Cancer

Stand-up comic Tig Notaro brought her unique brand of comedy to Stanford early this week, and she didn’t disappoint the standing-room-only audience of students, faculty, staff and community members gathered on campus.

Notaro, a fairly successful stand-up comic before 2012, exploded on the national scene when she greeted an audience at the Largo in Los Angeles with the words, “Thank you, thank you, I have cancer, thank you, I have cancer, really, thank you.” She then told the audience: “Tragedy plus time equals comedy. But I don’t have the benefit of time. So I’m just going to tell you the tragedy and know that everything is going to be okay.”

In that now legendary comedy set, Notaro went on to share the tragedy of her bi-lateral breast cancer diagnosis, the unexpected early death of her mother, and the ending of a romantic relationship: all within a four-month span. Well-known comedian Louis C.K. was in the audience that night, and he tweeted: “in 27 years doing this, I’ve seen a handful of truly great, masterful standup sets. One was Tig Notaro last night at Largo.”

During her Stanford performance, which was sponsored by the Stanford Storytelling Project, the Stanford Arts Institute and ITALIC, Notaro gave a hilarious impression of a TSA agent trying to pat her down in the front. Notaro chose not to have reconstructive surgery after her bi-lateral mastectomy, so the agent had a hard time deciding if Notaro was a man or a woman. Laughing, Notaro said, “I had small breasts before, and I would joke about them all the time… how small they were.” Pausing for a moment, she grinned and said, “You know, I think my breasts heard me and decided to get revenge.” Notaro’s statement, and the audience’s responding laughter, illustrated what Louis CK has said about her comedy: “It is an amazing example of what comedy can be. A way to visit your worst fears and laugh at them.”

In a Q&A session after her performance, Notaro said using comedy to deal with her cancer was a “godsend. I hadn’t planned to talk about it as part of my act, but it just came out.” And today, she says, she’s glad it did. “I get letters every day from people who have been diagnosed with cancer, or people who have lost a loved one to cancer. If my comedy can help just one person who has to travel the same journey I have traveled, it is worth it.”

Jacqueline Genovese is assistant director of the Arts, Medicine and Humanities Program within the Stanford Center for Biomedical Ethics.

Previously: Saying thank you with art: Stanford undergrad pens one-woman play on cancer
Photo courtesy of Tig Notaro

UPDATE: This entry has been corrected from a previous version, which incorrectly implied that these scans were used for cancer screening.

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Sometimes, getting a clear picture of the tumors in a newly-diagnosed cancer patient requires exposing the patient to potentially harmful ionizing radiation, which can be particularly harmful to young patients who are still growing. Now, researchers from Lucile Packard Children’s Hospital Stanford have developed a technique to scan for tumors that takes radiation out of the equation, lowering the young patients’ risk of later developing secondary tumors.

From our release:

The new method… is a modification of magnetic resonance imaging that employs a novel contrast agent to find tumors. The MRI-based method is as effective as cancer-detection scans that use ionizing radiation — specifically, positron emission tomography-computed tomography — the researchers found.

Although whole-body PET-CT technology provides essential information for detecting cancer, it has one big drawback: A single scan exposes the patient to as much radiation as 700 chest X-rays.

…

To find tumors via MRI, the Stanford team used a new contrast agent consisting of nanoparticles of iron. Injections of these iron nanoparticles are approved by the Food and Drug Administration to treat anemia, and the researchers obtained FDA permission for the experimental use. The nanoparticles are retained in the body for many days. On MRIs, they cause blood vessels to appear brighter, providing anatomic landmarks. The nanoparticles also cause healthy bone marrow, lymph nodes, liver and spleen to appear darker, making tumors stand out.

The images generated from the experimental MRIs provided comparable information to the PET-CT scans that study subjects received as part of their care. The PET-CTs detected 163 of 174 total tumors in the 22 patients; the MRIs found 158 of 174 tumors. The two methods had similar levels of sensitivity, specificity and diagnostic accuracy.

