Kristy Martin: Atypical Presentation of Acute Myeloid Leukemia
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M E M O R I A L H E R M A N N
S P R I N G 2 0 21
SURVIVORSHIP
Kristy Martin: Atypical Presentation of Acute
Myeloid Leukemia
On March 5, 2020, Kristy Martin woke
up to find her legs weren’t working cor-
rectly. The 46-year-old mother of four
was scheduled to see her primary care
physician for a follow-up appointment
for back pain that day. “Since I couldn’t
drive, I called an Uber car to take me to
my appointment,” she says. “I didn’t
think it was urgent.”
When Martin arrived at the offices
of primary care physician Douglas Tsu-
chida, MD, on the campus of Memo-
rial Hermann Memorial City Medical
Center and explained what she was
experiencing, Dr. Tsuchida wheeled
her directly into the hospital’s Emer-
gency Center. Pictured, from left to right: Adan Rios, MD; Kristy Martin; Michelle Schulhauser, RN; and Jay-Jinguang Zhu, MD, PhD.
There, an MRI revealed a large mass
in the region of her lower spine. In of the most advanced neuroscience Describing Martin’s diagnosis, Dr.
the operating room, a team of neuro- centers in Houston, where where she Rios says, “The presence of leukemic
surgeons, led by affiliated UTHealth began receiving inpatient occupational tissue outside the bone marrow oc-
Neurosciences neurosurgeon Spiros and physical therapy under the care of curs in about 3 percent to 9 percent of
Blackburn, MD, associate professor neuro-oncologist Jay-Jinguang Zhu, patients with acute myeloid leukemia.
in the Vivian L. Smith Department of MD, PhD, professor in the Vivian L. It can occur in the skin or in any organ.
Neurosurgery at McGovern Medical Smith Department of Neurosurgery at In her case, it occurred as a very large
School at The University of Texas Health McGovern Medical School. mass that compressed her spinal cord
Science Center at Houston (UTHealth), “That was where my story took a on the right side from the level of the
removed the tumor (as much as could turn,” says Martin. thoracic vertebral body eight (T8) down
safely be removed without causing The pathology laboratory results indi- to the lumbar vertebral body L1 in the
further damage to the spinal cord). In cated the tumor was a myeloid sarcoma, lumbo-sacral region, extending into the
addition, the team performed a laminec- acute leukemia outside the bone marrow. anterior portion of her abdomen.”
tomy, a surgical procedure to ease the Given the diagnosis was not a neurologi- Dr. Rios, who Martin describes as a
pressure on her spinal cord and nerve cal tumor but rather an unusual form Atypical Presentation continues on page 2
roots that was causing her pain and her of acute leukemia, Dr. Zhu brought in
inability to walk. Tumor samples were Adan Rios, MD, professor in the Divi-
sent to a pathology lab for analysis. sion of Oncology at McGovern Medical
Martin was transferred to the School, whose special interests include
Neuroscience Center at Memorial hematological malignancies (leukemia,
Hermann Southwest Hospital, one lymphoma and multiple myeloma).
Atypical Presentation continued from page 1 see my kids and the rest of my family,” IN THIS ISSUE
“collaborative genius,” consulted with she says. “But the nurses and chaplains SURVIVORSHIP 1-6
colleagues across multiple disciplines really helped lift my spirits. They helped Kristy Martin: Atypical Presentation of
to create a care plan for Martin. In me video chat with my family and even Acute Myeloid Leukemia
tandem, plans were made to initiate shared their own stories with me.” Young Dad Beats Colon Cancer,
dose-intensive inpatient chemotherapy Martin was discharged from the hospital Welcomes Second Child
at Memorial Hermann-Texas Medical on June 5, 92 days after arriving via Uber Drama Therapy: Empowering Cancer
Center and to initiate a rehabilitation car at her primary care physician’s office Thrivers to Grow and Heal
program at TIRR Memorial Hermann in for her follow-up visit. Throughout her Exercise May Increase Cancer Survival
the Texas Medical Center. journey, she was cared for by over a dozen A NOTE FROM LEADERSHIP 7
“In injuries of the spinal cord, the UTHealth and Memorial Hermann affili- EXCELLENCE IN CANCER CARE 8-12
immediate restoration of function and ated specialists—emergency physicians, Natalie Davis: Surprise Colon Cancer
rehabilitation are essential for recovery surgeons, neurologists, hematologists, Diagnosis
of these patients,” says Dr. Rios. “Even oncologists, radiologists and neuroreha- What You Need to Know About
when she was at TIRR, she was getting bilitation specialists—plus a host of physical Breast Cancer: Experts Weigh In
her chemo treatment. There aren’t and occupational therapists, nurses, social Breast Cancer Prevention and
Survivorship: A Family’s Story
many institutions where this type of workers, chaplains, home health providers
Ahmed Samara: Back on the Road
dose-intensive chemotherapy and multi- and others, who worked in concert to
After Metastatic Melanoma
disciplinary team are available.” ensure the best possible outcome.
USPSTF Updates Lung Cancer
Martin’s care plan would eventually Martin has regained some use of her Screening Recommendations
include radiotherapy, provided by radia- legs, although she’s mostly wheelchair
ADVANCES IN CANCER TREATMENT 13-16
tion oncologist Mark Amsbaugh, MD, dependent. But that’s not holding her
Oncologic Emergencies: Improving Patient
assistant professor of neurosurgery at back. She recently relearned to drive a Care Through Enhanced Collaboration
McGovern Medical School and medical car using hand controls. (“It’s so cool to Dale Thornton: Thriving After Robotic
director of radiation oncology at Memo- be on the road again!”) A self-described Rectal Cancer Surgery
rial Herman-TMC, and oral chemother- “good home chef,” she’s relearning to Transoral Robotic Surgery Speeds
apy maintenance treatment, prescribed chop at a different angle. Throat Cancer Patient Recovery
by Dr. Rios to prevent recurrence. “My whole life changed. Every- Karen Echols: The Warning Signs Were There
As if Martin’s medical challenges thing changed,” she says. “But it has ON THE PODIUM 16-17
weren’t enough, just as she was diag- been such a positive journey. It made Memorial Hermann Oncology Certified
nosed, the COVID-19 pandemic hit, and me realize what’s important and Nursing (OCN) Review a (Virtual) Success
hospital visitation restrictions were put what’s not. Everyone worked together. Reducing Preventable Emergency Center
in place. “It was hard because I couldn’t It all worked out.” g Visits by Chemotherapy Patients
Changing the Way We Work—
With Surprisingly Positive Results
BEFORE AFTER
RESEARCH 18-27
Ongoing Clinical Trials
VOLUNTEER SPOTLIGHT 28
Peyton Welch Tells His Story and Helps
Others Tell Theirs
COMMUNITY OUTREACH 29-33
Memorial Hermann Delivers ‘A Shot of Hope’
Preparing for the Inevitable:
Advance Care Planning
Return to Wellness: Prioritizing Cancer
Screening During a Pandemic
Memorial Hermann Distributes Colon
Cancer Screening Kits
In the Pink Distributes $450,000 to Local
Organizations Fighting Cancer
PET CT reveals a very large myelosarcoma mass PET CT shows complete resolution of the mass
compressing the patient’s spinal cord on the her following treatment.
