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Cancer, Neuroscience, Stanford News, Technology, Videos

Stanford celebrates 20th anniversary of the CyberKnife

Stanford celebrates 20th anniversary of the CyberKnife

Just about 30 years ago, Stanford neurosurgeon John Adler, MD, traveled to the Karolinksa Institute in Sweden, home to Lars Leksell, MD, and a device Leksell had invented called the Gamma Knife. Leksell had long been a visionary figure in neurosurgery, and Adler – inspired by the device that enables non-invasive brain surgery – began to imagine a next step, driven by the addition of computer technology.

Coming up with an idea, of course, can happen in a matter of minutes. Adler had no idea that it would take 18 years before his next step, the CyberKnife, would treat its first patient. Stanford Hospital was the first to own a CyberKnife, and Adler unhesitatingly admits that without the agreement of hospital administrators to purchase that very first device – designed to treat tumors, brain and spine conditions, as well as cancers of the pancreas, prostate, liver and lungs – its development would not have been completed.

This year, Adler and his Stanford colleagues are celebrating the 20th anniversary of the CyberKnife. Stanford has two, one of just a handful of medical centers with that distinction, and it has accumulated the longest and largest history of patient care with the device. To honor Adler and those Stanford physicians who continue to explore its ever-lengthening list of applications to patient care, a new video featuring Adler was created. It’s a quick glimpse of the determination – and luck – required to make that leap from inspired idea to groundbreaking therapy.

Previously: CyberKnife: From promising technique to proven tumor treatment

Cancer, Infectious Disease, Pediatrics, Research, Stanford News

Summer’s child: Stanford researchers use season of birth to estimate cancer risk

Summer’s child: Stanford researchers use season of birth to estimate cancer risk

Four_seasons

One of the hardest parts of unraveling childhood cancers is understanding what causes them. In recent years, evidence has been mounting that cancer and many other chronic diseases begin early in life – and perhaps even in utero. To untangle some of these early causes of cancer in children and young adults, Stanford epidemiologist and family physician Casey Crump, MD, PhD, is partnering with researchers at Lund University in Sweden, a working relationship was set up by Marilyn Winkleby, PhD, MPH, professor emeritus of medicine here. The team is using Sweden’s national registries for birth certificates and medical records to track how factors during gestation and soon after birth – called perinatal factors – affect cancer risks.

Because Sweden has a national health care system, it’s relatively easy to track the course of illness in individuals. By comparison, the U.S.’s health care system is fragmented across dozens of health care providers and insurers, so getting medical records for a single person that might span decades is a much more difficult prospect.

Crump’s team is focusing on cancers that are common in childhood and early adulthood: brain tumors, leukemia and lymphoma among them. Two papers published earlier this year examine how the time of year a child is born affects cancer risk. The most recent, published ahead of print in April in the International Journal of Cancer, examined whether the season of birth was linked to the risk of developing either Hodgkin’s lymphoma or non-Hodgkin’s lymphoma later in life. Crump explained:

Lymphomas are among the most common cancers in childhood but the causes are still largely unknown. It’s been hypothesized that infectious exposures, such as Epstein Barr virus and others may play an important role, but it’s still unclear what the critical age window of susceptibility might be. We had an opportunity to use season of birth from birth records as a proxy for infectious exposures in the first few months of life, and see the relationship between that and subsequent risk of Hodgkin’s and non-Hodgkin’s lymphoma – following these people from birth through childhood and on into young adulthood.

The researchers found that children born in spring or summer had a higher risk of developing non-Hodgkin’s lymphoma later in life compared to kids born in winter. The team didn’t find any similar seasonal pattern for risk of Hodgkin’s lymphoma. The results lend additional support to the “delayed exposure hypothesis.” Children born in spring or summer may not be exposed to critical pathogens during a critical early period of immune system development, leaving them vulnerable later in life. Children born in the fall or winter, by comparison, do get that important exposure at just the right time. Crump was quick to note that season of birth provides only a rough estimate of these exposures, since the team didn’t have accurate measures of exposures to Epstein Barr or other viruses, but he also added that these results “shed additional light on possible pathways of risk that may contribute to the development of non-Hodgkin’s lymphoma.”

A similar study published in January in the International Journal of Epidemiology found that children born in spring and summer had a higher chance of developing melanoma later in childhood or early adulthood. The team hypothesized that spring and summer babies are exposed to more UV radiation in warm summer months in the first few months of life – an exposure that fall and winter babies are less likely to have.

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Cancer, Genetics, Stanford News, Videos, Women's Health

Despite genetic advances, detection still key in breast cancer

Despite genetic advances, detection still key in breast cancer

Just a few years before the launch of the first national breast cancer awareness month, I found a small lump in my left breast. I still remember the cold chill that ran through me – and stayed with me until several days later when a surgeon discovered that the lump was not a tumor. His parting words have never left me: “Remember how you’ve been feeling.” He wanted to make sure I would go on to have regular mammograms.