The method is described in a paper published today in The Lancet Oncology. “I’m excited about having an imaging test for cancer patients that requires zero radiation exposure,” senior author Heike Daldrup-Link, MD, associate professor of radiology at Stanford and a diagnostic radiologist at the hospital, told my colleague. “That is a big deal.”

Previously: Questioning whether physicians are equipped to care for childhood cancer survivors and Five days instead of five weeks: A less-invasive breast cancer therapy
Image by Jessica Donig

When it comes to encouraging teenagers to take measures to reduce their risk of skin cancer, new research suggests parents and health educators should emphasize how ultraviolet light causes wrinkles and other signs of premature aging.

In the study, researchers recruited high-school students and randomly assigned them to two groups. One set of participants watched a health-based video that highlighted skin-cancer risks, while the other group viewed a video focusing on the cosmetic changes due to ultraviolet light. Students completed questionnaires demonstrating their knowledge about ultraviolet light and use of sun-protective behaviors before and after watching the videos. According to a University of Colorado Cancer Center release:

… despite knowing the skin cancer risk from ultraviolet exposure, the group that had watched the health-based video showed no statistically significant increase in their sun-protective behaviors. On the other hand, the group that had been shown the appearance-based video reported a dramatic increase in the use of sunscreen.

“For teenagers, telling them [ultraviolet] exposure will lead to skin cancer is not as effective as we would hope. If our endgame is to modify their behavior, we need to tailor our message in the right way and in this case the right way is by highlighting consequences to appearance rather than health. It’s important to address now – if we can help them start this behavior when younger, it can affect skin cancer risk when older,” [says study co-author April Armstrong, MD.]

Previously: Beat the heat – and protect your skin from the sun, As summer heats up take steps to protect your skin, How ultraviolet radiation changes the protective functions of human skin, Medical experts question the safety of spray-on tanning products and The importance of sunscreen in preventing skin cancer
Photo by David van der Mark

When I was first diagnosed with a neuroendocrine pancreatic tumor I didn’t dwell on the fact that I had cancer. With three kids at home, I knew we needed to do all we could to beat the disease. I was 39 years old when I was diagnosed, I had always been healthy, and I knew that God was giving me signs that things were going to be OK. What I didn’t know was that He was giving me an opportunity to meet so many wonderful and caring people over the next eight years of my journey.

Like many others who are diagnosed, I had no signs or symptoms. My cancer was found completely by chance. I went into the emergency room, in a city we didn’t live in, with excruciating pain, and was told I had kidney stones. I was given pain medicine and told that the stones would pass. They never did. Instead, I ended up in another ER (in the city we had just moved to) with doctors doing a CT scan of my abdomen. They found an 8-cm mass on the head of the pancreas and told me to contact my primary care physician to schedule some more tests.

Shortly thereafter I heard those dreaded words, and through all of the tests, procedures and second opinions, I kept seeing signs that things were going to be all right. And so many gifted people were now in my life to help me through the diagnosis, surgery and recovery. The surgeon I had, confident and strong, yet so caring and compassionate. The young intern who sat with me at night and quizzed me on things so that he could present my case during rounds. Having a rare form of pancreatic cancer makes you something of a celebrity.

A few months after my Whipple procedure, I went to a symposium of the Pancreatic Cancer Action Network. It was at that forum that I knew what my next purpose was. I had lived through the frequent trips to the bathroom after meals, the not knowing if the twinges and aches I was now feeling were normal parts of the recovery or not, and the feelings of extreme fullness after having only eaten three bites of a meal, but I couldn’t live with the fact that no one knew much about this insidious disease and that research dedicated to pancreatic cancer lagged so far behind other major cancers. I got involved, and now I’m an advocate for others.

As time passes and the medical appointments get farther apart, I worry a little less. Knowing more about this disease has helped me become more confident in myself, my faith, and my ability to help others faced with the same word I once faced: “You have cancer.”

Tammy Andries is a volunteer and advocate for the Pancreatic Cancer Action Network.

