Breast Cancer Patients

If you are currently undergoing treatment for breast cancer, it’s important to know about possible complications that may occur afterward. One such complication is lymphedema. Lymphedema is the persistent swelling of the arm that may occur after mastectomy and lymph node removal during breast cancer treatment, due to the buildup of excess lymphatic fluid.

But what are the risk factors of lymphedema? Moreover, what treatment options are available for those who receive this diagnosis?

Factors That Increase the Risk of Lymphedema

At MedStar Georgetown University Hospital, we have observed that approximately 20 percent of women who undergo breast cancer treatment will end up with lymphedema. While there is no way of knowing during treatment who would be diagnosed, there are some risk factors we’re aware of that may increase the chances of getting lymphedema after breast cancer treatment.

For example, women with a higher chance of lymphedema have had many of their lymph nodes removed. Another risk factor is exposure to radiation during treatment, since this can cause scarring and blockages. Women who smoke or are obese are also more likely of developing lymphedema after breast cancer treatment.

While not all risk factors are avoidable, some are. If a patient is looking for ways to reduce their risks, smoking cessation and weight loss are two options.

Diagnosis of Lymphedema

Some patients get relief by having the affected area massaged and the excess fluid drained. But most patients end up needing surgical treatment for more long-term relief.

To find out the best treatment options, you should meet with a multidisciplinary team that includes oncologists, physical therapists and other medical professionals who will help with diagnosis and immediate action.

A common way to diagnose lymphedema is called bioimpedance, which is a way to measure electrical flow through body tissue. Once it is confirmed that the lymphatic channel - which contains clear, thin lymphatic fluid - is blocked, a team of doctors will determine the best treatment. In the meantime, they will try to reduce the swelling, often by wrapping the arm with a sleeve to get some relief.

Treatment Options for Lymphedema

One surgical option for mild to moderate lymphedema is a lymph node transfer.  Lymph nodes are located in multiple places throughout your body; as a result, doctors can take lymph nodes from anywhere - such as the neck, groin or back - and transplant them wherever they’re needed using a microsurgical technique.

It’s akin to bringing in a pump and activating it by making sure blood can flow in and out to avoid swelling.

Another procedure that may be considered is lymphaticovenular bypass, also known as LV bypass. This is referred to as super-microsurgery, as it involves connecting the lymphatic channel right into a vein to ensure proper flow.

If lymphedema is more severe, liposuction may need to be performed on this area. This surgery uses a cannula to suck out the extra swollen tissue and fat that’s behind lymphedema. All three of these options work best in a team environment where they are being managed before and after surgery.

Recovery for Lymphedema Treatment

Whatever path is chosen, most patients can look forward to a quick recovery. Most treatment options take about three to four hours to complete, and you can usually return home the next day. They typically involve small incisions, followed by a wrap to protect and compress the area that was treated. The patient returns to the doctor a week later to have the sutures removed.

Expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future, however, as they start functioning properly again, the swelling will recede once more.

Due to advancements in less invasive treatment options, lymphedema is no longer a lifelong concern for life after breast cancer treatment.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Breast Cancer: Is Natural Breast Reconstruction Right for You?

Breast cancer patients who undergo mastectomies are often faced with the decision of how best to reconstruct their breasts. Currently, implant reconstruction is the most common way of rebuilding the shape of their breasts after surgery. However, one drawback of implants is that they typically need to be replaced every 10 to 15 years.

An alternative to implant reconstruction that's growing in popularity is known as natural breast reconstruction, or breast reconstruction using natural tissue. This method uses skin and fat from certain body parts to create a natural-feeling breast.

But what exactly does natural breast reconstruction entail, and is it the right choice for you?

What Is Natural Breast Reconstruction?

The human breast consists mainly of fat, especially after a woman's child-bearing age. At its core, natural breast reconstruction involves transplanting fat from one area of the body — such as thighs, buttocks and back — to another.

