Immunotherapy Gave Hope for One Thymic Carcinoma Patient

It started as a nagging thought, back in November 2012. I just didn’t feel like my usual self, but I couldn’t define why, precisely. Little things crept into the cracks of my well-being and seemed to erode my vitality. I developed shortness of breath when I was climbing stairs or working out, but my breathlessness was a little more pronounced than usual. I started having episodes of high blood pressure. That seemed odd to me since I was only 52 and an endurance athlete at the time.

I have always been in tune with the deep, inner signals of my body and very aware of “doing the right things” for my health. So I guess I knew something was wrong. But denial can be a powerful force.

The Bleak Outlook of Diagnosis

One of my strongest recollections of that period of time between symptom onset and my diagnosis was an evening out with my girlfriends in mid-April 2013. They were worried about me, worried that I didn’t seem to feel myself. Of course, I had no explanation for them. I remember our conversation that evening vividly. I tried to describe an “overwhelming sense of un-wellness.” I’ll remember those words forever. Just a week later everything came crashing down. My pillar of denial lay in rubble at my feet.

When I got my diagnosis, I felt like I was sitting in my living room and someone pulled the rug out from underneath both the furniture and me, sending everything that anchored me flying into the air. What came down wasn’t me, or my furniture; it wasn’t even my living room. It was my life. My doctor told me that a CT scan had found a mass in my chest.

I heard the words that terrified me: “You have thymic carcinoma.”

"Okay, stop right there," I said to myself. "I know I didn’t just hear that."

Moments of incomprehensible shock and disbelief followed. How ironic that I actually had prayed for lymphoma. That type of cancer is at least usually treatable. But as luck and fate would have it, my doctor told me that thymic cancer is very rare and usually very aggressive.

“Thymic tumors are rare and understudied,” says Giuseppe Giaccone, MD, Ph.D. “Moreover, there is a clear distinction between the different types of thymic tumors and the most aggressive form, thymic carcinoma – which only represents about 10 percent of all thymic tumors (less than a 100 new cases each year in the United States.) Surgery is the mainstay treatment in thymic tumors, but this is often not possible in thymic carcinomas, because they are already in advanced stage when they are diagnosed. Chemotherapy is then the standard treatment, sometimes associated with radiation, but results are underwhelming, with survival rates in the range of five years.”

From Treatment to Clinical Trial

I found it difficult to stay positive about my prognosis since there was little doctors or specialists could offer at the standard cancer centers. What I did learn over the next two years was that if you need a big fish (which I certainly did), you have to go to the big ponds. As a result, I was able to do fairly well physically and mentally, despite many radiation treatments to various metastatic sites.

I participated in a clinical trial that bought me some time. I learned to live in the moment and not to project the future, or what the future might bring. I kept up on the latest advancements in diagnosis and medication and frequently asked about immunotherapy.

In December 2014, my hopes were realized. I heard about a new immunotherapy trial just for Thymic cancer patients at the Georgetown Lombardi Comprehensive Cancer Center. Dr. Giaccone was the primary investigator (author) of the trial. I was accepted into the trial, and my hopes of finding a durable solution to this disease were renewed.

”At the time, Shannon had a lot of disease in her body, but she was still in good condition and very positive spirit,” shares Dr. Giaccone. “She was a good candidate for a study with pembrolizumab, an antibody that targets the immune system by making it fight the cancer.”

"You Have No Detectable Disease"

Elation cannot adequately describe the excitement and joy I felt after just one treatment. My metastatic sites started to shrink. And in April 2016, I once again heard what I previously thought was impossible: “You have no detectable disease.”

These five words were equally shocking to my original diagnosis but in the most incredible and delightful way. Today, I am filled with gratitude and thanks not just for the blessing of physical healing but also for the restoration of hope.

For those with rare cancers my advice, like so many who fight this disease, is never to stop looking for the "next big thing." I took courage from my hours of research and from participating in clinical trials. Even though my first treatments were ultimately not the treatments, they were the bridge to the treatment that ended my cancer story. So never, ever give up. Persistence pays off.

Shannon's full story can be viewed here: 

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.

Benefits of Robotic Prostate Cancer Surgery

After the initial shock of finding out that you have prostate cancer, you will probably think of multiple questions for the surgeon. A question we are frequently asked is whether surgery is the only course of action.

