Five Years Before Brain Cancer Diagnosis, Changes Detectable in Blood

Newswise, July 11, 2017– Changes in immune activity appear to signal a growing brain tumor five years before symptoms arise, new research has found.

Interactions among proteins that relay information from one immune cell to another are weakened in the blood of brain cancer patients within five years before the cancer is diagnosed, said lead researcher Judith Schwartzbaum of The Ohio State University.

That information could one day lead to earlier diagnosis of brain cancer, said Schwartzbaum, an associate professor of epidemiology and member of Ohio State’s Comprehensive Cancer Center.

The study, published in the journal PLOS ONE, focused on gliomas, which make up about 80 percent of brain cancer diagnoses. Average survival time for the most common type of glioma is 14 months.

Symptoms vary and include headaches, memory loss, personality changes, blurred vision and difficulty speaking. On average, the cancer is diagnosed three months after the onset of symptoms and when tumors are typically advanced.

“It’s important to identify the early stages of tumor development if we hope to intervene more effectively,” Schwartzbaum said. “If you understand those early steps, maybe you can design treatments to block further tumor growth.”

While widespread blood testing of people without symptoms of this rare tumor would be impractical, this research could pave the way for techniques to identify brain cancer earlier and allow for more-effective treatment, Schwartzbaum said.

Schwartzbaum evaluated blood samples from 974 people, half of whom went on to receive a brain-cancer diagnosis in the years after their blood was drawn. The samples came from Norway’s Janus Serum Bank.

Because of previous research – including her own on the relationship between allergies and brain cancer – Schwartzbaum was interested in the role of cytokines, proteins that communicate with one another and with immune cells to spark immune responses. Schwartzbaum’s previous work found that allergies appeared to offer protection against brain cancer.

In this study, Schwartzbaum evaluated 277 cytokines in the blood samples and found less cytokine interaction in the blood of people who developed cancer.

“There was a clear weakening of those interactions in the group who developed brain cancer and it’s possible this plays a role in tumor growth and development,” Schwartzbaum said.

Cytokine activity in cancer is especially important to understand because it can play a good-guy role in terms of fighting tumor development, but it also can play a villain and support a tumor by suppressing the immune system, she said.

In addition to discovering the weakening of cytokine interactions in the blood of future cancer patients, the researchers found a handful of cytokines that appear to play an especially important role in glioma development.

The results of this study must be confirmed and further evaluated before it could translate to changes in the earlier diagnosis of brain cancer, but the discovery offers important insights, Schwartzbaum said.

“It’s possible this could also happen with other tumors – that this is a general sign of tumor development,” she said.

The research was supported by the National Cancer Institute.

Colon Cancer: Early Detection Can Save Your Life

Newswise, June 6, 2017 — Colorectal cancer is the second leading cause of cancer death for men and women in the United States according to the American Cancer Society (ACS).

 In fact, the ACS estimates that 134,490 people in the United States were diagnosed with colorectal cancer in 2016, including 70,820 men and 63,670 women. In addition, the ACS estimates that 49,190 people, 26,020 men and 23,170 women, died from colorectal cancer in 2016.

According to Mitchell Rubinoff, M.D., Chair, Gastroenterology, Valley Medical Group, “In order to reduce the mortality rate of this disease, it is crucial for individuals to be aware of the signs of colon cancer—and not hesitate to have any cause for concern checked out as soon as possible. Early detection saves lives!”

What is Colon Cancer?

Often referred to together as colorectal cancer, colon cancer is cancer of the large intestine (colon), and rectal cancer is cancer of the last few inches of the colon. It most often begins as precancerous polyps on the inside lining of the colon. Colon polyps, as defined by the National Institutes of Health, are growths on the lining of your colon or rectum.

Who is At Risk?

Both men and women are at risk for developing colorectal cancer, even if they do not have any of the identifiable risk factors such as:• A family history of colorectal cancer• Being over age 50• Colorectal polyps• Genetic changes

Early Detection Through Screening Tests

“It is best to catch colorectal cancer before you become symptomatic. Doctors can actually prevent cancers from ever developing by removing polyps and they can cure more patients by diagnosing cancer at an early stage,” explains Dr. Rubinoff.