MEMORIAL HERMANN WELCOMES 34
right side, from the level of the thoracic vertebral ABOUT MEMORIAL HERMANN 35
body eight (T8) down to the lumbar vertebral body
L1 in the lumbo-sacral region, extending into the CANCER CARE
anterior portion of her abdomen.
2 MEMORIAL HERMANN CANCER JOURNAL
Young Dad Beats Colon Cancer, Welcomes Second Child In 2017, Daniel Begnaud’s world as more important than ever. he knew it came crashing down when In July 2018, his prayers were he was diagnosed with stage IV colon answered when scans showed the cancer at the age of 30. A father of a chemo had worked and he was a 1-year-old son, he was initially told candidate for surgery. His 13-hour that it was unlikely he would ever surgery included a colon resection, have more children. On top of a gallbladder removal, liver ablation cancer diagnosis, it was a hard pill to and a peritoneum and lymph node swallow. From the moment his son, removal. In October 2018, he was Luke, was born, he knew he wanted given a clean bill of health. His scans more children. He never dreamed it showed no evidence of disease. might not be an option. Despite all of the bad that comes “Up until I was told I had cancer, my with a cancer diagnosis, he says the sil- wife and I were living the dream,” says ver lining is that he can be an advocate Begnaud. “We were checking all the for his children. “It was a numbing boxes—career success, buying our first feeling to learn that the cancerous tu- house, celebrating five years of mar- mor had been growing in my body for riage, and Luke turned 1. There were so family when she told him he would be on about 10 years, meaning it started when I many great things happening in our lives, chemo for the rest of his life, would never was 20. I now know that my children will but in hindsight, I wasn’t feeling my best.” be able to have more children and had a need to undergo screening around that While Begnaud didn’t feel sick, he felt life expectancy of less than 2 years. “But time because of my diagnosis. At least sluggish, which he chalked up to being Daniel proved me wrong. And in this case, now I have the tools and knowledge to be a tired parent. But after finding blood in I wanted to be proven wrong,” she says. proactive and potentially prevent colon his stool, Begnaud had a colonoscopy, “He is a true testimony to his faith and cancer for them.” which revealed a large tumor in his co- believing his cancer would be cured.” Although Begnaud was diagnosed lon. Later, scans showed that the cancer Dr. Rowe says it is unusual to see at such a young age, he doesn’t have a had spread outside of the colon to the people in their early 30s with advanced family history of colon cancer. “Many liver, abdomen and lymph nodes. colon cancer, but more and more young people think if they don’t have a family Medical oncologist Julie Rowe, patients are being diagnosed. “Cancer history of cancer they don’t need to MD, assistant professor at McGovern research is focusing on trying to un- worry about screening,” he says. “But Medical School, who sees patients at derstand why this is happening and on I am living proof that’s not true. If you Memorial Hermann Cancer Center- finding ways to improve screening for have any inkling that something isn’t Texas Medical Center and Memorial cancer,” she says. “It’s also why the rec- right, get screened. It could add years to Hermann Cancer Center-Northeast, ommended screening age was recently your life.” says that while screening is definitely changed from 50 to 45.” Thankfully, it looks like that is the the key to catching cancer earlier, in “I remember when I went in for case for Begnaud. In July 2019, he rang Begnaud’s case, he did not meet the my colonoscopy, my biggest concern the bell that signified the end of his standard screening criteria because of was where I was going to eat pancakes treatment. In March 2020, his scan his young age. afterward,” recalls Begnaud. “I never came back clear. He says the only thing “I think, in general, a person needs considered I would be starting my first that topped that was the birth of his to ‘know’ his or her body well and watch of 21 rounds of chemo.” daughter, Ava, one week later. for signs that are not normal, such as The plan was to shrink the tumor Begnaud’s road to recovery has unintentional weight loss or changes enough to do surgery, but before this included some detours. “I had a recur- in bowels or urine,” says Dr. Rowe. “I happened there was a hiccup in his rence in July 2020. In August, I had a encourage patients to keep track of the plan when he experienced severe small mass removed laparoscopically things they feel are unusual and not pain. Doctors discovered his colon followed by 11 more rounds of mainte- ignore them. Ignoring these symptoms had stopped working, and they had nance chemo,” he says. can lead to more advanced cancer.” to put in a stent. A youth minister His recent scans were clear, so his Dr. Rowe remembers the heartbreak- at Central Baptist Church in Buna, next round of chemo should be his last. ing conversation with Begnaud and his Texas, Begnaud knew prayer was now And he will ring the bell again. g 3 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 3
Drama Therapy:
Empowering Cancer Thrivers to Grow and Heal
express feelings or achieve catharsis.
Through drama, the depth and breadth
of inner experience can be actively ex-
plored, and interpersonal relationship
skills can be enhanced.
Cancer Journal: From which therapeutic
approaches does drama therapy draw?
Welch: In my drama therapy work, I
often combine select elements from
existential therapy, which focuses on
self-awareness and freedom; person-
centered therapy, a non-directive,
empathic approach that empowers and
motivates the client in the therapeutic
process; and Gestalt therapy, which
focuses on the individual’s experience
in the present moment. However, each
approach is based on a client’s specific
needs and objectives.
Cancer Journal: What theater tech-
niques does drama therapy involve?
Rebecca Clarke, a metastatic cervical cancer “thriver,” shares her story via a tableau during a drama therapy Welch: Drama therapy employs a wide
session at Canopy. "I call it 'Solace' because it depicts the only comfort I can give my elderly mother, who has
lost two sons to cancer and feels helpless in coping with my cancer," she says. range of drama tools and techniques.