When surgery becomes the best option for removing prostate tumors, the next question typically is whether robotic prostate cancer surgery is an option what the risks are, and how long the recovery takes.

Robotic surgery is an innovative technique that can minimize bleeding, risk of infection and damage to surrounding tissues. Educating yourself about the benefits of robotic surgery may help allay your fears of the procedure, thereby reducing stress and worry, and enabling you to have a more positive treatment outcome.

The Risks of Traditional Prostate Surgery

The prostate gland is located in the deepest part of the male’s pelvis. This area is full of blood vessels and nerve structures that control sexual function. The prostate gland is also adjacent to the urinary sphincter, which controls urinary function. During traditional prostate tumor removal surgery, it can be difficult to identify the adjacent muscles, veins and nerves that tightly surround the prostate gland.

If these tissues, muscles or the sphincter are inadvertently damaged during surgery, it is likely that the patient will suffer from urinary incontinence or erectile dysfunction.

Robotic Prostate Cancer Surgery: Who Is a Candidate?

Robotic surgery uses tiny tools that can fit into a laparoscopic incision that is much smaller than the incision required for traditional procedures. The result is reduced ancillary damage to surrounding muscles and tissues, less bleeding, less chance of infection and a shortened recovery period. In fact, while recovery time from traditional surgery might require six to eight weeks, typically times with robotic surgery are about three weeks.

Not everyone is a candidate for robotic surgery. In fact, if you are like two out of three men diagnosed with slow-growing prostate cancer, you may not need surgery at all.

Factors that indicate viability for robotic prostate cancer surgery include:

  • Being sexually active
  • Having normal urinary function
  • A life expectancy of 15 years or more.

Necessary Testing Before the Robotic Surgery

Your doctor will order a 3D MRI that uses the latest technology to identify the prostate gland, urinary sphincter, various nerves and blood vessels that surround the prostate gland. The MRI will provide an accurate view – or map – of the area in order to minimize collateral damage to surrounding tissues.

Doing Your Own Research

Your doctor can provide you with a name of a well-respected surgeon. Look for a surgeon with extensive experience in robotic surgeries and narrow your list to doctors affiliated with facilities that can prove consistent positive robotic surgery outcomes. Ask for data that specifically focuses on the facility’s success with this type of surgery. Most reputable facilities are happy to share this information with potential patients.

If, after your initial visit with the surgeon, you are still undecided about going ahead with the procedure, ask him or her for names of patients who have undergone this type of surgery and who have agreed to answer other surgical candidates’ questions. Being able to talk frankly with other men who have experienced the surgery might help to calm your fears.

Recovery From Robotic Surgery

Some types of slow-growing prostate tumors don’t require surgery at all. Instead, your doctors and specialists can actively observe them during regularly scheduled checkups. Other types of aggressive tumors may require traditional surgery. If your prostate cancer diagnosis and treatment protocol includes surgery, ask your surgeon if you are a candidate for robotic surgery.

In fact, if your prostate cancer is aggressive and threatens to spread to nearby organs or tissues, robotic surgery may be the best choice for you. The advantages of robotic surgery are many, including faster recovery and less downtime.

No one wants to have surgery, but take comfort in knowing that the latest technology enables you to have a shorter recovery time and less chance of potential side effects of the surgery.

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.

Nurse Navigators Play a Critical Role in Cancer Care

Hearing a cancer diagnosis can bring on a flood of conflicting emotions. Shock, numbness, anger and confusion about your next steps. There are more than 14 million new diagnoses each year, and many patients are unsure about what to do - questions can range from how to break the news at home to what to expect during treatment.

At MedStar Georgetown Cancer Institute, nurse navigators are the healthcare providers who help with those questions and support patients at every step of their cancer journey. Helping patients see the big picture and keeping track of the small details is also an essential part of the role.

Why Are Nurse Navigators Crucial to Quality Care?

When you receive a cancer diagnosis, it's easy to feel overwhelmed by your options. Surgery, medications, radiation, and other treatment options may be presented to you. A nurse navigator can help you understand your choices and provide detailed information about the behavior of a specific cancer. By understanding cancer staging and how treatment works, you can make more informed decisions about your treatment.

Every cancer treatment regimen should be tailored to fit the individual; nurse navigators explain and address that necessity. We can even provide translation services to help eliminate any language barrier, should the need arise. And if making appointments is tough, transportation services might be available. Many secondary services can help you get the most out of every appointment.

During your first visit with your cancer treatment team, you get a lot of information - so much so, that it may be easy miss details, and you may have questions. That's where a nurse navigator comes in; they can help you figure out the best resource for any questions and offer suggestions about what to ask. In fact, part of the new patient process as a nurse navigator involves providing patients with valuable information, as well as potential questions to ask.

That is only the beginning of your journey, however. You may not have a lot of knowledge about cancer or what happens after treatment. Long-term surveillance is a big part of optimizing function and longevity, as well as monitoring risk of cancer recurrence. Helping you understand what to report and the support that is available at the end of treatment is a rewarding part of the role.

Nurse Navigator's Network

Navigators do more than answer questions and provide information; they also assist you in ensuring your critical records and information is available for the physician’s review prior to discussing your treatment plan. For example, you may not know what documents are most critical for a specific appointment, but a nurse navigator can help you with the scheduling and documentation needed to keep quality of care high and coordinated across the team supporting you.

As a patient resource, nurse navigators are there to traverse all disciplines and provide knowledge from a perspective inside the medical center. They help guide and shape your journey so you can make treatment decisions with all the information you need readily available.

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.

Planning to Preserve Function and Appearance After Surgery for Head or Neck Cancer

Head and neck cancers include a range of conditions such as sinus cancer or cancers of the throat or voice box. What can make these tumors a unique challenge is that they are invariably located near areas where senses and critical functions take place.

That means treatment of a tumor, whether through surgery or radiology, can impact a patient's ability to hear, see, smell or taste. More than that, it can impair a patient’s ability to swallow or speak. Working with a medical team that keeps all of these potential impacts in mind – and plans to avoid loss of functionality whenever possible – is important.

But functionality isn't the only concern many head and neck cancer patients have. When treatments occur near the face, patients can be concerned about how they will look following surgeries.

Some head and neck cancers do require aggressive treatment; surgery to treat severe sinus cancer, for example, could necessitate removal of an eye. When aggressive surgical treatment is unavoidable, it's important to work with a team that includes an experienced reconstructive surgeon to help maintain appearance. That experience, combined with modern treatment methods, can achieve remarkable results.

Look for Experience and a Multidisciplinary Approach

Patients who are facing decisions about treating head or neck cancer should look for providers that offer an unbiased approach to treatment. Each specialty provider  – such as a surgeon or a radiation oncologist – is trained in specific approaches and treatment methods. Without a balanced perspective, even medical providers can be somewhat biased in their approach.

For example, our MedStar Georgetown Cancer Institute team has met every week for over 20 years. Providers from a range of disciplines – for example, oncologists, surgeons and speech therapists – meet to discuss each active case, where treatment decisions are approached from a variety of perspectives. That's important not only for helping each patient make the best possible decision, but also for ensuring recovery is well planned.

Experience is also important when choosing a medical team. Our head and neck cancer surgery team alone brings over 50 collective years to the table. That experience helps us understand the long-term impact of any decision made to treat cancer today.

Talk to Your Providers About the Future

The landscape of head and neck cancer is changing. There has been a significant increase in the incidence of throat cancers that are the result of a prior infection with the human papilloma virus (HPV). These are often found in patients of middle age who do not have the classic throat cancer risk factors of chronic tobacco and alcohol use. The increased incidence of these tumors in otherwise healthy middle-aged patients is a major change in the field of head and neck cancer, but fortunately this new version of head and neck cancer has a high cure rate.

Not only are the cure rates for these types of cancer high, these younger patients often are healthier and do not present other illnesses or conditions that would further complicate their diagnosis and treatment. When determining the best course of treatment, medical teams and patients must balance the expectation of high survival rates with the possible long-term consequences of treatment on swallowing, on dental status and on other quality of life issues years after successful cancer treatment.

If both radiology and surgery are equally viable solutions, patients might choose radiation because they are afraid of surgery or there are more short-term disadvantages. However, radiation could lead to swallowing issues in 15 years, which might make surgery the better option in the long-term, for individual patients.

Though there are others, these are a few of the variables requiring consideration that make an experienced, multidisciplinary team approach essential to successful treatment and preservation of function for head and neck 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.

Sarcomas: What You Need to Know About This Rare Form of Cancer

Sarcomas are rare, only accounting for 1 percent of cancers diagnosed in adults. That means that many people don't learn about these cancerous tumors of the connective tissue unless they or a loved one have received a sarcoma diagnosis.