A team of researchers at the National Cancer Institute have conducted the largest study to date assessing the relationship between non-steroidal anti-inflammatory drugs and ovarian cancer risk. Their findings show that taking aspirin daily may lower women’s risk of ovarian cancer; however researchers caution that more studies are needed before clinical recommendations can be made.

In the study, researchers examined a dozen previous epidemiological studies that included roughly 8,000 women diagnosed with ovarian cancer and nearly 12,000 women who did not have the disease. According to an NCI release:

The researchers determined that participants who reported daily aspirin use had a 20 percent lower risk of ovarian cancer than those who used aspirin less than once per week. For non-aspirin NSAIDs (non-steroidal anti-inflammatory drugs), which include a wide variety of drugs, the picture was less clear: the scientists observed a 10 percent lower ovarian cancer risk among women who used NSAIDs at least once per week compared with those who used NSAIDs less frequently. However, this finding did not fall in a range that was significant statistically. In contrast to the findings for aspirin and NSAIDs, use of acetaminophen, which is not an anti-inflammatory agent, was not associated with reduced ovarian cancer risk.

This study comes on the heels of Stanford research showing that aspirin use appears to cut the risk of another type of cancer (melanoma) in women.

Previously: Can repackaging aspirin get more people to take it daily for prevention? and New research shows aspirin may cut melanoma risk
Photo by Chaval Brasil

When the first vaccines were introduced against the human papillomavirus, some people worried that this anti-cancer vaccine would give young women the wrong idea. The vaccines, which protect against common cancer-causing strains of HPV, don’t guard against other sexually transmitted infections or unwanted pregnancies. But some parents and physicians thought that vaccine recipients might forgo condoms more often, have more sexual partners or otherwise engage in riskier sexual behaviors than women who were not vaccinated.

However, a study published today in Pediatrics says that’s not the case. According to the new research, young women don’t change their sexual behaviors after receiving the HPV vaccine. The researchers asked more than 300 girls and women, aged 13 to 21, about their risk perception and their sexual behaviors when they received their first dose of the HPV vaccine. They followed the group over time, repeating the questions 2 and 6 months later, when the vaccine’s booster shots were delivered.

“Most participants in this study did not perceive that they had a lower risk for STIs other than HPV, and most believed that safer sexual behaviors were still important,” the study’s authors wrote. Later, they add, “These findings contribute to the growing literature suggesting that HPV vaccination is unlikely to alter sexual risk behaviors in young women.”

I asked Stanford’s Sophia Yen, MD, for her take on the results. Yen provides HPV vaccinations in her role as an adolescent medicine specialist at the Teen and Young Adult Clinic at Lucile Packard Children’s Hospital Stanford. “The findings are not surprising and re-emphasize what other studies have shown,” she told me, adding that she hopes the study will be repeated in males, since boys have now begun receiving the HPV vaccine, too.

In the meantime, Yen plans to continue using this and other scientific evidence to reassure parents about the value of the vaccine. “I hope that the findings of this study and its many other predecessors will become widely known to parents and other non-adolescent medicine specialists who see adolescents, and to policymakers,” she said. “Let’s prevent STDs and cervical cancer together.”

Previously: Study shows racial disparities in HPV vaccination, Packard Children’s adolescent and young-adult specialist offers tips for college-bound students, HPV-associated cancers are rising, HPV vaccination rates still too low, new national report says and Only one-third of teenage girls get HPV vaccine to prevent cervical cancer
Photo by wintersoul1

Curing cancer isn’t cheap; developing new drugs comes with a multimillion-dollar price tag. Plus, there’s the rigmarole of animal testing, IRB reviews, FDA approval, and so on. What if you could just skip all of that, and get the drug to patients directly and at a lower price than an existing treatment option? You could, if you can successfully recycle a drug that’s already on the shelves at the pharmacy.