Common approaches include improvi-
Registered Drama Therapist Peyton “Drama therapy is a wonderful addition sation, the use of masks, performance,
Welch understands the physical, men- to our line-up, which includes a wide va- storytelling, role playing, puppetry and
tal and emotional toll that debilitating riety of programs and services addressing playback theater.
illness, including cancer, can take. In the emotional, physical and social needs
Cancer Journal: What does a typical
October 2019, the 40-year-old Arkan- of those touched by cancer.”
drama therapy session look like?
sas native turned Houston transplant Cancer Journal: What is drama therapy?
was diagnosed with stage II/III brain Welch: Each session begins with a
Welch: Drama therapy is an expressive check-in in which participants share
cancer for which he underwent brain
and action-oriented therapy that fo- how they are currently feeling. This
surgery followed by radiation therapy.
cuses on the “here and now.” It actively provides important information to the
“The diagnosis hit me like a ton of
intertwines psychology with theater, drama therapist about how to lead the
bricks,” he recalls. “I remember think-
allowing participants to see and under- group that day, what issues are ready
ing, I will never be the same again.”
stand their real-life struggles in a new to be worked on and what resistances
Fortunately, years before his cancer
way, making discoveries through their will need to be worked past to get the
diagnosis, Welch, who suffers from
own experiences and experimentation. group to function openly and smoothly.
epilepsy, discovered—and ultimately
pursued a career in—a novel yet power- Cancer Journal: Who might benefit from Next, a warm-up gets everyone fo-
ful form of therapy: drama therapy. drama therapy? cused on each other and on being in
Now, he shares this beneficial approach Welch: Just about anyone can benefit— the “here and now.” A warm-up also
with other cancer thrivers and their individuals, families and communities prepares muscles that may be used in
families from all over Greater Houston struggling with change, loss or other activities later in the session and pre-
at Canopy at Memorial Hermann The challenges. This approach can provide pares imaginations so everyone is ready
Woodlands Medical Center. the context for participants to tell their to work together creatively and safely.
Amanda Poole, Canopy manager, says, stories, set goals and solve problems, Drama Therapy continued on page 5
4 MEMORIAL HERMANN CANCER JOURNAL
Drama Therapy continued from page 4 Then each person will write down one in drama therapy from Kansas State
Each session usually includes at least one obstacle they are currently facing. We University in 2017 and was registered
major drama therapy activity in which the put everyone’s obstacles on the chairs through the NADTA in 2019.
group participates, then discusses. Par- and go through the course again. There
Cancer Journal: What do you hope
ticipants who have assumed a role need to is no right or wrong way to go about it.
participants will take away from their
“de-role” afterward in order to reconnect I tell participants, I want you to be you.
drama therapy experience?
with themselves. The group ends with a What is your ideal way to overcome
closure activity, such as a game, ritual, these obstacles? Then we process, Welch: My personal mission statement
review of the session or song. which sparks ideas. We always close on is “Learning to accept life’s challenges
a positive note. and values by embracing hope, creativi-
Cancer Journal: Can you provide an ty and personal worth!” I tell everyone,
example of a “major drama therapy Cancer Journal: How does one become a your story matters. Share your story
activity”? drama therapist? and know there is always hope.
Welch: We often use metaphors and Welch: To become Registered Drama
symbolism. For instance, in one activ- Therapist (RDT), you must earn a To learn more about Welch and his
ity, participants navigate an obstacle master’s or doctoral degree in drama cancer journey, see “Peyton Welch
course made up of chairs, each labeled therapy from a program accredited by Tells His Story and Helps Others Tell
with a word or phrase representing an the North American Drama Therapy Theirs” on page 28. g
obstacle, such as “mud,” “monkey Association (NADTA) or a master’s or
bars” or “ice.” Each person navigates doctoral degree in theater or a men- To register for a drama therapy session at
the course, acting out how he or she tal health profession with additional Canopy, call 713.897.5939. To find out more
would overcome each obstacle. It’s in-depth training in drama therapy about the services and programs offered at
fun to see how different people face through NADTA’s alternative training Canopy, visit memorialhermann.org.
and deal with different challenges. program. I received my master’s degree
Exercise May Increase Cancer Survival
It’s common knowledge that exercise is
important for good health. In addition,
studies have shown that regular exer-
cise can lower cancer risk and improve
a person’s quality of life during cancer
treatment. But did you know that regular
exercise may also help decrease the risk of
cancer recurrence and improve survival?
Reducing Cancer Risk
Physical activity may lower risk of cancer
by helping control weight, regulating
hormones or insulin and strengthening
the immune system.
A study from the researchers at the
American Cancer Society and the Na-
tional Cancer Institute, published in the
May 16, 2016, issue of JAMA Internal
Medicine, linked physical activity with a
lower risk of 13 specific types of cancer,
including colon, breast, endometrial,
esophageal, liver, stomach, kidney, head
and neck, rectum, bladder and lung
cancers, as well as myeloid leukemia and
multiple myeloma.
Excercise continues on page 6
5 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 5
Excercise continued from page 5 swell Park Cancer Center and National Not One-Size-Fits-All
Boosting Quality of Life During Cancer Cancer Institute, concluded that exer- Sisk says that while cancer patients and
Treatment cise after a cancer diagnosis—even once survivors can certainly benefit from
Patients undergoing cancer treat- or twice a week, and even in patients regular physical activity, there’s no
ment may also benefit from being as who had not exercised prior to their one-size-fits-all answer. “Each person’s
physically active as possible during cancer diagnosis—improved survival. exercise program should be based on
cancer treatment. Among the benefits, The study found that “habitually ac- his or her condition and abilities,”
exercise can help improve balance, tive” patients had the biggest survival she says. “While several studies have
strengthen muscles, improve cardiac advantage over their sedentary coun- shown the benefits of exercise for can-
health, reduce anxiety and depression, terparts. Those who exercised three to cer patients, overdoing it can put cer-
improve self-esteem and lessen nausea four times a week before and after their tain cancer patients, including those
and fatigue. cancer diagnosis reduced their overall who are seriously ill or have comorbidi-
“One of the most common com- mortality risk by 39 percent and their ties, at additional health risk,” she says.
plaints I hear from patients undergoing cancer-specific mortality by 36 percent. “Patients should speak to their doctor
cancer treatment is about the fatigue,” Patients who engaged in exercise 1 to 2 before starting any type of exercise.”
says Memorial Hermann Oncology days a week before and after their cancer Sisk says physical activity doesn’t have
Nurse Navigator Angela Sisk, RN. “I diagnosis experienced a 32 percent to be strenuous to be effective. “Emerg-
try to bring it up even before they do. reduction in both all-cause mortality ing research shows yoga use by cancer
I tell them, ‘I know it seems counter- and cancer-specific mortality. patients can improve overall wellbeing
intuitive to get up and exercise when But the study also found that those in addition to relieving stress, anxiety
you’re so tired, but if you can get up and who had been sedentary in the decade and some of the negative side effects
exercise a bit, you’ll feel better.’” prior to their diagnosis experienced a related to cancer treatment.”
