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Cancer

Cancer, Medical Education, Medicine and Society, Patient Care

Cancer Ninja fights patient misinformation, one cartoon at a time

Screen Shot 2015-06-15 at 1.16.14 PMThere seems to be a trend towards using cartoons for health education: In just the past few months, we’ve posted on children’s books, depression blogs, global-health videos, and art-based clinical skills, all using non-realist art to convey information and qualitative experience. A new blog by Andrew Howard, MD, radiation oncologist at the University of Chicago and the University of Illinois at Chicago, fits right in with this innovative bunch. His blog, Cancer Ninja, aims to use cartoons to convey both how cancer works and what it’s like to be diagnosed and treated for it. Howard started it just one month ago, so his project was fresh from the creative oven when I spoke with him on the phone last week.

What motivated you to start Cancer Ninja?

I’d been frustrated for a while with how little my patients know about cancer. They come in with all these confusions; they don’t understand the difference between chemotherapy and radiation (and from a doctor’s perspective, there’s a huge difference). They don’t understand our rationale for choosing one treatment or another or a combination. One patient was convinced that hot sauce caused cancer and was really upset that she had gotten cancer because she had gone out of her way to avoid hot sauce all of her life. I realized there is a lot of misinformation out there, and that was the purpose for starting this blog.

My wife and I have two little girls, and in the evenings sometimes they say, ‘Draw dinosaurs with me, Daddy!’ So I started drawing with them, and I enjoyed it so much that I would sometimes stay up at night after they had gone to bed, still working on my dinosaur. My wife saw me enjoying that a lot, and thought maybe I could combine this with educating people about cancer.

Your website is targeted to be generally informative about cancer; why did you start with breast cancer? 

Breast cancer is really common in this country, unfortunately, and it’s also very well studied, so we understand a lot about it, which makes it a nice model. There’s a pretty clear algorithm for the proper way to treat a patient with such and such stage breast cancer, so it makes it easy to follow along.

How many characters or episodes are you hoping to do? So far, there’s just “Jane.” 

Screen Shot 2015-06-16 at 1.36.59 PMI’m kind of experimenting. I envision that I’m going to follow Jane though her diagnosis and treatment, but my wife told me that Jane can’t die; she really likes Jane. But 40 percent of people with cancer will ultimately die of their disease, so I want to draw and write about what it’s like to be confronting one’s death, at least as I have witnessed it. What can medicine offer those people, and what can’t it? So I want to introduce a character who dies. I feel like there’s so much that’s already happened in Jane’s story, and I could go back and fill in the details. The mutation steps that turn a cell into a cancer cell, that’s actually a really complicated transformation that I could explore in greater depth.

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Cancer, Imaging, Research, Stanford News, Surgery

Better tumor-imaging contrast agent: the surgical equivalent of “cut along dotted line”?

cut horseIt would be tough for most people to take a snubbed-nose scissors to an 8-1/2″ x 11″ sheet of blank paper and carve out a perfect silhouette of, say, a horse from scratch. But any kid can be an artist if it means merely cutting along a boundary separating two zones of different colors.

Tumor-excision surgery requires an artist’s touch. It can be tough to distinguish cancerous from healthy tissues, yet the surgeon needs to approach perfection in precisely removing every possible trace of the tumor while leaving as much healthy tissue intact as possible. To help surgeons out, technologists have been designing contrast agents that target only tumor cells, thus providing at least a dotted line for scalpel wielders.

Stanford pathologist and molecular-probe designer Matthew Bogyo, PhD, in a study published in ACS Chemical Biology, has now demonstrated, using mouse models of breast, lung and colon cancer, the effectiveness of a fluorescence-emitting optical contrast agent that selectively accumulates in tumors and can be used to guide surgery. In effect, the probe lights up the tumor, providing a convenient, high-resolution dotted line for its excision.

Perhaps more striking, the new study showed that this probe, designed by Bogyo’s group, is compatible with a robotic remote minimally invasive surgery system that is already enjoying widespread commercial use. Intuitive Surgical, Inc., the company that sells this system, collaborated on the study.

Previously: Stanford researchers explore new ways of identifying colon cancer, Cat guts, car crashes, and warp-speed Toxoplasma infections and Compound clogs Plasmodium’s in-house garbage disposal, hitting malaria parasite where it hurts
Photo by Merryl Zorza

Cancer, Dermatology, Events, Stanford News, Videos

Free skin cancer screening offered on June 13

Free skin cancer screening offered on June 13

Skin cancer is one of the most preventable cancers – and one of the most treatable, if it’s detected early enough. Knowing the possible risk factors, such as fair skin, excessive sun exposure, or atypical moles, might help in recognizing the signs of the disease, and getting a professional screening is also always a good idea.