Spreading the word about the disease and the importance of detecting it in its early stages was – and is – the point of the national awareness campaign. In the almost 30 years since that first campaign, advances in imaging technology have enabled earlier detection of breast cancer, genome sequencing has identified some of the mysteries behind the development risk, and selecting the most effective surgery and chemotherapy is more and more of an individualized choice.

Stanford has a powerful team of physicians addressing all aspects of breast cancer science and care. On Oct. 16, breast-imaging specialist Jafi Lipson, MD, assistant professor of radiology, and breast cancer surgeon Amanda Wheeler, MD, clinical assistant professor of surgery, will give a free lecture, “The Latest Advancements in Screening and Treatment for Breast Cancer,” at the Sheraton Palo Alto. And throughout the month, Stanford Health Care will post short educational videos and infographics on a variety of breast-cancer topics, including types of breast cancer, options in surgical reconstruction, and why enduring the pain of compression in mammography is worth the effort. Today, Stanford Health Care kicks off the month with a video featuring Stanford breast cancer expert Alison Kurian, MD, explaining the role that genetics play in disease development (above).

Because one in eight women will develop breast cancer in her lifetime, I would urge all of us to keep in mind the reality of this disease – and to honor those we know who have survived, or not, by paying attention.

Previously: NIH Director highlights Stanford research on breast cancer surgery choicesBreast cancer patients are getting more bilateral mastectomies —  but not any survival benefitBreast cancer awareness: Beneath the pink packaging and At Stanford event, cancer advocate Susan Love talks about “a future with no breast cancer”

Cancer, Clinical Trials, In the News, NIH, Patient Care, Research

National Cancer Institute looking for "Exceptional Responders"

OLYMPUS DIGITAL CAMERAHope is a powerful force in cancer treatment. For patients and their families, the hope is that, no matter how unlikely, the treatment plan will cure the patient and eradicate the disease. Sadly, this is sometimes a long shot. But sometimes, against all odds, the therapy is unusually successful. Now the National Cancer Institute is trying to learn why.

This week the institute launched a study into the phenomena of “Exceptional Responders” – that is, cancer patients who have a unique response to treatments (primarily chemotherapy) that have not been effective for most other patients. As they describe in a Q&A about the effort:

For this initiative, exceptional responders will be identified among patients enrolled in early-phase clinical trials in which fewer than 10 percent of the patients responded to the treatments being studied; patients who were treated with drugs not found to be generally effective for their disease; patients who were treated in later-phase clinical trials of single agents or combinations; and even patients who were treated with established therapies. In this pilot study, malignant tissue (and normal tissue, when possible) and clinical data will be obtained from a group of exceptional responders and analyzed in detail. The goal is to determine whether certain molecular features of the malignant tissue can predict responses to the same or similar drugs.

The researchers would like to obtain tumor samples, as well as normal tissue, from about 100 exceptional responders. They’ll compare DNA sequences and RNA transcript levels and other molecular measurements to try to understand why these patients were such outliers in their response to treatment. In at least one previous case, an exceptional responder with bladder cancer led researchers to discover a new molecular pathway involved in the development of the disease, and suggested new therapeutic approaches for other similar patients.

Do you know someone who might qualify for the study? More from the Q&A:

Patients who believe they may be exceptional responders should contact their physicians or clinical trialists to see if they can assist in submitting tissue for consideration. […] Investigators who have tissue from a potential exceptional responder should send an email to NCIExceptionalResponders@mail.nih.gov. The email should include a short description of the case, without patient identifiers; information about whether tissue collected before the exceptional response is available; whether informed consent was given to use tissue for research; and the patient’s vital status.

Photo by pol sifter

Cancer, Global Health, Health Policy, Infectious Disease, Public Health

Treating an infection to prevent a cancer: H. pylori and stomach cancer

Treating an infection to prevent a cancer: H. pylori and stomach cancer

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The number of newly diagnosed stomach cancer cases in the United States is less than a tenth of the number of prostate cancer cases or breast cancer cases, which may be part of the reason it doesn’t get the same attention as breast and prostate cancer. But the mortality rate is much higher for stomach (or gastric) cancer. Nearly 11,000 Americans will likely die from gastric cancer this year, with only 28 percent of cases surviving five years or more. For comparison, the five-year survival rate for prostate cancer is nearly 99 percent and for breast cancer, it’s more than 89 percent.

On a global scale, an estimated 700,000 people will die from gastric cancer this year, as Stanford infectious disease specialist Julie Parsonnet, MD, and her co-authors note in a Viewpoint piece in the most recent issue of the Journal of the American Medical Association. The authors also point out that worldwide, about 77 percent of gastric cancer cases are linked to chronic infections of Helicobacter pylori, a helix-shaped bacteria that was identified in the early 1980s and found to be linked to gastric ulcers a few years later, as well as to gastritis, an inflammation of the stomach lining that is a precursor to stomach cancer.