A few years ago, Stanford researchers led by Philip Beachy, PhD, got an inkling that a pink-and-blue capsule that removes unsightly toenail fungi also has a secret superpower: It might be able to treat skin cancer. The first set of clinical trials testing the effect of the oral pill, itraconazole, on skin cancer is the focus of a new study published online today.

Led by Stanford dermatologist and senior author Jean Tang, MD, PhD, the study shows proof of itraconazole’s ability to reduce tumor size and spread in patients with basal cell carcinoma, the most common type of skin cancer.

“We are shortcutting the [drug development] process,” says Tang, “by using a drug that’s already been around for 25 years and given to tens of thousands of people.”

From our press release on the study:

Itraconazole, which is prescribed for common fungal infections, kills fungal cells by blocking the production of a vital membrane component. In cancer cells, the drug appears to disable the Hedgehog signaling pathway — a cascade of cellular events triggered by the Hedgehog protein signal that is vital to cell growth and development.

Oral drugs for basal cell carcinoma are rare. These tumors are usually treated through radiation or cut out surgically. But surgery on advanced stage tumors may not always be effective and can greatly scar and disfigure patients.

Tang tested the drug itraconazole on 29 patients with a total of 101 tumors and found that it both blocked the Hedgehog pathway and reduced tumor size at the normally-prescribed anti-fungal dosage. As I describe in the release:

Patients were given itraconazole pills twice a day for a month. Another small group was given a lower dosage of itraconazole for a longer duration (an average of 10 weeks). In the first group, the drug reduced Hedgehog pathway activity by an average of 65 percent and tumor size by 24 percent. Patients in the second group, with lower itraconazole doses, showed similar reductions in tumor size.

And the best part? This medication is several times cheaper than vismodegib, the current and only go-to oral drug for basal cell carcinoma ($20 versus vismodegib’s $250 per day). It can also potentially treat tumors that are immune to vismodegib and other Hedgehog-pathway-blocking cancer drugs, says Beachy.

Ranjini Raghunath is a writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: New skin cancer target identified by Stanford researchers, Funding basic science leads to clinical discoveries, eventually, Studies show new drug may treat and prevent basal cell carcinoma and Common drug might help prevent skin cancers
Photo by Worak

For many cancers of the stomach and intestinal tract, removing the tumor is the best way of treating a patient. The problem is that the cancerous cells don’t necessarily look any different from the normal cells. I wrote recently about a new technique to pick out those cancerous cells and help surgeons completely remove the tumor.

What’s fun about this story is that the idea started with a chemist, Livia Eberlin, PhD, who’s a post-doc in lab of chemistry professor Richard Zare, PhD. Zare is a member of Stanford’s Bio-X and from that has experience working with colleagues across campus. He suggested to Eberlin that she find a surgeon who would be willing to collaborate with her and test her approach to identifying the cancerous cells.

Eberlin knew that surgeons rely on pathologists during a surgery to help them figure out if they’ve removed the entire tumor, but the initial results aren’t always accurate. In some cases, pathologists find out days later, when results of a slower, more accurate test are complete, that the patient might need to come back for another surgery to remove more tissue.

Eberlin called up surgeon George Poultsides, MD, to see if he’d like to collaborate on her idea. As I wrote in my piece:

Eberlin’s expertise is in mass spectrometry, a tool not commonly used in a hospital setting. It takes a sample in one end, turns the molecules into charged particles, then detects how long it takes each charged molecule in that sample to migrate down a vacuum tube. The result is a jagged mountain range of tens of thousands of peaks, each representing a single chemical in the sample. The height of the peak indicates how much of that chemical the sample contained.

The idea was that maybe some of those peaks would be different in tissue samples that had cancerous cells versus those that didn’t. If it worked, this mass spectrometry approach might end up being more accurate than the approach being used now.

It took a team of statisticians, pathologists, surgeons and chemists to develop and test Eberlin’s idea. In the end, their approach seemed to be more accurate than what’s being used now. They are going to try their approach on a larger group of stomach cancers and in other cancers to see if it can help improve the odds of completely removing all cancerous cells during surgery.