Each year, Stanford dermatologists offer a free screening for skin cancer; this year’s event is happening Saturday, June 13 from 8:00-11:30 AM at the Stanford General Dermatology Clinic in Redwood City. If you’re a local reader, plan to stop by.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: The importance of sunscreen in preventing skin cancerSkin cancer images help people check skin more often and effectively, and Study shows link between indoor tanning and common skin cancer

Cancer, Global Health, Medicine and Society, Patient Care, Stanford News

Educating cancer patients in Africa and beyond

Educating cancer patients in Africa and beyond

ph_grid7_20554_74781Imagine beginning chemotherapy without being aware of the side effects. You’re feeling sicker than you felt before the medication, experiencing nausea, muscle weakness and losing your hair. You wonder if this is normal, but you can’t interpret the drug safety information because you don’t know how to read. You’re tempted to stop taking the medication.

Realizing that many of their patients had grappled with this dilemma, cancer care providers at Queen Elizabeth Central Hospital in Blantyre, Malawi approached Global Oncology, a non-profit co-founded by Ami S. Bhatt, MD, PhD, for help.

With one oncologist and an overstretched clinical team, clinicians at Queen Elizabeth recognized they often don’t have time to explain the chemotherapy treatment process to each patient. And, many of these patients struggle to read and comprehend complex instructions and medical terminology.

So they decided to create clinically relevant and culturally appropriate education materials designed for a low literacy patient population.

Veronica Manzo, a first-year medical student at Stanford and a member of Bhatt’s lab, is part of a team of Global Oncology volunteers developing the educational materials. She began volunteering with GO while she was working at the Dana-Farber Cancer Institute and is working to establish a chapter of the GO Young Professional Alliance at Stanford. The group held its inaugural meeting on campus last month.

cancer pamphlet“The existing materials were often too high-level for low literacy patients – wordy, complex and not designed for that culture or audience,” Manzo told me. “We looked at the most common chemotherapies in Malawi and created materials designed to target the specific side effects associated with the treatment.”

Together with Cambridge-based design firm, THE MEME Design, Manzo and a team consulted with medical and health-literacy experts to simplify complex medical information – incorporating simple language and culturally relevant illustrations – and package it in a way that could be easily printed and distributed by partners in low resource settings. The final 8-page booklet, “Cancer and You,” was introduced at Queen Elizabeth last summer and has become a helpful tool that educates patients and caregivers and improves treatment adherence.

Since the project began in 2013, the team has also collaborated with Partners in Health to modify and implement the materials in Rwanda and Haiti, and they hope to expand the work to Guatemala, India and additional sites in Africa and South America. To help support this expansion, Global Oncology has launched a 30-day fundraising campaign through Global Giving with the aim to raise $5,000 from 40 donors by the end of June.

“It’s exciting to see the positive impact the patient education materials have had in Malawi and Rwanda, and we’re looking forward to expanding this initiative to help close the gaps in patient cancer education worldwide,” said Bhatt, director of global oncology at the Center for Innovation in Global Health.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Oncology hashtag project aims to improve accuracy of online communication about cancer, Stanford fellow addresses burden of cervical cancer in Mongolia and Providing medical, education and technological tools in Zimbabwe
Images by Global Oncology and THE MEME Design

Big data, Cancer, Genetics, Research, Science, Stanford News

Stanford researchers suss out cancer mutations in genome’s dark spots

Stanford researchers suss out cancer mutations in genome's dark spots

lighted pathOnly a small proportion of our DNA contains nucleotide sequences used to make proteins. Much of the remainder is devoted to specifying how, when and where those proteins are made. These rules are encoded in our DNA as regulatory elements, and they’re what makes one cell type different from another, and keep them from running wild like children in an unattended classroom. When things go awry, the consequences (like rampant growth and cancers) can be severe.

Geneticist Michael Snyder, PhD, and postdoctoral scholar Collin Melton, PhD, recently combined information from The Cancer Genome Atlas, a national effort to sequence and identify mutations in the genomes of many different types of cancers, with data from the national ENCODE Project, which serves as an encyclopedia of DNA functional regions, or elements. Their aim was to better understand the roles that mutations in regulatory regions may play in cancer development.

Snyder and Melton found that fewer than one of every thousand mutations in each cancer type occurs in the coding region of a gene. In contrast, more than 30 percent of the mutations occur in regulatory regions. The study was published this morning in Nature Genetics.

As Snyder explained to me:

Until recently, many mutations outside the coding regions of genes have been mostly invisible to us. Cancer researchers largely focused on identifying changes within coding regions. Using ENCODE data, we’ve been able to define some important regions of the genome and found that certain regulatory regions are often enriched for mutations. This opens up a whole new window for this type of research.