Researchers are still trying to understand exactly how H. pylori causes cancer or even how it colonizes the gastrointestinal track – they believe it’s picked up via food or water. Until recently, there was a dearth of randomized clinical trials that looked at the effectiveness of screening and treatment for H. pylori as a method for preventing stomach cancer.

Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy

In the opinion piece, the authors describe the recommendations of a working group that met in December 2013 at the behest of the International Agency for Research on Cancer. Taking the burden of the disease and the availability of treatment options in consideration, the group considered gastric cancer “a logical target for intervention,” according to the authors of the JAMA piece. They go on to write:

Screening and treatment for H pylori is generally acceptable and affordable. An inexpensive serological test can determine who may be infected, with a sensitivity and specificity that could be sufficient for population-based prevention programs. Low-cost treatment regimens using 2 or 3 generic antibiotics plus a proton pump inhibitor for 7 to 14 days can eradicate the infection in more than 80% of cases, depending on the antibiotic resistance patterns of H pylori within the population. Economic modeling studies indicate that H pylori screening and treatment strategies are cost-effective under a large range of assumptions about effectiveness and costs. However, the models are limited by reliance on observational data rather than randomized trial results, by a lack of information on possible adverse effects of treatment, and by limited data from lower-income countries.

Researchers still have many gaps in their understanding of the best methods to prevent stomach cancer, but several trials may answer some of those questions in the coming decade.

Stomach cancer is not the only cancer known to be linked with an infection. Doctors routinely test whether women who come in for a PAP smear are infected with the human papilloma virus (HPV), which is linked to cervical cancer. Chronic hepatitis B and C infections are known to be linked to liver cancer. In time, screening for H. pylori to prevent stomach cancer may become routine. Until then, Parsonnet and her coauthors say in their conclusion, “Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy.”

Previously: Researchers identify potential drug target in ulcer bug that infects half the world’s population, Good-bye cancer, good-bye stomach: A survivor shares her tale and Image of the Week: Helicobacter pylori colonizing the stomach
Photo by Shuman Tan and Lydia-Marie Joubert

Applied Biotechnology, Bioengineering, Cancer, Research, Stanford News

New "decoy" protein blocks cancer from spreading

New "decoy" protein blocks cancer from spreading

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Cancer becomes most deadly when it’s on the move – jumping from the breast to the brain or the pancreas to the liver and then onward.

But now, a team of Stanford researchers led by radiation biologist Amato Giaccia, PhD, and bioengineer Jennifer Cochran, PhD, have created a protein that may be able to thwart the metastasis.

They published their results this week in Nature Chemical Biology.

“This is a very promising therapy that appears to be effective and nontoxic in preclinical experiments,” Giaccia said in a Stanford release. “It could open up a new approach to cancer treatment.”

The researchers created a protein that mimics Axl, a protein found on the surface of cancer cells. This decoy protein intercepts incoming messages – intended for the original Axl – cueing the cancer cells to find a new home.

The decoy Axl worked wonders in mice. Mice with breast cancer given the treatment had 78 percent fewer new tumors, and mice with ovarian cancer had 90 percent fewer new tumors than mice with cancer not given the treatment.

Becky Bach is a former park ranger who now spends her time writing about science or practicing yoga. She’s a science-writing intern in the Office of Communications and Public Affairs.

Previously: Studying the drivers of metastasis to combat cancer, A computer kit could lead to a better way to design synthetic molecules, Common drug class targets breast cancer stem cells, may benefit more patients, says study
Photo by Rod Searcey

Cancer, Health and Fitness, Research

Exercise may boost effectiveness of chemotherapy

Exercise may boost effectiveness of chemotherapy

running_092214Staying physically active during chemotherapy treatment can benefit patients’ physical and mental health. But findings from an animal study show that exercising may also help reduce the size of tumors.

As reported by Futurity, University of Pennsylvania researcher Joseph Libonati, PhD, and colleagues originally set out to test whether adding a fitness regimen to chemotherapy would offset cardiac damage related to the drug doxorubicin. While the team failed to find any significant evidence that exercise provided protection against negative cardiac side-effects, they did find that mice that exercised while receiving chemotherapy had notably smaller tumors than those that had chemotherapy alone. From the article:

Further studies will investigate exactly how exercise enhances the effect of doxorubicin, but the researchers believe it could be in part because exercise increases blood flow to the tumor, bringing with it more of the drug in the bloodstream.

“If exercise helps in this way, you could potentially use a smaller dose of the drug and get fewer side effects,” Libonati says. Gaining a clearer understanding of the many ways that exercise affects various systems of the body could also pave the way for developing drugs that mimic the effects of exercise.