28 percent drop in all-cause and cancer- A Certified YogaNurse®, Sisk taught
Improving Cancer Survival specific mortality when they exercised yoga classes at Memorial Hermann
Now, researchers are finding that regu- just one to two times a week during the Greater Heights Hospital prior to the
lar physical activity may also reduce a year following their diagnosis. pandemic and hopes to resume teach-
cancer survivor’s risk of cancer recur- And these survival benefits were ing when it’s safe to do so. “I have been
rence and improve survival. found to occur regardless of the pa- an oncology nurse for 25 years and
A 2018 study of the cancer survival tient’s sex, age, weight, smoking status have been practicing yoga for almost
benefits of exercise, funded by the Ro- or cancer state. as long,” she says. “I’ve found that re-
storative, therapeutic yoga offers a safe,
gentle practice that is especially helpful
for patients with cancer.”
Yoga classes are also offered at Can-
opy at Memorial Hermann The Wood-
lands Medical Center. “Canopy offers
a wide variety of free programs and
services to address the emotional, phys-
ical and social needs of those touched
by cancer,” says Amanda Poole, man-
ager of Canopy. “In addition to offering
yoga classes twice a week, we also offer
Pilates, barre and tai chi classes. Many
of our classes are taught both online
and in person. In-person class sizes are
limited to allow for social distancing.” g
For a complete list of Canopy offerings,
call 713.897.5939.
ANGELA SISK, RN
Oncology Nurse Navigator
Memorial Hermann Greater Heights Hospital
6 MEMORIAL HERMANN CANCER JOURNAL
A NOTE FROM LEADERSHIP
I want to urge mission on Cancer accredited centers walking into our facilities to receive
everyone who to safely provide for all your cancer care.
is reading this screening and cancer care needs. At Memorial Hermann, I feel privi-
message today Detecting cancer early is the leged to work alongside some of the
to return to primary goal of cancer screening best and brightest surgical, medical
wellness care, because finding cancer earlier can and radiation oncologists our city has
including cancer mean a better outcome for you. Talk to offer. Our multidisciplinary teams
screening. Have to your healthcare provider today work together to create personalized
you had your about scheduling your mammogram, treatment plans that give every
mammogram in cervical screening, prostate cancer patient the best chance at survival.
the last 12 months? Have you spoken screening, colon cancer screening Even with the challenges we have
to your provider about a colon cancer and lung cancer screening. Memorial faced recently, we will continue
screening test? Are you ready to have Hermann is ready to help you get your to provide every patient with the
a low-dose CT lung cancer screening in-person screenings done safely and personalized care and support they
exam? Many of you have delayed can- quickly. deserve. At Memorial Hermann,
cer screenings during the coronavirus As we continue to navigate the pan- no one faces cancer alone.
pandemic. The American College of demic, it is my hope that the commu-
Surgeons Commission on Cancer and nity understands the safety processes Sandra Miller, MHSM, RN, NE-BC
Memorial Hermann Cancer Centers we have put into place to be able to Vice President
urge you to you to return to regular treat everyone safely. We are com- Memorial Hermann Oncology
wellness care and cancer screening. mitted to doing everything we can to Service Line
Memorial Hermann has eight Com- make sure people feel comfortable
Every year outlined by national health leaders. medical team takes very seriously.
brings change. It’s understandable that some may It is my hope that the public sees our
It’s a part of life feel hesitant to get the vaccine. After commitment and places trust in us
for all of us, but all, this is new to all of us. However, so we can continue to make strides in
no one could the important thing to remember is beating COVID-19. Be the change.
have predicted that the vaccine’s efficacy is backed Do it for yourself and for your loved
how drastically by science and has been reviewed ones. I already have.
our world has by panels of experts in the field.
changed since These mRNA vaccines, which deliver In good health,
the pandemic genetic material to create proteins,
started. From have been studied for more than a Ron J. Karni, MD
the way we view social gatherings decade and have shown to be very Chair, Oncology CPC Subcommittee
to wearing masks as part of our daily effective in preventing COVID-19 Memorial Hermann Physician
routines, the pandemic has changed infection. Doing your part in getting Network
our mindsets and the way we practice vaccinated is the first step in help-
medicine. ing to achieve herd immunity to help
The one thing that should never slow the spread of the coronavirus.
change is our commitment to our As a vaccine hub for the state of
own personal health. Part of this Texas, Memorial Hermann has a
commitment is getting the COVID-19 responsibility to take care of the com-
vaccine when it is available to you, as munity, a responsibility our entire
7 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 7
EXCELLENCE IN CANCER CARE Natalie Davis: Surprise Colon Cancer Diagnosis “Cancer” was not what Natalie Davis “By using the robot, we can spare the was expecting to hear. After all, she patient an open surgery,” says Dr. Gaj- was 50 years old. She had no history of jar. “A minimally invasive surgery yields colon cancer in her family. The colo- smaller incisions, less pain, a shorter noscopy—her first—was routine. And hospital stay, less risk of infection and a she felt perfectly fine. faster recovery and return to work.” “Life has a sense of humor,” says “Everything went really well,” says Davis. “Up until that day, my only ex- Davis, who describes her surgery as posure to colorectal cancer was writing “uneventful.” She was moving around about it for a paper in grad school.” that night and walking the next day. Yet in October 2019, Davis found Because her cancer was caught at herself in the office of Memorial Her- an early stage, Davis did not require mann Medical Group gastroenterolo- radiation or chemotherapy. “Early gist Shaheryar Siddiqui, MD, who had detection through cancer screening performed her colonoscopy at Memo- is so important,” says Dr. Gajjar. “So rial Hermann Southwest Hospital a many younger people are getting couple days earler. diagnosed with colon cancer these While her diagnosis came as a “I explained to Natalie that dur- days. Everyone thinks 50 is the age at surprise, Davis says about a month ing the colonoscopy, I found a lesion which you should get your first colo- before her diagnosis, she decided to in her sigmoid colon, which was too noscopy. But recently, the American adopt a more plant-based diet and lost large to be removed through a colonos- Cancer Society began recommending her lifelong “sweet tooth.” “I still eat copy,” says Dr. Siddiqui. “I tattooed that the general public should start meat on occasion, but I have added the area (marked the area of the lesion getting colonoscopies at the age of more leafy greens and legumes to my on the outside of the colon so that a 45*, earlier if a person is experienc- diet,” she says. “And I recently re- surgeon could locate it, if surgery were ing symptoms or has a family history sumed my yoga practice. I feel better required) and sent a sample to the pa- of colon cancer.” than I did before the cancer.” g thology laboratory to be biopsied. The Davis wholeheartedly concurs. “I’ve results indicated she had colon cancer. been telling people, even if you have no *Due to recent changes in screening Fortunately, the cancer had not spread