Natural breast reconstruction is also known as DIEP flap, or deep inferior epigastric artery perforator flap. This procedure removes extra skin and fat from the lower abdominal area, where many women carry surplus tissue. However, the muscle and function of the abdominal area will still be maintained after the surgery.

Once this tissue is removed, blood vessels from the tissue are attached to blood vessels in the breast area. The arteries and veins from the removed tissue are sewn to arteries and veins in the chest area using a microscope to restore blood flow to the tissue and make the transplant a success.

Natural Breast Reconstruction Myths vs. Facts

Because synthetic implants are still the prevailing choice for breast reconstruction, several myths have propagated throughout the medical community regarding the downsides of natural breast reconstruction. Many patients worry that the surgery will be too long, that the recovery will be too difficult, or that there will be a significant chance of failure.

However, these concerns are usually unfounded. Typically, the surgery lasts about five hours when in the hands of an experienced physician. Patients usually recover in the hospital for two to three days, with nonopioid medications that mitigate the pain well.

A full recovery typically occurs within two to six weeks, with an average recovery time of four weeks. This is only slightly longer than implant breast reconstruction, which has an average recovery time of three weeks.

In addition, the risks of failure and complications are minimal. The failure rate of natural breast reconstruction is very low, at around 0.7 percent, and can be lowered with the right surgical team. The hernia rate from this type of operation is less than 2 percent.

By dispelling these myths around natural breast reconstruction, an operation that once seemed scary becomes something realistic and tolerable, and perhaps preferable for certain situations.

Making the Right Choice for You

The benefits of a successful natural breast reconstruction are invaluable. Rebuilding breasts with their own body tissue provides patients significant improvements in their mental attitude and bodily sensation.

Of course, there are real downsides to natural breast reconstruction surgery, including the risk of infection or serious bleeding, and not every patient is a good candidate for the surgery.

However, if you are curious about natural breast reconstruction, schedule a consultation with an experienced breast reconstruction surgeon. They can help by answering questions and empowering you with the knowledge you need to make the best decision.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Improving Breast Reconstruction Patient Outcomes with SPY Elite and Hyperbaric Oxygen Therapy

Sarah Bessin, a 47-year-old breast cancer survivor, received her diagnosis in July 2015. In October, Bessin opted to begin breast reconstruction at the same time as her mastectomy. The team at MedStar Georgetown University Hospital was able to save Bessin’s breast tissue and improve her breast reconstruction outcome through the unique combination of the following two tissue-saving technologies to diagnose and avoid serious complications:

  • The SPY Elite fluorescent imaging system that gives breast surgeons and plastic surgeons the ability to assess the quality of blood flow in the breast tissue in order to make the critical decision on whether to insert implants immediately or wait.
  • Hyperbaric oxygen therapy to facilitate the healing process.

“My surgeon told me he would decide during surgery whether or not I could undergo breast reconstruction immediately, but I’m so glad he decided to wait before proceeding with implants. It gave me a chance to heal, and the results of my reconstruction are just remarkable,” Bessin shared.  

“Everything that we do in plastic surgery involves blood flow. If blood flow is disrupted, the overlying skin can die. This is the reason we need to be able to anticipate these problems intraoperatively so we can act quickly,” said Troy Pittman, MD, Bessin’s breast reconstruction surgeon. 

SPY Elite: A New Valuable Player in the Operating Room

After a mastectomy, the plastic surgery team enters the operating room with a fluorescent imaging system called SPY Elite. SPY Elite has a long arm that connects to an infrared lamp device, which is used for scanning over a patient’s body. A special contrast is injected through the patient’s IV line, and a TV monitor shows the scans of breast tissue and blood vessels in real time.

A breast reconstruction surgeon will move the SPY Elite lamp over different areas of the breast to detect the quality of blood flow in breast tissue before proceeding with the surgery. The system’s monitoring of the blood flow helps surgeons determine if the patient’s tissue is in a safe state to move forward with surgery and place an implant.