“People don’t take a drug and then sit down all day,” he says. “Something as simple as moving affects how drugs are metabolized. We’re only just beginning to understand the complexities.”

Previously: Stanford preventive-medicine expert: Lay off the meat, get out the sneaks, From leukemia survivor to top junior golfer, Examining exercise and cancer survivorship and Study shows benefits of exercise for patients with chronic health conditions
Photo by MilitaryHealth

Cancer, Stanford News

Stanford Cancer Institute offers latest in cancer news, 140 characters at a time

Stanford Cancer Institute offers latest in cancer news, 140 characters at a time

Untitled-3 copyThe American Cancer Society’s 2014 annual report states that more than 1.6 million people in the U.S. will be diagnosed with cancer in the coming year. In response to this reality, many people try to arm themselves with as much information as possible about how to prevent, detect and/or treat the disease.

The Stanford Cancer Institute is committed to making cancer news and information more accessible and recently launched a new Twitter feed – @StanfordCancer – that delivers the latest developments in cancer research and clinical care from Stanford and around the world.

Combined with the Campaign for Stanford Medicine’s Transforming Cancer Care initiative, the Stanford Cancer Institute’s foray into social media is just one of Stanford Medicine’s many efforts to raise awareness about all the innovation scientists and physicians are pouring into disease detection, prevention and treatment.

Kylie Gordon works on the digital media team at Stanford University Communications. She received her undergraduate degree from Stanford in Modern Thought and Literature and has a graduate degree in Creative Writing from Northwestern University.

Biomed Bites, Cancer, Research

Discover the rhythms of life with a Stanford biologist

Discover the rhythms of life with a Stanford biologist

This is the second installment of our Biomed Bites series, a weekly feature that highlights some of Stanford’s most compelling research and introduces readers to innovative scientists from a variety of disciplines. 

What do giant bamboo plants — which flower once every 64 years — and cancer cells have in common? Both are governed by a biological cycle that Stanford professor James Ferrell, MD, PhD, is working to decipher. “We’re trying to figure out how these clocks work,” Ferrell says in the video above.

Ferrell says he has to use many tools familiar to physicists who work commonly with oscillations, although he studies living organisms as part of the burgeoning field of chronobiology.

Humans are governed by a network of closely rhythms, Ferrell explains:

We are intrinsically rhythmic organisms. We are a different person in the morning from the person we are in the evening. This might have profound consequences in terms of the proper way to treat disease.

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

Becky Bach is a former park ranger who now spends her time writing or on her yoga mat. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Studying the drivers of metastasis to combat cancer, Why sleeping in on the weekends may not be beneficial to your health, The key to speed? Inside the cell, it’s trigger waves 
Photo in featured entry box by Breezy Baldwin

Cancer, In the News, NIH, Research, Stanford News, Women's Health

NIH Director highlights Stanford research on breast cancer surgery choices

NIH Director highlights Stanford research on breast cancer surgery choices

The director of the NIH, Francis Collins, MD, this morning weighed in on a topic that has garnered much attention lately: the type of surgery that women diagnosed with breast cancer choose. The post, found at the NIH Director’s blog, describes a recent study by Stanford researchers published earlier this month in the Journal of the American Medical Association that examined survival rates after three different types of breast cancer surgery for women diagnosed with cancer in one breast: a lumpectomy (removal of the just the affected tissue, usually followed by radiation therapy), a single mastectomy (removal of the whole affected breast), and double mastectomy (removal of the unaffected breast along with the affected one.)

In a previous post we wrote in detail about the study and the finding that the number of double mastectomies in California have increased dramatically. However, except for women with the BRCA1 or BRCA2 genes, the procedure does not appear to improve survival rates for women who undergo the surgery compared with women who choose other types of breast surgery. Collins notes:

It isn’t clear exactly what prompted this upsurge in double mastectomy, which is more expensive, risky, and prone to complications than other two surgical approaches. But [researchers] Kurian and Gomez suggest that when faced with a potentially life-threatening diagnosis of cancer in one breast—and fears about possibly developing cancer in the other—women may assume that the most aggressive surgery is the best. The researchers also said it’s also possible that new plastic surgery techniques that achieve breast symmetry through bilateral reconstruction may make double mastectomy more appealing to some women.

Despite its recent upsurge in popularity, the study found double mastectomy conferred no survival advantage over the less aggressive approach of lumpectomy followed by radiation.

Collins also points out that the slightly worse survival rates of women who undergo single mastectomies probably reflect the fact that poorer women were more likely to have this surgery and is evidence of yet another health disparity linked to economic status.

Previously: Breast cancer patients are getting more bilateral mastectomies – but not any survival benefit

Stanford Medicine Resources: