Anatomy of the thyroid and parathyroid glands. The thyroid gland lies at the base of the throat near the trachea. It is shaped like a butterfly, with the right lobe and left lobe connected by a thin piece of tissue called the isthmus. The parathyroid glands are four pea-sized organs found in the neck near the thyroid. The thyroid and parathyroid glands make hormones. (Courtesy of the National Cancer Institute)

A needle biopsy may not be enough to diagnose thyroid cancer: A needle biopsy of a suspicious area in the thyroid is an excellent initial method of identifying cancer in the thyroid gland. Cells collected using a small needle are examined under a microscope to determine whether a thyroid cancer is present. In many people, a biopsy will exclude a cancer.  However some patients, the biopsy will be “indeterminate,” meaning it is not possible to determine whether the cells are cancerous based on their appearance under the microscope.

Indeterminate biopsies are an extremely common reason for people to undergo thyroid surgery. It is an unfortunate fact that most thyroid surgery is done to determine whether cancer is present rather than to treat a cancer. In medical terms, this is to say that the procedure is diagnostic rather than therapeutic. Many patients have one half (hemithyroidectomy) or even the whole gland (total thyroidectomy) removed only to find out later that there was never any risk of cancer at all.

There is great interest among researchers and physicians to develop non-invasive or minimally invasive tests to identify thyroid cancer. A good thyroidologist will sometimes be able to integrate the imaging characteristics and needle biopsy results, with or without a battery of molecular tests to make impressive predictions about whether cancer is present. The use of molecular testing is helpful.

With a careful evaluation, it may not be necessary to have surgery just to exclude the possibility of thyroid cancer.

When to be concerned about a feeling of something being stuck in the throat: Complaints such as this are surprisingly common, and were described in antiquity rather uncharitably as “globus hystericus.”

Patients may bring their complaints to their primary doctor. But the throat is not readily examined by most primary physicians, who order ultrasounds and CAT scans in a misguided attempt to find the source of the problem.

Fortunately, the vast majority patients who have these complaints don’t end up having cancer. Nevertheless, a look either with a mirror or an instrument permitting a careful inspection of the throat in the office may be warranted.  An office examination by an experienced otolaryngologist or head and neck surgeon is the best initial step to evaluate for cancer.

Some things make it less likely that the sensation of a lump in the throat is cancer, for example, if the sensation has been present for less than 2 weeks or for a couple of years.

In contrast, a sensation that is always only on one side of the throat is more concerning, especially if there is also one-sided ear pain, a new visible or palpable neck lump or unintentional weight loss.

Some factors that physicians used to use to distinguish people at higher risk for throat (oropharyngeal) cancer are no longer valid. For example, globus-type complaints from older men who smoked were more likely to be taken seriously than similar complaints from young individuals who never smoked cigarettes. However, currently, the most common cause of oropharyngeal cancer is the human papilloma virus, the same virus that causes cervical cancer, not smoking. Vigilance is warranted.

Visit Fox Chase Cancer Center for more information on thyroid cancer diagnosis and treatment.

This post was written by Miriam N. Lango, MD

Miriam N. Lango, MD, is a surgical oncologist at Fox Chase Cancer Center. She is the Medical Director of the Speech Pathology Service and an Attending Surgeon, Head and Neck Oncology. Dr. Lango specializes in treating patients with head and neck cancer; thyroid tumors; minimally invasive surgery for pharyngeal and laryngeal cancer; parotid tumors; complex or recurrent thyroid cancer; advanced skin cancers including melanoma, sinonasal malignancies; sinonasal malignancies and skull base tumors; voice and swallowing disorders.

The post Is Surgery Necessary to Diagnose Thyroid Cancer? appeared first on Cancer Conversations.

As genetic counselors, we see patients every day who are deciding whether or not they want to know their genetic risk for cancer.  If they test positive for a genetic mutation, the decision about what to do for screening and prevention and when to do it can be devastating.  The support of family and friends is important during this time.  Ms. Jolie illustrated this point when she talked about the support of her partner, Brad Pitt.  She and others like her are also often balancing children and careers.

The decision about genetic testing and what to do with that information is not an easy one.  Support and accurate information are essential.  Having a genetic counselor who specializes in cancer risk can go a long way in giving you the knowledge you need to make a decision that is right for you and your family and in supporting your choices for risk reduction and cancer screening.

If you or someone you know has a personal or family history of breast or ovarian cancer, particularly cases that are young, consider meeting with a genetic counselor to see if you might also be at risk for a genetic mutation.  While these mutations are very rare, identifying them is important when predicting risks for cancer.  You can contact the Risk Assessment Program at Fox Chase Cancer Center at 877-627-9684 or visit www.nsgc.org to find a genetic counselor near you.

This post was written by Andrea Forman, MS, CGC

Andrea Forman, MS, CGC, is a genetic counselor with the Risk Assessment Program and Department of Clinical Genetics at Fox Chase Cancer Center in Philadelphia, PA. She works with people who want to learn more about how genetics and their family history may influence their risk for cancer. For more information, write to Andrea at rap-info@fccc.edu.

The post If you knew you had an 87% chance of developing breast cancer, what would you do? appeared first on Cancer Conversations.

Based on the NLST results, consensus guidelines have been issued from national expert consensus panels including the American Society of Clinical Oncologists (ASCO), National Comprehensive Cancer Network (NCCN), American College of Clinical Pharmacy (ACCP) and American Association for Thoracic Surgery (AATS).  These guidelines shape the standard of care offered by clinicians, helping them to appropriately counsel patients regarding the risks and benefits of lung cancer screening.

Most recently, the American Cancer Society recommended that clinicians discuss CT screening with high-risk individuals, based on similar criteria to those used for entry in the NLST.  These include patients age 55 to 74, with at least a 30 pack-year history of smoking, who are either currently smoking or have quit within the past 15 years.  The guidelines advise clinicians to refer patients to high-volume, high-quality lung cancer treatment and screening centers, where multidisciplinary teams evaluate and manage patients in a similar fashion to the NLST, thereby minimizing the risks and maximizing the benefits offered by this important screening program.  The guidelines also emphasize the importance of counseling about smoking cessation since such an intervention is the most significant way in which current smokers can reduce their risk for lung cancer, other cancers, and cardiovascular disease at large.

(CA Cancer J Clin 2013; 63; 106-117)

Trends in Smoking Related Deaths by Dr. Mary Daly, medical oncologist, Fox Chase Cancer Center

This post was written by Stacey Su, MD

Stacey Su, MD, is an attending surgeon specializing in treating patients with thoracic cancers.

The post American Cancer Society Issues Guidelines Regarding Lung Cancer Screening appeared first on Cancer Conversations.

In the past, therapies focused on palliation with the use of chemotherapy or surgery. In the present era, our current treatment paradigm focuses on using a multimodality approach to treat disease at the macroscopic and microscopic level. Patients who undergo a multimodality treatment course (such as surgery followed by adjuvant chemotherapy) have been demonstrated to have longer survival compared to those who only underwent surgery alone or chemotherapy alone.

Presently, there are two most commonly used types of surgical treatment options for mesothelioma:

1. Extrapleural pneumonectomy, whereby the surgeon resects the pleural tumor, along with the ipsilateral lung, diaphragm, and pericardium.
2. Radical pleurectomy/decortication, whereby the surgeon spares the lung, but resects the pleural tumor (in its pleural envelope), often along with the diaphragm and pericardium.

It is believed by many thoracic surgeons, that the pleurectomy/decortication procedure is more technically demanding, but achieves higher quality-of-life indices for mesothelioma patients, compared to the extrapleural pneumonectomy procedure. These higher quality-of-life indices are thought to be related to lung preservation. However, in some instances, a patient with very advanced mesothelioma may not be a candidate for lung preservation, and may need to undergo an extrapleural pneumonectomy for full extirpation of pleural tumor. The thoracic surgical team at Fox Chase is skilled at performing both procedures, and makes every effort to perform a lung-sparing radical pleurectomy whenever possible.

This post was written by Prashant Shah, MD

Prashant C. Shah, MD, is an attending surgeon in the Division of Thoracic Oncology at Fox Chase Cancer Center. His area of expertise is to treat surgical diseases of the chest, as it pertains to the lung, esophagus, mediastinum, pleura, and diaphragm. Dr. Shah's clinical focus has been placed on complex thocacic cancer cases, minimally-invasive foregut/esophageal surgery, VATS lung and mediastinal surgery, and the surgical management of mesothelioma. Dr. Shah is specially trained in treating many different types of benign thoracic surgical problems, such as GERD and hyperhidrosis.