symptoms, get screened. By the time recommendations, please consult your outside the colon, including to the you have symptoms, your cancer may insurance provider to confirm coverage lymph nodes.” have already advanced.” if you are under age 50. Dr. Siddiqui referred Davis to colon and rectal surgeon Aakash Gajjar, MD, for a surgical consult. Dr. Gajjar saw her What You Need to Know About that same day. “Dr. Gajjar explained my situation to Breast Cancer: Experts Weigh In me, and we had a conversation about how things could go,” recalls Davis. “I could tell from the conversation he One in eight women will be diagnosed breast cancer and breast cancer preven- knew what he was doing. I felt comfort- with breast cancer in her lifetime, making tion, in October 2020, three members able I would be in good hands.” breast cancer the second most common of the Memorial Hermann affiliated In December 2019, Dr. Gajjar per- cause of death from cancer in women in cancer team participated in an on- formed a robotic sigmoid colectomy, a the U.S. after lung cancer. Early detection line breast cancer awareness webinar minimally invasive surgical procedure saves lives. When breast cancer is caught hosted by the Houston International to remove the diseased part of Davis’ early, before it has spread outside the Women’s Ministry and the Houston colon. The procedure, which took a breast, the 5-year survival rate of women International Seventh Day Adventist few hours, was performed at Memorial with the disease is 98 percent. Church. Hermann Sugar Land Hospital. In an effort to educate women about Breast Cancer Experts continued on page 9 8 MEMORIAL HERMANN CANCER JOURNAL
Breast Cancer Experts continued from page 8 for years. She even had a biopsy when carbohydrates, sugar and red meat
Here, we share highlights from the she was 42, but it was negative for with a diet rich in fresh fruits and veg-
2-hour webinar. cancer. She has been worried about etables, whole grains (which are high
her breast health for years, since it in fiber) and soy-based protein, beans
Who is considered at high risk for seemed every other year, she was and lean animal protein, such as skin-
breast cancer? called back for a 6-month follow-up less chicken and fish. Dr. Gonzalez
According to the American Cancer screening. recommends a stepped approach,
Society, the average risk for breast The patient started her period at giving up one bad thing a week and
cancer is 13 percent and increases with age 11. She is 5'2" and weighs 168 adding one healthful one.
age until age 80. The average age of pounds. She had kids after graduate Not only can a healthful diet help
diagnosis is 62. school, her first at age 32. She is stave off cancer and other serious
A woman is considered to be at higher- not menopausal. She has been taking health problems, including heart
than-average risk for breast cancer if she: the same contraception (progester- disease and diabetes, but eating
• Has been told that her breast tissue is one and estrogen) for years. Her aunt healthfully can also increase cancer
very dense on her father’s side of the family had survivability and help prevent cancer
• Began puberty before age 12 breast cancer. recurrence. Lowering alcohol intake
• Began menopause after age 55 Based on her risk profile, her to fewer than six glasses of wine a
• Underwent hormone replacement lifetime risk for developing breast week will also decrease a woman’s
therapy after menopause cancer is between 22.7 percent and risk of breast cancer.
• Has a personal history of breast biopsy 25.7 percent, significantly higher
• Has a family history of breast or than the average of 13 percent. What are the stages of cancer, and what
ovarian cancer Therefore, she qualifies for yearly do they mean to patients?
• Has above normal body mass index breast mammograms, yearly breast There is a spectrum of cancer diagnoses
(BMI) after menopause MRIs and risk-reducing medications. from stages 0 to IV:
• Stage 0 – Abnormal cells are present
African American women are more What is genetic testing? but have not spread outside the
likely to: As Drs. Jones and Gonzalez explained, breast.
• Be diagnosed with cancer before there is a hereditary link for breast and
age 40 other forms of cancer. There are ways • Stages I, II and III – Cancer is present.
• Be diagnosed with breast cancer at a to test a person’s DNA, their genes, to The higher the number, the larger
later stage determine if he or she is more predis- the cancer tumor and the more it has
• Have a more aggressive breast cancer posed to cancer. spread to nearby tissues.
• Die from their breast cancer • Stage IV – The cancer has spread to
What is the difference between a screening distant parts of the body.
What is a personalized breast cancer mammogram and a diagnostic mammogram?
Drs. Gonzalez and Jones recom- Dr. Jones said that if breast cancer has
risk assessment? spread to lymph nodes in the armpit,
Dr. Jones explained that each woman’s mend annual screening mammo-
grams starting at age 40. If, during a it is still a curable disease but with a
risk profile for breast cancer is unique higher risk of recurrence and needs
and is based on the risk factors outlined screening mammogram, a potential
irregularity is noted, the patient may to be treated more aggressively. She
above. When Dr. Jones first sees a emphasized that screening mammo-
patient, she creates a personalized risk be called back for diagnostic mammo-
gram, to gain additional views of the grams can help prevent the spread,
assessment for the patient on which she reiterating that the 5-year survival
bases a personalized treatment plan. breast. Both physicians emphasized
that getting a call-back does not nec- rate of patients with stage I and II
In the webinar, she offered the follow- essarily mean there is a cancer. breast cancers is 98 percent, adding
ing example: that if a woman doesn’t get annual
The patient is a 45-year-old woman. mammograms, she puts herself at
What can a woman do to reduce her risk of
She has been getting annual mam- risk of getting a later-stage disease.
breast cancer?
mograms since age 40 because Dr. Gonzalez added that if breast
While some risk factors, such as
when she was in her 30s, she had cancer spreads to organs and bones—
genetics, cannot be overcome, there
lumpy breasts that her primary meaning it is stage IV—it can be
are still actions a woman can take to
care physician frequently imaged treated but not cured. But treatment
reduce her risk. If she is overweight,
with an ultrasound. The patient has can help prolong life.
she should evaluate her diet, replac-
heard her breasts are “very dense” ing fast food, packaged foods, starches, Breast Cancer Experts continued on page 10
9 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 9Breast Cancer Experts continued from page 9 To schedule an appointment or to refer a
JESSICA JONES, MD
patient to the Memorial Hermann Breast Medical Oncologist
What is the role of a caregiver to a breast Cancer Prevention Program, call the UT Assistant Professor, McGovern Medical School
cancer patient? Physicians Multispecialty–Bayshore clinic Leader, Memorial Hermann Breast Cancer
Prevention Program
Ruiz, whose mother was diagnosed at 713.486.6325.
with breast cancer 3 years ago, says a ANELIESE GONZALEZ, MD
caregiver plays a very important role Medical Oncologist
SHIRLEY RUIZ, RN
Associate Professor and Director, Hematology
in the physical and emotional wellbe- Oncology Division, McGovern Medical School
Oncology Nurse Navigator,
Memorial Hermann-Texas Medical Center
ing of a cancer patient. Her advice? Be Medical Director, Memorial Hermann Cancer
Center-Texas Medical Center
a support system for them by provid-
ing transportation to appointments.
When accompanying them to their
appointments, be a second set of ears Breast Cancer Prevention and
for them. But as important, simply
be there for them. Listen and provide Survivorship: A Family’s Story
emotional support.
Claudia Osorio, 32, and her sister, Ana was rough. “Mom was on ‘red devil’
What is the role of the Oncology Nurse Osorio, 33, are hoping to keep the (doxorubicin), which caused her to lose
Navigator? wolf at the door—breast cancer—at bay. all of her hair and made her nails turn
Ruiz and her fellow Memorial Her- Their mother, Rosa Osorio, 55, was purple. She literally couldn’t speak for
mann Oncology Nurse Navigators diagnosed with breast cancer in 2019. three days after her treatments. Dad had
help cancer patients find support, Their sister, Elizabeth Osorio, 36, was to help her go to the restroom.”
such as online support groups, men- diagnosed a year later. As soon as Rosa’s insurance policy
tors and financial resources. They Fortunately, all four women are patients took effect January 1, 2020, the sisters
help patients find transportation to at a new UT Physicians clinic dedicated sought treatment for their mom in
medical appointments. Assist pa- to improving breast health, preventing Houston. “We did a ton of research to
tients with their mental wellness. And breast cancer in high-risk patients and find her the best care,” says Claudia.
provide information on resources for providing compassionate, quality cancer “We made an appointment with Dr.
survivors, such as Canopy at Memori- care. Claudia and Ana are also benefitting Jones, and it was amazing. Mom’s doing
al Hermann The Woodlands Medical from a new Memorial Hermann Breast great. She’s glowing with good health.”
Center, open to cancer survivors and Cancer Prevention Program. “Rosa’s daughters went above and
their families and caregivers across The clinic and Program are led by beyond to make sure that they were
the Greater Houston area. medical oncologist Jessica Jones, MD, getting the appropriate care for their
assistant professor of oncology at mother,” says Dr. Jones.
What has been the effect of COVID-19 on McGovern Medical School, who is Now that Rosa has completed her
breast cancer? affiliated with Memorial Hermann- therapy, she sees Dr. Jones every 3
Unfortunately, the COVID-19 pandemic Texas Medical Center and is involved months.
has resulted in a sharp decline in breast in breast cancer research.
Elizabeth: Stage II Breast Cancer
cancer screenings. According to a study Rosa: Stage II Breast Cancer Having watched her mother go through
published in the November 2020 issue Rosa learned she had breast cancer cancer, Elizabeth insisted she and her
of JCO Clinical Cancer Informatics, while accompanying her daughter sisters get mammograms. Elizabeth
screenings for breast cancer were down Claudia to a doctor’s appointment got hers at The Rose. Abnormalities
85 percent in April 2020 from April 2019. in Mexico. “The minute the doctor seen in the mammogram necessitated
The researchers concluded that “the touched mom’s breast, his eyes opened a biopsy, which revealed she had cancer
pandemic has resulted in decreases and wide, and he told her she needed to get in both breasts.
delays in identifying new cancers and it biopsied right away,” recalls Claudia. “Fortunately, she had already met
delivery of treatment. These problems, “She had been feeling lumps before, Dr. Jones,” says Claudia.
if unmitigated, will increase cancer mor- but she just waited and waited.” “With Elizabeth, we hit the ground
bidity and mortality for years to come.” In July 2019, a biopsy revealed Rosa running and personalized her treat-
Drs. Jones and Gonzalez urge women had breast cancer. In August, she un- ment and care,” says Dr. Jones. “To
not to delay screenings, again reiterat- derwent surgery to have her right breast ensure the best surgical outcome, we
ing that early detection through screen- removed, followed by chemotherapy, initiated chemotherapy up front. Since
ing saves lives. g both in Mexico. Claudia says the chemo A Family's Story continued on page 11
10 MEMORIAL HERMANN CANCER JOURNALA Family's Story continued from page 10 history of breast cancer and Elizabeth’s taken if a woman is pregnant or plan-
she did not have an identifiable ge- age for breast cancer, Ana and Clau- ning to become pregnant) is on the
netic mutation, expert consensus with dia both qualified for genetic testing. same screening schedule. Both women
cancer conference discussions led to the “Both tests came back negative,” says see Dr. Jones every 6 months.
physician-patient joint decision for bilat- Dr. Jones. “But I told them, ‘Just
eral mastectomy. She’s a mom. She has because you’re negative doesn’t A Brighter Future?
young kids. Throughout her treatment mean that your children are out of the Claudia says, “It’s unfortunate that my
we wanted to help her do all the things woods.’ If you have a family history of mom and sister had to have cancer for
that she’s doing right now, to support cancer, like a mom or sister, you are at us to be aware and get preventive care.
her through that. She’s in her 30s and increased risk. So we treat you dif- When our daughters and nieces get
doesn’t have a nest egg yet, so our cancer ferently if you report changes in your older, they will start even sooner.”
center found financial support. Know- breast. Everything is triaged differ- Of the sisters, Dr. Jones says, “They
ing there’s more to preventing breast ently. If you tell me you have a lump, used to be scared. Now they’re doing
cancer than mammograms, we said, it’s more worrisome.” something about it. Every generation
‘Let’s talk about your diet, your weight, Dr. Jones conducted a comprehen- has more hope. Every generation it gets
and your other lifestyle choices.’ And sive breast cancer risk assessment on better for them.” g
when her teenage daughter was having a Ana and Claudia. Then, based on their
hard time seeing her mom with cancer, risk profiles, she created a personal- To schedule an appointment or refer a
we helped her find a therapist.” ized breast cancer prevention program patient to UT Physicians Multispecialty –
Elizabeth finished her last round for each. Dr. Jones prescribed Ana the Bayshore clinic, call 713.486.6325.
of chemo in January 2021. In March, hormone therapy drug Tamoxifen, a
she underwent curative intent breast daily oral medication that prevents JESSICA JONES, MD
Medical Oncologist
surgery at Memorial Hermann-TMC, cancer cells from using estrogen and Assistant Professor, McGovern Medical School
performed by Emily Robinson, MD, progesterone to grow. Along with Leader, Memorial Hermann Breast Cancer
Prevention Program
professor of surgery at McGovern preventing cancer, it can help re-
Medical School. duce the density of Ana’s very dense
breast tissue—another risk factor for EMILY ROBINSON, MD
Ana and Claudia: Personalized breast cancer. Ana has tandem mam- Professor of Surgery, McGovern Medical School
Chair, Memorial Hermann Integrated Network
Preventive Care mograms and breast MRIs every 6 Cancer Committee
Because of Rosa’s personal history of months. Claudia, who chose not to Chair, Texas Medical Center Cancer Committee
breast cancer, the extended family’s take Tamoxifen (which shouldn’t be
Ahmed Samara:
Back on the Road After Metastatic Melanoma
Ahmed Samara was expecting the care physician referred him to medical had in fact spread to his lymph nodes,”
call. His primary care physician had oncologist Nadya Hasham-Jiwa, DO, says Dr. Duncan. “Since the cancer had
removed a mole on his back and had who did a full body scan to see if the not spread to other organs, his diagno-
sent it out to be examined. But Samara cancer had spread to other organs. It sis was stage III metastatic melanoma.”