Possible screening tests for colorectal cancer include stool tests, colonoscopy, or virtual colonoscopy. A colonoscopy is an outpatient procedure that is used to try to detect colon polyps and remove them before they can become cancerous. Your doctor will work with you to decide which test is appropriate for your individual history and symptoms.

It is also important for individuals who are not showing any symptoms of colorectal cancer to go for routine screenings. The CDC states that “The U.S. Preventive Services Task Force recommends that adults age 50 to 75 be screened for colorectal cancer.

“The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened. People at higher risk of developing colorectal cancer should begin screening at a younger age, and may need to be tested more frequently.”

Signs and Symptoms

There are many potential symptoms of colon cancer and it is important to note that there is a great deal of overlap between colon cancer’s symptoms and symptoms of other illnesses. And, while it is possible that your symptoms may be caused by something else, you should still be aware of what to look out for and make sure to see your doctor right away if you experience any of the following symptoms:

• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days• A feeling that you need to have a bowel movement that is not relieved by doing so• Rectal bleeding• Dark stools, or blood in the stool (often, though, the stool will look normal)• Cramping or abdominal (belly) pain• Weakness and fatigue• Unintended weight loss

Recognizing these symptoms, which are outlined by the American Cancer Society, is the first step to early detection. Once you alert your doctor to these symptoms, you may be sent for screening tests to confirm a diagnosis.

Prevention

You can help to prevent cancer by exercising, eating fresh fruits and vegetables, and maintaining a healthy weight. Be proactive and take charge of your health!

The New Face of Colon Cancer

WASHINGTON, May 18, 2017 - Matt Wixon is not the typical colon cancer patient. He has none of the risk factors sometimes associated with the cancer — he is active and fit, eats healthy and smoked only for a very short time. But, most unusual of all, Wixon is young  — he was 39 when he was diagnosed with stage 4 colon cancer last December.

However, Wixon and patients like him are the new faces of colon cancer. A study published February 28 in the Journal of the National Cancer Institute found that colorectal cancer rates are rising in people under age 50, who will make up one in ten of the 135,500 new cases of colorectal cancer expected to be diagnosed in 2017.

That means that people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born in 1950.

Of the 1,000 GI cancer patients seen at his clinic last year, nearly half were under age 50, says John L. Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center and chief of hematology and oncology at MedStar Georgetown University Hospital. Many are in their 20s and 30s; one was just 17.

“This has been a trend that has become an alarming issue in the last decade,” he says. “Treatment of colorectal cancer in patients over 50 has improved — there is less cancer and lower mortality — but we seem to be trading that good news for this really disturbing trend that people in the prime of life are getting a diagnosis no one was expecting.”

FINDING THE SILVER LINING

That was certainly true for Wixon, a patient at the Ruesch Center, who owns a moving company. When he received his news, he and his wife were anticipating the birth of their first child.

“This is a grave diagnosis that came as a shock, an existential threat,” says Wixon. “This was two weeks before Christmas and my wife was seven months pregnant with a boy. All the plans I had for our son— the books I would read to him, the vacations we would take, the joy we would have — just vanished.”

Wixon had noticed some changes in his bowel habits, but they weren’t severe and hadn’t been going on for long. Still, when he met with his gastroenterologist, who suggested he might have hemorrhoids, Wixon insisted on a colonoscopy. Knowing that the test would not be covered by insurance, he was concerned enough that he was ready to pay for the test out of pocket.

Now he is on three different drugs, several of which require infusions every two weeks. Wixon makes the most of these events. “I bring friends, read books, joke around a lot with the really extraordinary nurses and staff at Georgetown.”

Wixon tries to find the silver lining in the cloud hanging over his head. He knows his youth is a benefit and sometimes he finds it hard to believe he is as sick as he is. He is active on “Colontown,” a Facebook group that Marshall told him about, where he has found “hope and solace.”  He is planning for the day when he is healthy enough to have surgery that can remove the tumors that have metastasized in his liver.

LOTS OF THEORIES

Marshall doesn’t know why this trend is happening, nor do other colorectal experts.  “I did not sign up to be a cancer doctor for young people,” he says. “Most of my young patients are marathon running, cardboard eating people.”