Snyder, who leads Stanford’s genetics department and directs the Stanford Center for Genomics and Personalized Medicine, likens looking for cancer-causing mutations only in coding regions as “looking under the lamppost” for keys lost at night. Until recently, the coding regions of genes were the most well-studied, and unexpected mutations stood out like a sore thumb. We’ve known there’s a lot more of the genome outside the coding regions, but until the ENCODE project was largely completed in 2012, researchers were often in the dark as to where, or even how, they should look.

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Cancer, Medical Education, Stanford News, Surgery, Videos, Women's Health

Why become a doctor? A personal story from a Stanford oncologist

Why become a doctor? A personal story from a Stanford oncologist

Why become a doctor? It certainly isn’t easy, and it requires years of study and a sizable financial investment. If you ask physicians how, and why, they selected their careers, you’ll get a variety of stories that offer insight into the many benefits of pursuing medicine.

Pelin Cinar, MD, a GI oncologist here, tells her own story in this recent Stanford Health Care video.

As a child, Cinar was impressed with the respect her uncle, a gynecologist, received from family members. Then, in high school, her mother was diagnosed with cancer. Meanwhile, she began pursuing the courses that matched her interest in science. Her mother recovered but then relapsed when Cinar was in college and taking pre-med requirements.

During her medical education at the University of California-Irvine, Cinar discovered that all of her favorite rotations and subjects were based on oncology. “It took off from there,” she says in the video.

Previously: Students draw inspiration from Jimmy Kimmel Live! to up the cool factor of research, Stanford’s senior associate dean of medical education talks admissions, career paths and Thoughts on the arts and humanities in shaping a medical career

Cancer, In the News, Media, Medicine and Society

Oncology hashtag project aims to improve accuracy of online communication about cancer

Oncology hashtag project aims to improve accuracy of online communication about cancer

6399145505_49e812a63d_zThere’s lots of talk about the need for doctors to communicate better with their patients, and social media is taking off as a medium for doing so. At this year’s meeting of the American Society for Clinical Oncology, which ends in Chicago today, Matthew Katz, MD, a radiation oncologist at the University of Texas’ MD Anderson Center, exhibited a poster displaying a new series of hashtags for different types of cancer. There are at least 20: #leusm for leukemia, #melsm for melanoma, #blcsm for bladder cancer, etc. Patients and doctors alike can use them to be more accurate and specific in sharing information.

As reported in a MedCity News piece, Katz is a big believer in social media as a way for patients and doctors to communicate. He developed the hashtags to provide better access to reliable, high-quality health information for both patients and providers, and he’s quoted as saying:

Hashtags are a filter that can make it possible to make Twitter less noisy. Twitter has a lot of discussion of healthcare, but finding reliable information is not as easy… Patient-physician engagement is important, but the purpose is not to enhance therapeutic relationships. The disease-specific tags may be a way to adapt Twitter’s open platform to focus conversations and bring people together for education, advocacy and support.

Katz’s “cancer tag oncology” is based on research begun in 2013, which found that a wide variety of people did use the Twitter hashtags. Katz also founded Rad Nation, an online community of radiation oncologists.

Previously: Upset stomachs and hurting feet: A look at how people use Twitter for health information, Finding asthma outbreaks using Twitter: A look at how social media can improve disease detection, Advice for young doctors: Embrace Twitter, Twitter 101 for patients, and How using Twitter can benefit researchers
Photo by Michael Coghlan

Cancer, Dermatology, FDA, Health Policy, In the News, Public Health

Experts call on FDA for a “tanning prevention policy”

Experts call on FDA for a "tanning prevention policy"

6635416457_a62bfeb09d_zIndoor UV tanning beds are known carcinogens that are responsible for many cases of skin cancer, which is the most commonly diagnosed form of cancer in the U.S. A recently issued Call to Action to Prevent Skin Cancer from the U.S. Surgeon General states that “more than 400,000 cases of skin cancer [8% of the total], about 6,000 of which are melanomas, are estimated to be related to indoor tanning in the U.S. each year” while “nearly 1 out of every 3 young white women engages in indoor tanning each year,” making indoor tanning a serious public health issue.

In a JAMA opinion piece published yesterday, Darren Mays, PhD, MPH, from the Georgetown University Medical Center‘s Department of Oncology, and John Kraemer, JD, MPH, from Georgetown’s School of Nursing and Health Studies, argued that the FDA needs to step up its regulatory approach and restrict access to this technology – due to its limited therapeutic benefits and known damaging effects.