wasn’t expecting the news. had not. Following the surgery, Dr. Hasham-
“When she called, she said, ‘Are you She then referred Samara to surgeon Jiwa started Samara on immuno-
sitting down? Are you driving?’ And I Casey Duncan, MD, assistant profes- therapy. After 2 or 3 months, Samara
said, ‘Go ahead. I’m sitting down. I’m a sor of surgery at McGovern Medical began to experience swelling in his
big guy. I can take it.’ That’s when she School, who surgically removed the underarm, indicative of additional
told me I had cancer,” says Samara. remainder of the lesion at Memorial cancer. Dr. Hasham-Jiwa ordered scans,
Samara’s cancer journey began in Hermann Southeast Hospital and which indicated a recurrence of cancer
early 2020 when, within a month, a simultaneously performed another in the remaining lymph nodes in his
mole on his back, present since birth, procedure to evaluate if the cancer had underarm. She referred him back to Dr.
became much larger and harder. When spread to the lymph nodes.“We excised Duncan for a second surgery to remove
the lab results came back diagnosing the large melanoma on Mr. Samara’s the remaining lymph nodes.
the lesion as a melanoma, his primary back and determined that the cancer Melanoma continues on page 12
11 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 11Melanoma continued from page 11 says Samara. “Now I tell people,
After the second surgery, Samara if you see something, go and
began radiation therapy under the care have it checked out, because
of radiation oncologist Theodore Yang, it’s not worth it. The earlier you
MD. “I did 30 rounds of radiation— find out, the better. Cancer is
Monday through Friday, 15 minutes a not a joke.”
day at Memorial Hermann Southeast, Dr. Duncan says she’s seeing
he recalls. “There was no pain in- a lot of people, including people
volved, but it made me really weak. If I in their 20s, with melanoma.
went upstairs to my bedroom and came “Skin cancer is the most com-
back downstairs, I would have to rest mon form of cancer in the
before going back upstairs.” U.S.,” she says. “The highest
Samara, 56, who drives a party bus risk factor for skin cancer is sun
and has a used-car business, completed exposure and tanning beds.
his radiation treatments and has begun And the cancer can even show
to feel like his old self again. He is now up in places that normally
on a targeted therapy and says he has don’t get sun exposure.”
some residual numbness in his right She recommends using a
arm, which is expected to dissipate over sunscreen with at least 30
time. In his follow-up appointment in SPF, doing regular self skin
March 2021, there was no evidence of checks and seeing a dermatolo-
cancer. gist once a year, more often if
“I had no history of skin cancer in my you’ve been diagnosed with
family. I never even thought about it,” melanoma.
USPSTF Updates Lung Cancer
Screening Recommendations
On March 9, 2021, the U.S. Preventive Services Task Force (USPSTF) issued an
updated recommendation regarding the use of low-dose computed tomography
(LDCT) to screen for lung cancer. The new recommendation lowers both the
minimum age for screening—from 55 to 50 years of age—as well as the number
of pack-years a person has smoked—from 30 pack-years to 20.
The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a
20-pack-year smoking history and currently smoke or have quit within the past 15 years.
Lung cancer is the second most common cancer in the U.S. In 2020, an estimated 228,820 people were diagnosed with lung
cancer, and 135,720 people died of the disease. Smoking is estimated to account for about 90 percent of all lung cancer cases,
and the median age of diagnosis of lung cancer is 70 years.
According to a statement released by the American College of Radiology (ARC) on July 7, 2020, the new screening guidelines
could save 30,000 to 60,000 lives in the U.S. each year.
Pulmonologist Sandeep Gupta, MD, affiliated with Memorial Hermann Southeast Hospital, who says his clinic has seen as
many as five lung cancer patients a week, applauds the efforts to expand screening. “Lung cancer is the leading cause of can-
cer death among both men and women, comprising about 25 percent of all cancer deaths. Each year, more people die of lung
cancer than of colon, breast and prostate cancers combined. But there is hope. As people continue to stop smoking—and with
advances in early detection and treatment—the death rate from lung cancer continues to drop.”
To schedule a lung cancer screening at Memorial Hermann, visit
memorialhermann.org/services/low-dose-ct-scan/lung-cancer-screening-locations
12 MEMORIAL HERMANN CANCER JOURNALADVANCES IN CANCER TREATMENT
Oncologic Emergencies: Improving Patient Care
Through Enhanced Collaboration
When it comes to oncologic emergen- rial Hermann Cancer Center clinical nursing departments and really heard
cies, every second counts. pharmacists Nwabugwu “Simone” what they had to say. We asked, ‘What
“Providing excellent care for inpa- Ndujiuba, PharmD, BCOP; and Brian C. can we do for you to make treatment for
tients being treated for acute leukemia, Dinh, PharmD, BCOP. our patients better?’ We listened, and we
acute lymphoma, hemophagocytic “Our mission is to improve utilization heard them. Moreover, we acted.”
lymphohistiocytosis (HLH), central of antidotes and emergent chemotherapy At the outset, five oncologic emergen-
nervous system tumors and sarcoma for inpatient oncologic emergencies cies were identified on which to focus on
requires a multidisciplinary approach, by updating processes for communica- initially. These were drawn from across
with everyone operating as a team,” says tion, guidelines and education through the four oncologic emergency types—
medical oncologist Jessica Jones, MD, close collaboration between nursing, metabolic, hematologic, structural and
assistant professor of oncology at Mc- pharmacy, laboratory services and side effects from chemotherapy agents.