If blood flow is limited, surgeons will add hyperbaric oxygen therapy after surgery to promote healing in the tissue.

“SPY Elite lets me look at the blood supply of the breast tissue and the nipple in real time,” Dr. Pittman said. “This helps us diagnose a problem early on and initiate hyperbaric oxygen therapy within 24 hours, if we need to.”

SPYing a Problem During Bessin’s Procedure

During Bessin’s procedure, the SPY Elite imaging system informed Dr. Pittman’s team that there were worrisome vascular changes in her breast skin following the mastectomy. To avoid compromising the vascular health of the skin, Dr. Pittman decided on a different plan.

The new breast reconstruction approach for Bessin meant waiting on the implants and placing tissue expanders, a type of deflated temporary implant, in the surgery site. This plan allows for healing time in the hyperbaric oxygen therapy chamber. 

“Our goal is to get patients in for treatment as soon as possible. We are aggressively treating the patient to save their breast tissue and augment their healing,” said Kelly Johnson-Arbor, MD, medical director of Hyperbaric Medicine in the Department of Plastic Surgery. “Our dedicated team of physicians, nurses and technicians work to ensure that patients remain safe and comfortable during their treatment regimen.”

Healing Tissue Within Days with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy exposes patients to pure oxygen in a pressurized space. Sending patients to the hyperbaric oxygen chamber treats the initial blood flow issue and can help the patient avoid future healing problems. Treatment begins within  24 hours after surgery and does not require patients to stay in the hospital. 

Bessin’s tissue healed in only 13 hyperbaric oxygen therapy treatments. Her hyperbaric oxygen therapy schedule began with two visits to the hospital per day, which later decreased to one visit per day near the end of her treatment.  

“I bounced back quite quickly. I’m already working my normal schedule, and my energy level is back to normal,” Bessin shared. “I’m so grateful to my doctors for providing this therapy!”

Hyperbaric Oxygen Therapy: Rest and Relaxation Time

Bessin recalled that she spent most of her time relaxing in the hyperbaric oxygen therapy chamber, which is a large glass tube. In the chamber, patients cannot wear makeup, lotion, nail polish or outside clothing, nor can they bring in a cellphone, books or paper. A glass of water and a cotton gown are permitted inside the chamber. During treatment, a nurse or technician stays in the room the whole time to administer the hyperbaric oxygen therapy, answer questions or assist with movie selections.

“Georgetown has a great movie selection,” Bessin pointed out.

Access for Every Breast Reconstruction Patient at MedStar Georgetown

Dr. Pittman has used SPY Elite with hyperbaric oxygen therapy at MedStar Georgetown for five years. For breast reconstruction, Dr. Pittman’s team uses SPY Elite on almost every patient, but particularly in those who want to begin breast reconstruction with an implant immediately after a mastectomy.

“SPY Elite and hyperbaric oxygen therapy allow us to aggressively treat patients safely and predictably,” said. Dr. Pittman. “This approach gives our patients the best chance for success.”

To date, MedStar Georgetown University Hospital is the only center in the greater Washington, D.C., region to offer both SPY Elite and hyperbaric oxygen therapy for patients with breast cancer.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Genetic Testing for Breast Cancer

The last several years have produced significant advances in the field of genetic testing. Doctors are utilizing preventative measures to decrease cancer risk, and are now using genetic testing to help patients and their families understand their cancer risks. So how does generic testing work and what are the potential positive outcomes for those with a breast cancer diagnosis?  What are the concerns about the risk?

When and How Genetic Testing Is Used

Genetic testing can be considered at various stages, depending on the individual and their background. For example, an individual recently diagnosed with breast cancer may undergo genetic testing in an attempt to understand why she developed cancer and whether her family is at risk.

On the other hand, healthy women with a family history of breast cancer may want to know their risks.

Modern genetic testing can be performed using either a blood test or a saliva sample collected to look for specific genetic information. The sample is sent to a lab, where a team of specialists looks for unique genetic mutations that indicate an increased risk for breast cancer.