Although there are dozens of different types of sarcoma, they can be grouped into two main kinds: soft tissue sarcoma and bone sarcoma. Read on to learn more about the symptoms, treatment options and challenges associated with this rare form of cancer.

What to Know About Sarcoma

Sarcoma does not always present with symptoms in the early stages or when located inside the abdomen, and only about half are discovered before they involve surrounding parts of the body. The symptoms that patients do notice vary based on the location of the sarcoma, the type of sarcoma and the presenting stage. At that point, the treatment plan has to be personalized to each patient, taking into account any presence of additional chronic disease or condition.

The majority of sarcomas present in the extremities (arms and legs) or trunk, in which case you might see a lump that has been growing over time. The second most common type of sarcoma involves the retroperitoneum, an anatomical space located toward the back of the abdomen. With this type of sarcoma, the only symptoms experienced might be pain or possibly blood in a patient's vomit or stool.

The survival rate of sarcoma depends largely on many factors, but importantly the sarcoma type, size, grade, location, and - of course - stage. For example, stage one with favorable features can have a 90-percent, five-year survival rate, while stage three can drop below a 56-percent, five-year survival rate. It should also be noted that the survival rate is higher when the sarcoma is found in the extremities.

Sarcoma Treatment Options and Challenges

The right treatment for sarcoma depends on several factors, such as the stage of the cancer, as well as its location and type. But generally speaking, surgical intervention and radiation therapy are the most common courses of treatment. In addition, chemotherapy may be leveraged as a treatment strategy, either before or following surgery, as a means to shrink the tumor or prevent further spreading of the cancer.

Despite the generally positive outcomes for most sarcoma patients, the journey of treatment is not without challenges. Sarcoma tends to present slightly in extremities and can be located close to joints, blood vessels or critical nerves. This means a doctor needs to be able to remove the entire sarcoma without leaving the patient with a nonfunctioning extremity.

By contrast, it’s harder to detect it in the retroperitoneal or abdominal areas. Patients may be bloated or simply think they’ve gained weight, so they might put off going to the doctor. In some cases, the only time the doctor detects sarcoma in the abdomen is when the patient has a CT scan for a different reason.

Sarcoma Treatment and Recovery Is About the Patient

If you or a loved one is diagnosed with a sarcoma, it is important to seek out a specialty center with an expertise in sarcoma. This is especially true since there are over 50 types of sarcoma. In addition, you should engage specialists that have the experience necessary to not only identify the stage of cancer upfront, but also determine the right sequence of treatments.

Most of all, the right physician will understand the needs and desires of the patient come first, down to the sequence and length of treatments, and should make it clear that this is a journey that you are all on together.

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.

Head and Neck Cancer: What to Expect from Transoral Robotic Surgery (TORS)

Head and neck cancer can be difficult to manage, but thanks to recent developments in medical technology, surgeons now have more effective ways to treat it. In the past, certain tumors in the head and neck could only be removed by either cutting through the neck or opening the jaw.

These rather morbid procedures resulted in poorer functional outcomes and carried a higher risk of complications than their modern-day counterpart, transoral robotic surgery - commonly referred to as TORS.

What Is Transoral Robotic Surgery (TORS)?

TORS is a minimally invasive procedure in which a series of robotic arms are passed through the mouth in order to reach a tumor and resect it. It's most commonly used for tumors in the throat, particularly tonsil and tongue tumors. TORS is a good option for treating head and neck cancers not only because it's minimally invasive, but also because it can reduce the need for additional therapy. Patients who elect to undergo TORS often find that they require a lower dose of radiation --and some can even avoid radiation and chemotherapy altogether.

However, effective as the procedure is, it's important for you to understand what to expect before, during and after TORS, so that you can prepare yourself for the best outcome possible.

Before Surgery

Before undergoing TORS, your surgeon will need to conduct some tests to understand exactly how to approach the tumor. A PET/CT scan is usually necessary to visualize the tumor, and a biopsy to confirm the diagnosis and determine the extent of its development. Preparation for surgery will also include common preparations such as blood testing so that your surgeon may have a thorough understanding of your health.

You may be asked to avoid certain medications during the week prior to the operation, such as aspirin or other anti-inflammatories, as these can cause complications. Your surgeon will advise you on the steps to take prior to your surgery to make sure you are in the best condition possible.

The Day of Surgery

As is common for many surgeries, you will be advised not to eat any food after midnight the night before your TORS. It's important that you arrive two hours before the scheduled surgery so that the nurses, anesthesiologists and surgeons have time to admit you and get everything in place.

Immediately after the operation, you may find that your tongue feels somewhat swollen. This is a common side effect that should subside after a few weeks, and it is unlikely to seriously impair your speech. Either the day of the TORS or the day after, you will have a bedside swallow evaluation to ensure that your throat is functioning well. If necessary, a speech pathologist will be involved to help you along the way.

After Surgery

It's common for patients who undergo TORS to be concerned about whether they will be able to speak or eat. The fact is that TORS results in great functional outcomes, and within just one or two days of the operation, most patients are speaking and eating comfortably. Once you demonstrate that your pain is under control and you are capable of eating and moving around comfortably, you will be able to return home. Hospital stays rarely exceed two or three days.

Although very uncommon, some bleeding may occur around the site of surgery. A sudden case of bleeding in the throat can be dangerous, so be vigilant for the first week or two after your TORS. In the interest of safety, surgeons recommend having someone nearby for that short period after the operation.

Final Thought

TORS is an exciting development for head and neck cancer patients, as it has revolutionized how those diagnoses are treated. Because it is minimally invasive and can reduce the need for further treatment, patients like you are experiencing faster, more complete recoveries. Use this overview of what to expect from the procedure to be more informed when you speak with your doctor.

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.

Techniques Used to Improve Quality of Life for Bone Tumor Patients

Not only is bone cancer a worrisome diagnosis for patients and their families, the prospect of treating any cancer can be frightening, as you may not know what challenges you can expect or how to overcome them.

In this article, we'll be looking specifically at bone sarcomas, which are cancers that arise in the body's bone, muscle and connective tissue. There are several other types of bone tumors, including:

  • Other cancerous tumors that arise in the bone marrow;
  • Benign tumors of the bone; and
  • Non-bone cancer that spreads into the bone.

Each of these types of tumors brings its own unique care challenges and treatment strategies.

Alleviating Fears

When patients learn they have bone cancer, one of the most common fears is that they'll need to have a limb amputated. Historically, this kind of aggressive treatment was the first line of attack against bone cancer, and many prominent cases were treated this way.

But for many patients today, this is no longer the case. The limb is spared, and amputation is not necessary. Modern treatments for bone cancer treat the tumor(s) with a combination of medical and surgical methods. Doctors do this while preserving as much limb function as possible, maximizing the patient's ability to function and ensuring a high quality of life, both during and after treatment.

The Diagnosis Process

Providing an accurate diagnosis, with vital information about the type and stage of cancer, is critical to treatment. An accurate, thorough diagnosis helps your team of doctors create a treatment plan that's safe, effective and thorough, and minimizes unnecessary treatment.

One of the most vital aspects of the diagnosis is the biopsy, which is an examination of a tissue sample collected from the body. A good biopsy should be minimally invasive, only testing parts of the tissue suspected to be affected. CT-guided or ultrasound-guided needle biopsies, or needle biopsies performed in a major clinic, allow precise, careful testing of tissue.

An appropriately-placed biopsy takes just enough tissue to test, and no more. But at the same time, some doctors – especially those who do not commonly work with bone cancers – take too little tissue for a definite diagnosis, forcing a re-biopsy. Our doctors always work to take the proper amount for the biopsy – not too much, and not too little.

Devising a Treatment Plan

Different types of bone cancer require different treatments. The limbs affected and the stage of cancer will also affect the treatment plan. For some cancers, chemotherapy is needed prior to a limb-salvaging surgery. Other cancers don't respond as well to chemotherapy and require surgery (not necessarily an amputation) to treat. This is why obtaining an accurate diagnosis is so crucial.

Primary bone cancer is very rare, and its treatment is often highly specialized and complex. One of the best ways you can assure swift, safe and thorough treatment is to receive diagnosis and treatment at a large center that employs a team of experienced oncologists, surgeons, radiologists, pathologists and other doctors. This way, you know you'll get the care you need, and your quality of life will be assured.

Final Thought

When your doctor suspects bone cancer, one of the most important ways to ensure successful treatment and a high quality of life is to receive an accurate diagnosis at a major medical center. If you do indeed receive a bone cancer diagnosis, receiving comprehensive treatment from a team of experienced doctors at a major care facility is vital to ensuring you receive the best care possible.