Govern Medical School and leader of the physicians,” says Dr. Rowe. “Multiple For each emergency, the team performed
new Memorial Hermann Breast Cancer steps have been involved in this quality an extensive literature review to create
Prevention Program. project, from making project charters to evidence-based guidelines along with a
“In the setting of any oncologic creating education videos for the nursing process map and educational materials.
emergency that may happen within the staff. Education and communication are The education materials were then used
hospital, every department must be clear integral to making the project a success.” to conduct interactive in-services for phy-
of the roles and expectations of not only Once the program received a green light, sicians, nurses and pharmacy personnel.
their own department but of the other de- core team members met with the differ- Based on positive feedback and
partments involved in the patient’s care ent departments to understand and map results to date, the team has started
as well,” she says. “And true empower- out current and desired future states and to implement the new guidelines
ment requires not just an understanding what needs to happen to get from the across the Memorial Hermann
of what needs to happen, but why.” former to the latter. Health System. “What has resulted is
Last summer, the internal medicine “It’s a very multidisciplinary ap- a knowledge and understanding that
residency and oncology fellowship pro- proach,” says Dr. Jones. “We’ve engaged is unparalleled, and furthered excel-
grams from McGovern Medical School at with our pharmacy, laboratory and lent patient care,” says Dr. Jones. g
UTHealth and the Memorial Hermann
Cancer Center-Texas Medical Center
launched a quality improvement project
to further elevate inpatient oncology
Dale Thornton: Thriving After
patient safety and care. The program is
being led by Dr. Jones and oncologist Robotic Rectal Cancer Surgery
hematologist Julie Rowe, MD, associate
professor of gastrointestinal malignan- In eager anticipation of the birth of his me, I don’t want to know.’ And he told me,
cies at McGovern Medical School. first grandson, Dale Thornton recently ‘Dale, that’s the wrong way to think about it.
The program is a team effort among pulled his son’s massive Lego collection It’s when you start hurting that it’s too late.’”
the oncology/hematology fellows, out of the attic. Having survived rectal A self-described procrastinator,
including second-years Wei Yang and cancer, the retired agriculture teacher Thornton finally took action two years
Frances Cervoni-Curet and first-years from Alvin, Texas, now realizes the value later. “I was sitting on my patio, and
Binou Yohannan and Arthi Sridhar, of taking proactive care of this health. a feral cat jumped onto my fence and
working alongside Adan Rios, MD, pro- This wasn’t always the case. “The day I bit me,” he says. “While I was on the
fessor of hematological malignances retired, a co-worker came into my shop to phone with a doctor about the cat bite,
at McGovern Medical School; Neha congratulate me, and I mentioned to him I scheduled a full physical. And I’ve
Maithel, MD, assistant professor of that I had never had a physical,” recalls been getting annual physicals ever
genitourinary malignancies at Mc- Thornton. “I was 57, and I said, ‘Now that since.”
Govern Medical School; and Memo- I’m retired, if there’s anything wrong with Rectal Cancer continues on page 14
13 MEMORIAL HERMANN CANCER JOURNAL S P R I N G 2 0 21 13Rectal Cancer continued from page 13 as much healthy tissue and function- On November 17, 2020, Dr. Askenasy
During his physical in 2018, a stool ality as possible,” says Dr. Askenasy. performed the 2 ½-hour procedure at
sample revealed blood in his stool. His “Traditional surgery for rectal cancer Memorial Hermann Southeast. Thorn-
primary care physician referred him to requires an incision down the middle ton recalls waking up to good news. “Dr.
colon and rectal surgeon Erik Askenasy, of the abdomen, which can mean Askenasy said, ‘Dale, I’ve got nothing
MD, an assistant professor in the Depart- longer recovery times. This minimally but good news. The cancer’s gone, you
ment of Surgery at McGovern Medical invasive approach allows us to make don’t need to wear an ostomy bag and
School, who is affiliated with Memorial smaller incisions, which can decrease you don’t need radiation. You just need
Hermann Southeast Hospital. pain, shorten hospital stays, speed to get checked at least once a year.’”
Dr. Askenasy performed a flexible recovery and lower the occurrence of The day after his surgery, Thornton was
sigmoidoscopy, which revealed two post-operative complications, such as released to go home.
lesions on Thornton’s rectum. Pathol- infections.” Asked what advice he would give to
ogy and imaging results confirmed that Prior to the surgery, Dr. Askenasy others who are putting off getting regu-
Thornton had stage I rectal cancer. “I described the procedure and po- lar cancer screenings, including their
presented Mr. Thornton’s case to our tential outcomes to Thornton. “Dr. colonoscopies, Thornton replies, “I
cancer conference, and the recommen- Askenasy explained that he would be tell people, I have no history of cancer
dation was to perform surgery up front. removing the cancerous part of my in my family. I am in good health. It can
It was determined that the patient rectum then would reattach my colon get you too. Don’t wait.” g
was a good candidate for minimally to the remaining part of my rectum.
invasive robotic low anterior resection He said, worst case, I would spend 3
ERIK ASKENASY, MD
(RLAR),” says Dr. Askenasy. to 5 nights in the hospital, and there Colon and Rectal Surgeon
“The goal of rectal cancer surgery is was a small chance I might need Assistant Professor, Department of Surgery,
to completely remove the cancer and to wear an ostomy bag for several McGovern Medical School
associated lymph nodes while sparing months,” recalls Thornton.
Transoral Robotic Surgery Speeds Throat Cancer
Patient Recovery
School and is affiliated with Memorial cancer occurs in the back of the throat
Hermann-Texas Medical Center. He and includes the base of the tongue
says prior to utilizing this minimally and tonsils. Oral and oropharyngeal
invasive approach, surgeons had to cancers are the eighth most common
perform open surgery on the patient. cancer among men. Smoking or being
“We basically had to split the patient’s infected with the human papilloma-
jaw to remove cancers in the back of virus (HPV) can increase the risk of
the throat and use a tracheostomy—a oropharyngeal cancer. HPV is believed
breathing tube in the neck—and feed- to cause 70 percent of oropharyngeal
ing tube.” cancers in the U.S.
Now, with the robot, the surgeon In 2009, the U.S. Food and Drug
is able to place two robotically guided Administration approved transoral
instruments, acting as the surgeon’s robotic surgery for early state oropha-
arms, into the patient’s mouth to safely ryngeal cancer. Robotic surgery for pa-
Head and neck surgeon Kunal Jain, remove tumors. As a result, patients can tients with early stage, oropharyngeal
MD, is helping patients with throat leave the hospital in 2 to 3 days rather squamous cell cancer has been associ-
cancer recover faster and avoid chemo- than 2 weeks, and they are potentially ated with improved health outcomes,
therapy and radiation treatments with able to avoid radiation therapy and che- including better long-term survival,
transoral robotic surgery (TORS) at motherapy and their side effects. according to a Cedars-Sinai study pub-
Memorial Hermann. In 2021, an estimated 54,010 adults lished in the August 20, 2020, issue of
Dr. Jain is assistant professor of head (38,800 men and 15,210 women) in JAMA Oncology.
and neck oncology and microvascular the U.S. will be diagnosed with oral and Dr. Jain is one of a handful of sur-
reconstruction at McGovern Medical oropharyngeal cancer. Oropharyngeal Throat Cancer continues on page 15
14 MEMORIAL HERMANN CANCER JOURNALYou can also read