Today, there are two primary forms of genetic testing:

  • Single or limited numbers of gene testing which analyzes a small number of genes to test for the presence of mutations.
  • Multigene panel testing which analyzes many genes for mutations. While this field is evolving rapidly, some of the gene mutations included in these panels do not yet have clearly defined cancer risks or clear data on the impact of more intensive screening or prevention options.

While both tests are useful, many factors such as family history, personal preference, health coverage and a need for immediate results, will influence which test is most appropriate for an individual.

Benefits We’ve Seen from Genetic Testing

Georgetown University's Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research in Washington, D.C., has served as the epicenter for research to improve cancer identification and diagnosis, including the use of genetic testing.

People who test positive for mutations in BRCA1 or BRCA2 (two of the most common cancer genes) can take preventative action to decrease their risk of developing or succumbing to ovarian or breast cancer. This is one of the most compelling benefits of modern genetic testing.

There are, of course, concerns regarding the added stress of knowing one carries a mutation or from receiving an inconclusive outcome from testing.  However, multiple studies conducted at the Fisher Center have concluded that the benefits of genetic testing far outweigh those challenges, as the genetic testing results allow patients to make better-informed decisions about the most effective treatment options and course of action in their medical care.

What's more, genetic testing can also determine that some relatives of people with a known mutation in a breast cancer gene understand that they do not carry mutated genes. This can relieve a significant amount of mental and emotional stress and alleviate a person's concern about an increased risk for cancer. 

What to Keep in Mind

It is possible to test for either one gene or multiple genes associated with breast cancer. While this is an exciting possibility, choosing which test to perform can be extremely complicated, but working with a genetics counselor will help ensure you choose the right test for you.

Genetic testing is complex, and in many cases, the results of the test may have implications for other members of their family such as a sibling or cousin. Patients should keep in mind that results may not resonate in the same way with their family members and should be prepared for how to handle that conversation. A genetic counselor can be instrumental in helping to understand genetic test information and in disseminating the information gleaned from it.

Finally, it's critical to keep in mind that genetic predisposition only accounts for 10 to 15 percent of all breast cancer cases.

The Case for Genetic Testing

If you were tested over three or five years ago, you should consider getting tested again in light of the recent advances that have taken place. Genetic testing for breast cancer has the potential to increase the health and longevity of women and men around the country.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

The Benefits of Minimally Invasive Surgical Options for Lung Cancer

A diagnosis of lung cancer can leave you and your loved ones with a lot of questions, as well as fears. What treatment options are available? How will you recover? What will your quality of life be like?

For lung cancer patients, there is good news on the horizon. Recent innovations in minimally invasive surgical approaches are presenting more positive outcomes than what has been available in the past.

How is a minimally invasive approach different from traditional lung cancer surgery? And what benefits are patients seeing, as a result?

Traditional Approach to Lung Cancer Surgery

Unfortunately, this approach, known as a thoracotomy for lobectomy of the lung –in which the cancerous anatomical portion of the lung is removed – puts pressure on the ribs, as well as the underlying nerves causing significant pain for patients during recovery and for some patients, the pain is permanent. Moreover, this pain puts patients at increased risk for post-surgical health issues, including pneumonia.

How the Minimally Invasive Approach Works

Instead of relying upon one large incision and spreading the ribs, a minimally invasive approach only requires a few small incisions in which a camera and small surgical instruments are inserted.

Benefits for Lung Cancer Patients

Minimally invasive surgery translates into less pain for patients, as well as shorter recovery/healing time. This not only allows patients to return home within a day or two of their procedure, they are also able to return to their normal lives and routines with greater speed. This decreased recovery window enables doctors to administer follow-up treatments sooner.

Patients that might otherwise have been considered ineligible for surgery now have a new minimally invasive treatment option available to them. For example, patients with diminished lung function or emphysema – who might not have been eligible for more traditional surgical approaches – now can be considered for minimally invasive surgery.