But he suspects one player may be an altered microbiome, the galaxy of symbiotic bacteria that live in the human gut to aid digestion. “There is a beautiful coral reef of bacteria in the colon, but the reef may be dying or altered in some people due to modern habits — too much use of antibiotics and antibacterial hand wash, for example, that could reduce the known effectiveness of bacteria in protecting against cancer,” he says. But Marshall is the first to say there are many theories.

Mohamed Salem, MD, a gastrointestinal oncologist and researcher at Georgetown Lombardi, is among a team of investigators studying the foundations of young onset colon cancer. He is exploring whether colon cancer in these patients is more aggressive, and, if so, why, and where it occurs, whether on the left side or right, which matters in terms of outcome and drug treatment.

Then there is the question of diagnosis. No one imagines giving every person younger than 50 a colonoscopy, Marshall says. And for those with some symptoms, there are less invasive and cheaper screening tools than a colonoscopy. But it is important that frontline health care providers, such as primary care doctors, know about the real risk of colon cancer in young people, and “that they take it seriously,” he says.

“All I can say is that people really need to pay attention to their bodies, and if there is something real going on, they should not hesitate to be assertive with their doctors,” Wixon says. “So many people are afraid of bad news. But it will only get worse if you wait.”

Surprising Link Between Blood Sugar and Brain Cancer Found

Diabetes raises risk for many cancers, but not most common malignant brain tumor

Newswise, May 3, 2017—New research further illuminates the surprising relationship between blood sugar and brain tumors and could begin to shed light on how certain cancers develop.

While many cancers are more common among those with diabetes, cancerous brain tumors called gliomas are less common among those with elevated blood sugar and diabetes, a study from The Ohio State University has found. 

The discovery builds on previous Ohio State research showing that high blood sugar appears to reduce a person’s risk of a noncancerous brain tumor called meningioma.

Both studies were led by Judith Schwartzbaum, an associate professor of epidemiology and a researcher in Ohio State’s Comprehensive Cancer Center. The new glioma study appears in the journal Scientific Reports.

“Diabetes and elevated blood sugar increase the risk of cancer at several sites including the colon, breast and bladder. But in this case, these rare malignant brain tumors are more common among people who have normal levels of blood glucose than those with high blood sugar or diabetes,” Schwartzbaum said.

“Our research raises questions that, when answered, will lead to a better understanding of the mechanisms involved in glioma development,” she said.

Glioma is one of the most common types of cancerous tumors originating in the brain. It begins in the cells that surround nerve cells and help them function.

The disease is typically diagnosed in middle age. At present, there is no treatment that ensures long-term survival, but several potential options are being studied.

The Scientific Reports paper included data from two large long-term studies. One, called AMORIS, included 528,580 Swedes. The second, Me-Can, consisted of 269,365 Austrians and Swedes. In all, 812 participants developed gliomas.

Schwartzbaum and her collaborators evaluated blood sugar and diabetes data and its relationship to subsequent development of brain cancer and found that those with elevated blood sugar and diabetes had a lower risk of developing glioma. 

“This really prompts the question, ‘Why is the association between blood glucose levels and brain cancer the opposite of that for several other cancerous tumors?” she said.

The researchers found that this relationship was strongest within a year of cancer diagnosis.

“This may suggest that the tumor itself affects blood glucose levels or that elevated blood sugar or diabetes may paradoxically be associated with a protective factor that reduces brain tumor risk,” Schwartzbaum said. 

“For example, insulin-like growth factor is associated with glioma recurrence and is found in lower levels in people with diabetes than those who don’t have the disease.”

The brain accounts for only about 2 percent of body weight, but consumes about 20 percent of the body’s available glucose, Schwartzbaum said.

The body of research on restrictive diets and their effect on brain cancer development has shown mixed results and more work is needed to determine if there’s something about the sugar/tumor relationship that can be modified in a way that’s beneficial to brain cancer patients, she said.

The research was supported by the National Cancer Institute.

Schwartzbaum’s collaborators included co-lead author Michael Edlinger of the Medical University of Innsbruck in Austria and Grzegorz Rempala of Ohio State’s College of Public Health.