In 2011, California was the first state to ban access to indoor UV tanning beds to minors. The authors assert that “state-level policies restricting a minor’s access to indoor tanning devices are effectively reducing the prevalence of this cancer risk behavior among youth,” but argue that regulation at the federal level is in order:

Like tobacco products, a national regulatory framework designed to prevent and reduce indoor tanning could reduce public health burden and financial costs of skin cancer. …from a public health perspective the indoor tanning device regulations are not commensurate to those of other regulated products that are known carcinogens with very little or no therapeutic benefit.

However, the likelihood of this regulation taking place is questionable:

FDA did not leverage its authority last year to put a broader regulatory framework in place, which could have included a national minimum age requirement and stronger indoor tanning device warning labels… Critical factors seem to be aligning for such policy change to take place, but additional momentum is needed to promote change at a national scale. The US national political environment makes more expansive regulation by either FDA or Congress seem unlikely in the near future.

The authors concluded with a call for organizations other than governments to help build momentum on toward a “national indoor tanning prevention policy.” For example, they said, universities could implement “tan-free” campus policies similar to the “tobacco-free” campaign.

Previously: More evidence on the link between indoor tanning and cancers, Medical experts question the safety of spray-on tanning productsTime for teens to stop tanning?, Senator Ted Lieu weighs in on tanning bed legislation and A push to keep minors away from tanning beds
Photo by leyla.a

Biomed Bites, Cancer, Genetics, Microbiology, Research, Videos

Packed and ready to go: The link between DNA folding and disease

Packed and ready to go: The link between DNA folding and disease

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

In cells, DNA doesn’t make a lovely, languid helix as popularly depicted. It’s scrunched up, bound with proteins that smoosh one meter of DNA into just one micrometer, a millionth of its size. DNA wound around proteins form a particle called a nucleosome.

Yahli Lorch, PhD, associate professor of structural biology, has studied nucleosomes since they were first discovered more than 20 years ago, as she mentions in the video above:

When I began working on the nucleosome, it was a largely neglected area since most people considered it just a packaging and nothing beyond that.

Since I discovered that it has a role and a very important role in the regulation of gene expression, the field has grown many fold and it’s one of the largest areas in biology now.

Many diseases have been linked to the packaging of DNA, including neurodegenerative diseases, autoimmune diseases and several types of cancer such as some pancreatic cancers. Enhancing the understanding of the basic biology of DNA folding is leading to new and improved treatments for these conditions, Lorch says.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: DNA origami: How our genomes fold, DNA architecture fascinates Stanford researcher — and dictates biological outcomes and More than shiny: Stanford’s new sculpture by Alyson Shotz

Cancer, Neuroscience, Pediatrics, Research, Stanford News, Videos

How one family’s generosity helped advance research on the deadliest childhood brain tumor

How one family’s generosity helped advance research on the deadliest childhood brain tumor

Back in February 2014, Libby and Tony Kranz found themselves at the center of every parent’s worst nightmare. Their six-year-old daughter Jennifer died just four months after being diagnosed with diffused intrinsic pontine glioma (DIPG), an incurable and fatal brain tumor. At the time, the Kranzes decided to generously donate their daughter’s brain to research in hopes that scientists could hopefully develop more effective treatments for DIPG, which affects 200-400 school-aged children in the United States annually and has a five-year survival rate of less than 1 percent.

As reported in the above Bay Area Proud segment, Michelle Monje, MD, PhD, an assistant professor of neurology and neurological sciences who sees patients at Lucile Packard Children’s Hospital Stanford, and colleagues harvested Jennifer’s tumor and successfully created a line of DIPG stem cells, one of only 16 in existence in the world. More from the story:

Using Jennifer’s stem cell lines and others, Monje and her team tested dozens of existing chemotherapy drugs to see if any were effective against DIPG. One appears to be working.

The drug was able to slow the growth of a DIPG tumor in a laboratory setting. Monje’s hope is that this treatment one day could extend the life of children diagnosed with DIPG by as many as six months.

That would have more than doubled Jennifer’s life expectancy.

“It’s a step in the right direction if we can effectively prolong life and prolong quality of life,” Monje said.

Libby Kranz says that for their family, donating their daughter’s tumor to researchers “just felt right.” She and Tony hope that by aiding the research efforts, parents and families will have more, and better quality time with their sick children.

“It’s incredible and it’s humbling,” she said, “to know my daughter is part of it, and that we’re part of it too.”

Previously: Existing drug shows early promise against deadly childhood brain tumor, Stanford brain tumor research featured on “Bay Area Proud,Emmy nod for film about Stanford brain tumor research – and the little boy who made it possible and Finding hope for rare pediatric brain tumor

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