Start by Having a Conversation

Don’t write off surgery. Given the advancements for lung cancer patients available today, talk to your doctor, you may have more options than you realize.

As a surgeon, I find it very rewarding to see a patient after surgery. They often look like they haven't had an operation and in a few cases, patients say they feel like they haven't even had an operation at all. With the minimally invasive approaches, they have a minimal amount of pain and recovery. What could be better than that?

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Minimally Invasive Surgical Options for Esophageal Cancer

Esophageal cancer is found in the esophagus, the tube that connects the mouth to the stomach. It can occur at any point on that route and will be treated differently depending on its location and severity.

While the treatment for esophageal cancer has changed drastically over the decades, recent trends have seen the treatment options shift from highly invasive and destructive procedures to more minimally invasive procedures designed to uphold the patient's health and well-being throughout treatment.

Treatment Options for Various Types of Esophageal Cancer

Over the last several decades, adenocarcinoma (a type of esophageal cancer near the stomach) has become more widespread.

Unfortunately, because of the widespread availability of over-the-counter acid reflux medications, patients may not ever know they have this type of cancer and may write their chronic acid reflux off as nothing to worry about.

Cancer can present very few or no symptoms, so in most cases, patients with esophageal cancer don't know they have the disease until it's in an advanced stage. In many instances, esophageal cancer is diagnosed by accident when it has reached an advanced stage. At one point the only available treatment for late stage patients was a highly invasive" open case" treatment which involve large incisions in the abdominal and chest cavities), with a 50 percent risk of complications and chronic pain.

Fortunately, minimally invasive procedures are available that offer minimal pain, fast healing and the ability to go home and eat normally, rather than through feeding tubes.

Procedures for Early-Stage Patients

On the other hand, patients with very early-stage cancers can avoid to the removal of their esophagus, and instead only remove a portion of the tissue around the cancer, leaving the remainder of the stomach and esophagus without damaging the nerves or the valve that prevents reflux.

On the other hand, patients with later stages will need to remove more extensive amounts of tissue including the nerves to the stomach. While patients will have reflux and potential long-term stomach issues, it is a life-saving procedure for many.

Patients who have had previous open operations will still be able to access minimally invasive approaches, although it may take longer and be more challenging because of scar tissue.

What Minimally Invasive Options Mean for Patient Care

Minimally invasive surgery is the preferred, and often the best option vs. an open method. In addition to providing a faster healing time, minimally invasive procedures may offer a better cancer outcome than more invasive open approaches. Though doctors aren't exactly sure why this is true, it could be attributed to the fact that minimally invasive procedures minimize damage and are less stressful on the body during recovery.

It should be noted that minimally invasive surgical options are not the right course of action for all esophageal cancer patients. However, they can go a long way toward minimizing damage and expediting the healing process for these patients.

Looking Ahead

While further treatment options are sure to be developed in coming years, the current treatment options show great promise to patients and their families who are struggling through the murky waters of esophageal cancer and its many invasive and minimally invasive treatment options.

Between better outcomes and faster recovery times, it's easy to see why minimally invasive treatment options are becoming so popular among patients today.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

What You Should Know About Pre-Pectoral Breast Reconstruction

If you have been diagnosed with breast cancer, your thoughts might jump ahead to the possibility of needing a mastectomy and/or breast reconstruction, as part of your treatment. But just as each cancer is unique, so are your breasts.

There are several methods of breast reconstruction and you will need to speak with your breast surgeon and plastic surgeon to determine which is best for you. Pre-pectoral reconstruction involves placing the breast implant over the chest muscle.

But what are the advantages of pre-pectoral reconstruction? And are there any challenges you should be aware of?

Traditional Procedures and Drawbacks

During mastectomy, breast tissue is removed along with the cancer. Many times the cancer is located in a portion of the breast where the nipple can be spared, Traditionally, the plastic surgeon inserts a tissue expander or breast implant either partially or completely under the muscle.