A Softer Approach to Colon Cancer Screening: A Q&A with Samir Gupta

Newswise, April 20, 2017 — Perhaps you’ve seen the commercial: an animated box sitting on a toilet that tells you to “just go” — that is, collect your stool — and ship the sample to a lab to be screened for cancer and pre-cancer. This DNA-based, non-invasive test is just one option now available to screen for colon cancer.

In the past, colonoscopies were the go-to form of screening. While some people sign up for regular checkups, not everyone is so willing to be probed when they may not feel symptoms of disease. However, cancer can grow without noticeable signs and when disease becomes obvious, it may already be advanced.

Samir Gupta, MD, is a board-certified gastroenterologist at UC San Diego Health and Veterans Affairs San Diego Healthcare System with expertise in colorectal cancer screening and prevention., so we asked him about the importance of early detection and less intrusive testing, including fecal and blood tests, that might increase participation in screening for disease.

Question: Why are colorectal cancer screenings necessary?

Answer: Colorectal cancer is the second leading cause of cancer death in the United States. According to the National Cancer Institute, an estimated 134,000 new cases were diagnosed in 2016 and nearly 50,000 people died. But when discovered early through screening, colorectal cancer is highly treatable. Screening can even prevent cancers from developing through detection and removal of precancerous polyps. Also, screening can detect polyps and cancer before you even have symptoms.

Q: Which screening tests should be used?

A: The best test is the one that is most acceptable to you. The one that you are willing to have done now. Your physician might recommend a specific test based on your medical and family history, but ultimately it’s up to you. Tests include http://jamanetwork.com/learning/video-player/13030589 a traditional colonoscopy, a CT colonography, a stool test to check for blood or abnormal DNA or a sigmoidoscopy.

According to the United States Preventive Services Task Force (USPSTF), an independent group of national experts in prevention that makes evidence-based recommendations about clinical preventive services, including screenings, there is no information demonstrating that any one is better than another so pick one and get screened based on your personal preferences.

For example, if you want to place the greatest emphasis on sensitivity for colon cancer and polyps, ability to detect and remove polyps if present and a long interval between normal exams, colonoscopy may be the best test for you. If you prefer the convenience of a non-invasive, at-home test and don't mind repeating a test frequently, consider a stool test that checks for blood or blood and abnormal DNA. Your doctor can also help you decide the best test for you.

Q: Who should be screened for colorectal cancer and when?

A: Men and women of all racial and ethnic groups should be screened for colorectal cancer. The USPSTF recommends that men and women start screening for colorectal cancer at age 50 and continue until age 75. After that, it’s best to have a conversation with your physician to make individualized decisions on whether it is necessary. For people 85 and older, screening is no longer recommended. Although it is most often found in people 50 years or older, incidence in people younger than 50 is on the rise. If you’re under 50 and you have family history or notice a change in bowel movements, blood in your stool and/or weakness or fatigue, talk to your physician. It may be nothing, but to use an old cliché, isn’t it better to be safe than sorry?

Q: What happens if the test shows abnormalities?

A: Should the results of a test come back indicating the presence of polyps or cancer, your physician may request further tests.

New Clinical Trial for Early-Stage Eye Melanoma Offers Study of Targeted Therapy

Credit: Photo courtesy: Roger Barone / Wills Eye Hospital.

Wills Eye Hospital's Carol Shields, MD examines patient (clinical study participant). Oncology research fellow, wearing protective eyewear, also observes. 

Newswise, April 3, 2017 – A first-of-its-kind, potentially groundbreaking new option for treating a form of eye cancer is now in its first phase-1 clinical research trial at Wills Eye Hospital in Philadelphia.

The treatment, called light-activated AU-011, developed by Aura Biosciences of Cambridge, Massachusetts, is an investigational drug that targets and aims to selectively destroy malignant cancer cells in patients who have life-and vision-threatening eye cancer, also known as, ocular melanoma.

Ocular melanoma is a malignant cancer that develops within the eye. It affects as many as 3,000 people per year in the United States. While melanoma is often associated with skin cancer from sun exposure, ocular melanoma does not relate to the sun, developing instead from abnormal pigmented cells in the eye.