Previously: Good-bye cancer, good-bye stomach: A survivor shares her tale
Photo – of Livia Eberlin, PhD, at a mass spectrometer used to identify cancerous cells in tissue samples – by L.A. Cicero

In a New York Times SundayReview piece, Paul Kalanithi, MD, a chief resident in neurological surgery at Stanford, describes cancer prognoses from two perspectives, both his own. The 36-year-old doctor writes about reading scans to help colleagues decide if surgery is the right course of treatment for certain brain-cancer cases. He details the important and difficult job of facing patients who ask questions about their chance of survival. Kalanithi also reveals what he learned about the question and answer processes since he was diagnosed with cancer eight months ago, and how he’s learned to live with conviction despite a prognosis of uncertainty.

From the piece:

For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens: Nothing could be more obvious when your day’s work includes treating head trauma and brain cancer.

But on my first visit with my oncologist, she mentioned my going back to work someday. Wasn’t I a ghost? No. But then how long did I have? Silence.
…

The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me just one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”

Previously: Both a doctor and a patient: Stanford physician talks about his hemophilia, A patient’s journey with lung cancer, Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford study, Red Sunshine: One doctor’s journey surviving stage 3 breast cancer, Cancer survivor: The disease isn’t a “one-off, one-shot deal” and When the journalist becomes the patient

These days, most people say “thank you” with a quick e-mail or text. If they’re really grateful they may (gasp!) hand write a note. Stanford senior Camille Brown wrote a one-woman play.

Brown is a science, technology and society major and has penned and performed “Seeing the Spectrum,” a series of intimate monologues telling the story of Camp Kesem at Stanford – a summer camp for the children of cancer patients – from the campers’ perspective. Brown has volunteered with the student-run camp for her entire college career, and during that time she has counseled, hugged, face-painted and sat quietly with countless children facing the reality of a parent with cancer.

It’s a reality Brown knows all too well. The day she graduated high school her family learned of her mother’s diagnosis with Stage 3 colon cancer. Brown’s entire Stanford experience has been colored by cancer and, remarkably, she’s focused on her gratitude. Not for the cancer, of course, but for her Camp Kesem community, from which she says she’s received far more than she’s given.

So, as she approaches her final year of camp (only undergrads can be counselors) she created “Seeing the Spectrum,” with support from a Spark! grant from the Stanford Arts Institute, as her unique and lasting expression of appreciation.

I sat down with Camille Brown on the morning before her first performance – a very special private show for Camp Kesem counselors, campers and families. Here is part of our conversation.

Tell me about your play.

“Seeing the Spectrum” is a collection of eight monologues based on interviews I conducted with 15 Camp Kesem campers about their experiences with their parent’s cancer and with camp. Each monologue is fictionalized to preserve anonymity, and some are composites of two or more interviews.

The idea is to help people outside the program understand the enormous impact that Camp Kesem has on the lives of the campers and their families. For these children it is very important that they have a week that is more than bereavement counseling, but rather is a week of friends, water fights and silliness, because they are going through situations that essentially don’t let them be kids anymore. And Kesem is more than just the week of camp; these kids gain a year-round community.

What inspired you to create it?

I work at the Stanford Humanities Center and they assigned me to write an article about Anna Deavere Smith’s 2012 guest lecture on grace. She explained her process of basing her monologues on interviews. She picks a topic and then talks to a number of people to get multiple perspectives. While working on the article it occurred to me that Camp Kesem would make a great subject.

What has working with Camp Kesem meant to you?

I was initially terrified to do it, because I worried that if I became involved as a counselor I would be projecting my feelings about cancer onto the campers, and it would be a horrible experience for everyone. But in fact, the more work I have done with camp, the more I have just been able to fall in love with the kids and feel that I am combating this frustrating force of cancer in my life by helping to give them a chance to handle it. I actually feel a little bit selfish because the kids are like my therapy. They are so resilient – some going through situations worse than my own – and I feel that I have been able to learn more about myself by trying to be selfless for them.

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