Tissue expanders are meant to gradually stretch the skin, however it’s often painful because the chest muscle is slowly stretched as well. In addition to the post-operative discomfort, the aesthetic outcome tends to look flat and unnatural since the implant is under the muscle.

Due to the pain of stretching muscle and the aesthetic deficiencies of under the muscle implants, other methods have been developed, including one that involves partial muscle coverage. But like the previous method, this type of breast reconstruction method also has disadvantages.

For example, this procedure often produces a flat, unnatural look because the implant is located under the muscle. Furthermore, given the fact that it is directly under the skin, the muscle is visible especially when the patient uses their chest muscles. This is similar to watching a body-builder flex their chest muscles. This tends to be distracting when women are exercising in public, since every time they use their chest muscles, the implant shows visible distortion.

Looking beyond the individual outcomes for each of these procedures, traditional reconstruction techniques overall can result in chronic soreness for patients, in the years following their procedure.

How Pre-Pectoral Reconstruction Works

These drawbacks have left an opening for a more advanced option: pre-pectoral breast reconstruction. With this method, the implant is placed over the muscle. This means there is little to no muscle deformity or pain associated with the procedure, since the muscle does not have to be cut. Instead, the implant is placed directly under the skin.

Of course, like most surgeries, there are some disadvantages. Early complications may include bleeding, infection, pain or seroma, which is fluid collection around the implant. Once you heal, there is a small chance your implants will rotate so they look upside down, and or they may rupture. In addition, most implants last for 10 to 15 years, so most women will need to have another procedure for new implants in future.

It should be noted that, women who benefit from this procedure are in relatively good shape and have small to medium sized breasts that are not overly saggy. Additionally, the breast cancer cannot have been located in the nipple area, which must be left intact.

Finding the Right Surgery Team for You

If you are considering pre-pectoral breast reconstruction, you should set up an appointment with a board-certified plastic surgeon who specializes in this area and can offer individualized care. This way, your doctor can guide you toward the right type of surgery for your circumstances.

The top priority of breast cancer treatment is to remove cancer and do an extensive enough surgery to ensure the risk of recurrence is low. The second goal is to give you a safe, aesthetically pleasing breast reconstruction. For this reason, you need a team of surgeons and specialists working closely together with constant communication between doctors.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Targeted Therapies for Specific Types of Lung Cancer

For some people who have lung cancer, immunotherapy can be an effective tool because it relies on the body's immune system to eliminate cancer cells. Targeted therapies, on the other hand, do not directly affect the immune system; instead, they directly attack specific cancerous cells. Targeted therapy is meant for a small, defined population of lung cancer patients.

Targeted therapy acknowledges that lung cancer is not one diseaseThere are dozens of types of lung cancer, and each behaves differently. These different types of cancers require individualized types of treatment.

As medicine has come to understand those differences more completely, targeted therapies have been developed to address and treat the various types of lung cancer.

What You Should Know About Targeted Therapy

When it comes to targeted therapy, most of the questions people have are about the testing itself. Since targeted therapy uses medication that attacks specific components of a tumor's DNA, the first step is to determine whether a tumor will react to the regimen. This requires testing of the tumor through a biopsy. The biopsy may be tested on-site or may be sent out to another institution, but results are generally available in a matter of days.

When the biopsy reveals a mutation, an oncologist will work with you to determine which type of targeted therapy will be most effective against that particular mutation.

You should know that there are three specific DNA mutations for which the FDA has approved drugs for advanced lung cancer. These drugs are superior to chemotherapy and can begin working immediately. They typically come in the form of a pill taken once or twice a day and offer better responses than chemotherapy.

Even if the mutations that doctors expect are not present, your doctor can work with you to search for other mutations that can be treated with targeted therapies. Otherwise, you may move on to chemotherapy, an appropriate treatment approach.

Keep in mind that there may also be clinical trials that are available to patients with certain types of mutations.

How Targeted Therapies Influence Patient Care

Today, standard DNA and biopsy tests should be done on virtually everyone with lung cancer in the United States. Be aware that insurance may not cover more advanced tests, and that out-of-pocket expenses can be high. Don't despair, there are many assistance programs designed to help people afford advanced testing.

While advanced targeted therapies can work very well, they are not a "cure," and it is important for patients to temper their expectations accordingly. If a particular drug stops working, doctors will determine how the target has changed, and address the new reality accordingly.

While targeted therapies are effective for only a small percentage of lung cancer patients, they can be a well-tolerated and efficient form of medication that is intended for long-term administration. While they do not "cure" cancer, they can offer a durable solution that opens up a whole new cabinet of potential treatments for lung cancer patients.

As time goes on, doctors hope to identify more mutations and to offer more specific, targeted therapies to help improve the prognosis for other lung cancer patients.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Immunotherapy and Its Evolving Role with Lung Cancer Treatment

Immunotherapy is a promising treatment for lung cancer. The concept isn’t new. Since the 1970s, doctors have turned to medicine as a tool to stimulate the immune system’s defensive response to cancer. In the past, immunotherapy was used to treat kidney cancer and melanoma.

It is only recently that researchers have found ways to apply the same principles to treating certain types of lung cancer.

Changing the Treatment Outlook for Lung Cancer

Although there are several treatment options doctors can use to treat lung cancer, it isn’t unusual for these cancers to stop responding to chemotherapy after a few months. Fortunately, medical research indicates that immunotherapy might be an option when other methods of treatment prove ineffective.

In 2012, researchers reported encouraging results in a small percentage of people who used immunotherapy to treat non-small cell lung cancer. Other studies involved subsets of patients who lived for many years after receiving immunotherapy when their cancer did not respond to chemotherapy.

Whereas most developments in cancer care produce marginal improvements, immunotherapy has proven to offer dramatic, durable benefits to a limited group of patients. In fact, some patients have lived for several years beyond what would have been possible with conventional treatments.

Some patients in these groups tolerate immunotherapy medicines better than chemotherapy drugs, with fewer side effects, which means they can fight their cancer while enjoying a better quality of life.

Limitations of Immunotherapy

The challenge with immunotherapy is that it seems to work only for a minority of cancer patients. Doctors don’t always know which patients will respond to immunotherapy, although several medical studies are underway to identify which cancers and which patients respond to different immunotherapies.

Research has shown that some cancers express a particular protein called PD-L1 that predicts response to certain immunotherapy drugs. This test can be ordered by your physician.

Who Does Immunotherapy Work For?

For patients whose lung cancer expresses PD-L1, a recent study has shown immunotherapy with a drug called pembrolizumab was superior to chemotherapy as the first treatment for advanced lung cancer.

For other patients, chemotherapy may be the preferred treatment but when chemotherapy stops working, immunotherapy, with drugs like pembrolizumab, nivolumab, or atezolizumab, may be a good option. In this setting, immunotherapy would be expected to work for about 20 percent of patients. Doctors are not sure if the other 80 percent of patients will respond to other types of immunotherapy.

Clinical trials are currently studying the effects of new immunotherapy drugs and new combinations, which could become available soon.

Is Immunotherapy Right for You?

Immunotherapy isn’t right for everyone with lung cancer. If you have a serious autoimmune condition, it’s less likely to be a suitable treatment option for you. In fact, it could make your condition worse. Depending on the type of lung cancer you have, there might be other treatments that your oncologist would prefer to use instead.

Don’t rule out asking your oncologist if immunotherapy is an option for you. Most doctors are happy to discuss all available treatments with their patients and explain why they are or are not suitable. You might even be a candidate to join a clinical trial for a new immunotherapy drug.

Final Thought

If you have nonsmall-cell lung cancer, talk to your oncologist about immunotherapy. This treatment may be a good option if other treatments aren’t working for you. With new immunotherapy drugs in development, there may be an emerging medicine - or combinations of medicines - that could help control your cancer or send it into remission.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.