The danger with ocular melanoma is that there are often no symptoms, making it difficult to detect resulting in the potential of quietly spreading throughout other parts of the body.

Risk factors include being Caucasian, fair-skinned, and the risk of developing the disease also increases as we age. The best way to detect ocular melanoma is to have an annual comprehensive dilated eye exam by a board certified ophthalmologist.

This innovative treatment approach now being investigated at Wills Eye Hospital uses viral nanoparticle conjugates, which is a targeted therapy of growing interest in medicine.

The treatment involves injecting the AU-011 investigational drug into the eye affected by cancer followed by the brief use of a companion ophthalmic laser treatment to activate the drug.

The investigational drug is expected to destroy the membranes of the ocular melanoma while sparing key eye structures which may allow for the potential of preserving patients’ vision.

“Patients with ocular melanoma currently have few treatment options available that can effectively destroy tumor cells while preserving vision. Conducting valuable research trials like this one enables clinicians and researchers to examine new and better options for patients throughout the world,” said, Carol L. Shields, MD, Co-Director of the Ocular Oncology Service at Wills Eye Hospital where the first US patient was treated.

Dr. Shields is also a key investigator in the research trial and the author of numerous top peer-reviewed publications on ocular melanoma, including identification of the risk factors for early diagnosis (Kaliki & Shields 2016 in Nature Eye.)

Currently, the primary treatment option for ocular melanoma is plaque radiotherapy which was, in part, pioneered in the United States by the Shields Oncology team at Wills Eye Hospital.

While that therapy has achieved high success throughout the years in tumor control for patients, this new potential targeted therapy may open the door to a less invasive method of treatment.

“We are delighted to be one of the pre-eminent clinical trial sites in the nation for this unique and promising treatment. Wills Eye has always been a leader in the clinical application of emerging new therapies. We are 100% behind our world’s best oncology team,” said, Julia A. Haller, MD, Ophthalmologist-in-Chief, Wills Eye Hospital.

The trial, which began in early 2017, is expected to enroll up to 12 patients at Wills Eye and other clinical trial sites.

Trial investigators will focus on evaluating the safety of two dose levels of AU-011 for the treatment of patients with small to medium primary ocular melanoma. Potential participants must have a confirmed ocular melanoma diagnosis not previously treated. Patients treated in the trial will be observed and followed for 2 years.

About Carol L. Shields, MD: Dr. Carol Shields is Co-Director of the Oncology Service, Wills Eye Hospital, and Professor of Ophthalmology at Thomas Jefferson University in Philadelphia. She has authored or co-authored 9 textbooks, over 1000 articles in major journals, nearly 300 textbook chapters, given over 600 lectureships, and has received numerous professional awards of major national and international standing including The American Academy of Ophthalmology Life Achievement Honor Award.

Dr. Carol Shields is a member of numerous ocular oncology, pathology and retina societies and has delivered 30 named lectureships in America and abroad. She practices ocular oncology on a full time basis with her husband, Dr. Jerry Shields on the Oncology Service at Wills Eye Hospital.

About Wills Eye Hospital: Wills Eye Hospital is a global leader in ophthalmology, established in 1832 as the nation’s first hospital specializing in eye care. U.S. News & World Report consistently ranks Wills Eye as one of America’s top ophthalmology centers since the survey began and has the most nationally ranked ophthalmologists in the country.

Wills Eye is a premier training site for all levels of medical education. Its resident and post-graduate training programs are among the most competitive in the country. One of the core strengths of Wills is the close connection between innovative research and advanced patient care. Wills provides the full range of primary and subspecialty eye care for improving and preserving sight, including cataract, cornea, retina, emergency care, glaucoma, neuro-ophthalmology, ocular oncology, oculoplastics, pathology, pediatric ophthalmology and ocular genetics, and refractive surgery.

Ocular Services include the Wills Laser Correction Center, Low Vision Service, and Diagnostic Center. Its 24/7 Emergency Service is the only one of its kind in the region. Wills Eye also has a network of nine multi-specialty, ambulatory surgery centers throughout the tri-state area. To learn more, please visit www.willseye.org