The post Lung-Sparing Treatment Options for Malignant Pleural Mesothelioma appeared first on Cancer Conversations.

With Isolated Limb Infusion (ILI), the effects of chemotherapy can be concentrated regionally in one area, easing the strain and toxicity on the full body that can accompany standard chemotherapy. It also allows a much higher concentration of the dose than a standard intravenous chemotherapy would permit.

When the session is over, the drugs are flushed from the limb, and normal blood flow is returned. The full session can take three hours.

The ILI procedure can safely be repeated if deemed necessary.

This post was written by Fox Chase Cancer Center

Cancer Conversations is a blog published by Fox Chase Cancer Center's Communications Department. Our contributors include physicians, researchers, healthcare professionals, patients and friends of Fox Chase Cancer Center. To submit a topic for the blog, write to authors@fccc.edu.

The post Treating Extremity Sarcoma appeared first on Cancer Conversations.

(Courtesy of the National Cancer Institute)

Lung cancer remains the leading cause of cancer deaths, and lung cancer survival remains by and large discouraging on account of the advanced stage in which most cancers are diagnosed. This is spite of technological advances in detection and treatment.  However not all lung cancers are equal.  The most common type of lung cancer is adenocarcinoma, and among lung adenocarcinomas, one subtype is associated with better-than-expected prognosis and minimal metastatic risk.  This subtype was formerly called bronchioloalveolar carcinoma (BAC) according to the 2004 WHO histopathologic classification.

In 2011 a multidisciplinary expert panel representing the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS) and the European Respiratory Society (ERS) proposed changes in the nomenclature of lung adenocarcinomas.  (Travis et al, J Thorac Oncol 2011;6:244–85).

One major proposal replaced the term BAC with “adenocarcinoma in-situ” and “minimally invasive adenocarcinoma” (MIA).  These changes acknowledge the more indolent biology manifest by these “precursor” lesions and the manner by which they may remain stable or demonstrate minimal growth over periods of time. MIA may appear on CT scans as mixed solid/ground-glass nodules, and can only be definitively diagnosed following resection and evaluation of the surgical specimen.  There is an ongoing multicenter randomized controlled trial (CALGB 140503) which seeks to evaluate the role of lung-sparing resection as an alternative to lobectomy for surgical management of small peripheral lung cancers.  This will help to answer whether more favorable cancers such as MIA can be managed with curative intent using more limited surgical resections.

Classification of lung adenocarcinoma according to subtype, as suggested by the multidisciplinary proposals from the IASLC/ATS/ERS panel, does not play a part in the current TNM staging system for lung cancer.  But histopathologic sub-typing may still have an important role in clinical decision-making, as it does in other cancers such as breast and prostate cancer.

More commonly these days, diagnosis of lung cancer is made upon determination of the tissue type, cell type, followed by the presence of specific genetic markers.   To date, more than 50 percent of lung adenocarcinomas harbor at least one known kind of genetic mutation.  Although this does not all translate to known drug targets as yet, progress over the last decade has been exponential and equips us every day with increasingly more options with which to offer patients personalized and more effective treatments.

This post was written by Stacey Su, MD

Stacey Su, MD, is an attending surgeon specializing in treating patients with thoracic cancers.

The post Not all lung cancers are created equal: the clinical relevance of the new classification of lung adenocarcinoma appeared first on Cancer Conversations.

Even if a cancer can be seen or felt, a variety of tests may be performed when doctors are trying to find out whether a patient has a cancer, or whether one has spread. Radiology or Medical Imaging tests include: X-rays, CAT scans, MRI scans and ultrasound examinations. Sometimes these tests are done before a patient is even proven to have cancer—just on suspicion. Patients who are feared to have cancers of the throat, voice box, lung, esophagus, stomach, colon, and rectum may even go through “endoscopy” procedures, which allow doctors to look inside of the body’s “hollow” organs. Endoscopes are lighted tubes, often with a video camera, that may allow a doctor to see a tumor or other abnormality.

A PET Scan showing tonsil cancer with neck node metastases.

Once a tumor’s location is known, small pieces of tumor (“specimens”) can usually be taken for study with very small bites or by sucking cells out through a needle. Proof that a patient actually has cancer comes from seeing the cancer’s cells under the microscope—they usually don’t look like normal cells.

Removal and examination of a “specimen” is called a “biopsy.” Showing that a patient really has cancer should be an early step in treatment planning, but it isn’t always exactly clear where the cancer is located in the body, so the tests mentioned above might be needed before the biopsy can be performed.

Most cancers are assigned to a particular “stage” based upon their size and whether they have spread to nearby lymph nodes or elsewhere in the body. Medical imaging test and endoscopy are often useful for staging. They may be performed before or after a biopsy proves that the patient has cancer. PET scans may also help to show cancer spread, but they are not always helpful and are seldom done before a patient has been proven to have an active cancer.

For staging, the size of the primary tumor (where the cancer first started to grow), whether the cancer has spread to lymph nodes, and whether the cancer has spread elsewhere in the body are taken into account. Sometimes the way cells look under the microscope tells doctors important things about how the cancer will behave, so sometimes the cancer cell’s appearance is included in the staging as well. Occasionally different types of cancer may arise in the same organ, and they may be assigned different stages because they don’t behave the same way.

Usually, cancers that have already spread at the time they are found are harder to control than cancers that have not spread. Cancers that are harder to control will be assigned a higher stage. Most cancer stages are written with roman numerals, and run from I to IV, where IV is the most advanced.

Learn more about the Imaging Center at Fox Chase Cancer Center.

This post was written by John A. Ridge, MD, PhD, FACS

John A. Ridge, MD, PhD, FACS, is the Chief of Head and Neck Surgery at Fox Chase Cancer Center. He joined the staff at Fox Chase in 1991, moving from San Francisco to join one of the country's first multispecialty head and neck cancer teams. Since then, he has dedicated his career to curing as many patients with head and neck cancer as possible, while providing all of them with the best quality of life. To make an appointment with Dr. Ridge, call 888-FOX CHASE.

The post What Goes Into Cancer Staging? appeared first on Cancer Conversations.

After receiving a diagnosis of stage 3B Nodular Malignant Melanoma on November 21, 2011, I decided to start a blog called The Cancer SPOT (via Facebook) to offer support to fellow melanoma warriors. In addition, I hope to raise awareness of the issues surrounding melanoma.

On December 20, 2011, I underwent surgery at Fox Chase Cancer Center. Surgical oncologist, Dr. Jeffrey Farma, performed a wide excision and sentinel lymph node mapping on the cancerous mole of my upper left thigh.  The pathology report revealed that one of my lymph nodes removed during the sentinel node mapping was cancerous. That meant further treatment was required. I began a one year course of chemotherapy (Interferon alpha 2b) which concluded on April 1, 2013.

Although I do not know what my future holds, I am determined to make a difference and live life to the fullest. This includes finding something to laugh at everyday.  Life can often be challenging enough – but add a diagnosis of cancer, and your life is forever changed. My philosophy is that if we are not laughing we are angry or crying. I choose to laugh

“Welcome to the Humor Hospital where laughter is the only medicine administered.”

Having cancer and going through chemotherapy can be difficult due to the physical side effects, as well as the emotional affects of cancer. Since I try to look at the humorous side of everything, I started to look at my side effects as if I have entered an amusement park of Interferon Symptoms. These rides cause the same symptoms that some people experience on theme-park rides. Every time I experience vertigo and nausea, I say that I woke up on the tilt a whirl ride again that keeps spinning around and around … and no one will let me off and or stop the ride.

When I experience body aches, fever and fatigue as a result of chemotherapy, I feel like I’m on a bumper truck ride where people are slamming into my truck and making me feel like I was hit by a truck.  Just when I think my annual amusement park pass is finished, I wake up on new ride as a result of a new symptom. I hope to make my fellow cancer sisters and brothers laugh and or smile while reading my humor blog.

I would love to hear from all my cancer relatives so please leave a comment, idea and share your story. I love all forms of social networking such as Facebook, YouTube videos, youinspire.org, Twitter @DonnaPiunt and email. I use social networking to raise awareness of melanoma as well as to inspire my fellow melanoma survivors to laugh or smile each day.

Your Cancer Humorist,

Donna Piunt

This post was written by Donna Piunt

Donna Piunt is a Fox Chase melanoma survivor. She describes herself as a fun-loving, animated fifty-some-year-old woman determined to inspire, encourage and offer support to fellow melanoma warriors, as well as raise melanoma awareness world wide. She feels fortunate to be married to an amazing, loving and supportive husband. Donna is the mother of two beautiful and creative twenty-some-year-old daughters and has one sister and two brothers who serve as her support system. Donna has many wonderful and supportive girlfriends. The Piunt home has a mini-zoo that consists of two dogs (Shelties), two cats and a turtle which makes for an amusing life. Before being diagnosed with melanoma, Donna worked as a nanny, caring for an adorable toddler boy. She enjoys helping others and with her diagnosis with stage 3B Nodular melanoma on November 21, 2011, Donna launched a blog called The Cancer SPOT to offer support to fellow melanoma warriors as well as raise melanoma awareness. While working full-time, Donna earned her Associate's degree in Medical Billing and Coding on December 19, 2011, the day before her wide excision surgery at Fox Chase Cancer Center. After completing her treatment, Donna hopes to land a position utilizing her degree. She knows the future is uncertain, but is motivated to make a difference and live her life to the fullest.

The post Melanoma Patient Donna Piunt Looks for the Humor in Cancer Treatment appeared first on Cancer Conversations.

Published in Spring 2013 by The Experiment

The book launch for Jessica Wapner’s history of the discovery of The Philadelphia Chromosome is scheduled for Tuesday, May 14, 2013 at Fox Chase Cancer Center. Ms. Wapner’s program begins at 7pm in the Auditorium, followed by a reception with refreshments and books for sale.

The seminal discovery took place under a Fox Chase Cancer Center microscope in 1959, when David A. Hungerford, in collaboration with Peter C. Nowell, detected a tiny abnormality in the chromosomes from cultured blood cells taken from two patients with chronic myelogenous leukemia (CML). This would later be known as the “Philadelphia Chromosome,” the first consistent chromosome abnormality associated with neoplasia. Now, based on this research, hundreds of drugs for cancer that target specific molecules are in development and dozens have been approved. The Fox Chase Cancer Genome Institute, which performs DNA sequencing to target effective cancer treatment, is the latest extension of this idea.

To register for this FREE event, call 215-214-3954, email authors@fccc.edu or register online.

All guests are invited to join Ms. Wapner for a book signing and light refreshments following the program.

——————————————–

Jessica Wapner

ABOUT THE AUTHOR

Jessica Wapner is a freelance writer focused mainly on healthcare and medicine. Her work is published in The New York Times, Scientific American, Slate, Science, Nature Medicine, Ode, Psychology Today, and elsewhere. Her writing on cancer research and treatment also appears in the specialty magazines Oncology Business Review, Cure, and CR.

This post was written by Fox Chase Cancer Center

Cancer Conversations is a blog published by Fox Chase Cancer Center's Communications Department. Our contributors include physicians, researchers, healthcare professionals, patients and friends of Fox Chase Cancer Center. To submit a topic for the blog, write to authors@fccc.edu.

The post You’re Invited to Meet Jessica Wapner, Author of The Philadelphia Chromosome appeared first on Cancer Conversations.

Dr. Knudson illustrates his “two-hit theory.”

Fox Chase researcher Alfred G. Knudson Jr., MD, PhD, was recently inaugurated into the first class of the Fellows of the AACR Academy at the AACR Annual Meeting 2013, held in Washington, D.C. The inaugural group of fellows of the academy consists of 106 individuals, symbolizing the age of the organization upon establishment of the Academy. These fellows have been selected through a peer review process that evaluates individuals on the basis of their stellar scientific achievements in cancer research.

Dr. Knudson has previously been awarded the Kyoto Prize and the Lasker Award, and is perhaps best known for his Two-Hit Theory of Cancer Causation, which provided a unifying model for understanding cancer that occurs in individuals who carry a “susceptibility gene” and cancers that develop because of randomly induced mutations in otherwise normal genes.

This post was written by Fox Chase Cancer Center

Cancer Conversations is a blog published by Fox Chase Cancer Center's Communications Department. Our contributors include physicians, researchers, healthcare professionals, patients and friends of Fox Chase Cancer Center. To submit a topic for the blog, write to authors@fccc.edu.

The post Dr. Knudson and the Two-Hit Theory appeared first on Cancer Conversations.