- Advancements in Cancer Treatment | WTOP
- Q: What is immunotherapy?
- Q: What is targeted therapy?
- Q: How have surgical techniques improved?
- Q: What is precision medicine?
- Q: How do I know what cancer treatments are available to me?
- Navigating Head and Neck Cancer
- A Successful Series of Procedures for Patient with Laryngeal Cancer
- Esophageal Cancer Treatment | Johns Hopkins Medicine in Baltimore, Maryland
- What is esophageal cancer?
- What are the symptoms of esophageal cancer?
- What causes esophageal cancer?
- Locations and Appointment Information
- Meet Our Team
- Oropharyngeal Cancer
- What are the symptoms of oropharyngeal cancer?
- How is oropharyngeal cancer diagnosed?
- Oropharyngeal cancer treatment
- Hopkins staffers support push from people living with incurable cancers urging more research
Advancements in Cancer Treatment | WTOP
This content is sponsored by Johns Hopkins Medicine
Researchers around the world are searching nonstop for safer, more effective cancer treatments. Yet many people who are diagnosed think they have only three choices: chemotherapy, radiation or open surgery. That’s not always true. For many patients, other treatment options are available.
Be sure to ask your doctor to discuss newer therapies that may be available. To help you understand all of the options, oncologist Nicole Schmitt, M.D., from the Johns Hopkins Kimmel Cancer Center, explains the latest cancer treatment breakthroughs — and their benefit to patients.
Q: What is immunotherapy?
A: Un bacteria and viruses, cancer cells are good at evading your body’s natural defenses. Immunotherapy helps rev up your immune system to recognize and attack malignant cells.
Immunotherapy has become one of the biggest game changers in the cancer world. Within my own specialty, we’ve seen significant improvements in survival rates. Before immunotherapy, the survival rates for head and neck cancer hadn’t changed in over 30 years.
Q: What is targeted therapy?
A: As the name implies, targeted therapy drugs focus on specific genes — or “targets” — used by cancer cells to grow and spread.
Because targeted therapy drugs work so precisely, patients avoid some of the unpleasant side effects and toxicities of traditional treatments. Head and neck cancers, for example, are often treated with platinum-based chemotherapies, which can damage the liver and kidneys. For many patients, targeted therapies may be safer and easier to tolerate.
immunotherapy, targeted therapies can also be used to treat cancers that didn’t respond to other therapies first or have come back.
Q: How have surgical techniques improved?
A: Some cancer centers now offer robotic, minimally invasive procedures. These robotic systems allow doctors to better access hard-to-reach parts of the body. Patients who choose robotic surgery typically have smaller scars and faster recoveries.
For some cancers, robotic surgery is a standard practice. For others, it’s a new advancement. In particular, there’s been exciting progress for oropharyngeal cancers, which are located in the throat and are difficult to remove without newer tools and techniques. Before, patients with oropharyngeal cancer had only chemotherapy and radiation therapy, or larger, more invasive surgeries.
Q: What is precision medicine?
A: Precision medicine care is tailored to an individual’s background, genetics, lifestyle and disease type. Using these data, doctors create a personalized treatment plan.
Precision medicine is particularly interesting for salivary gland cancers, which are quite rare. Several studies have sequenced these tumors’ genes, which has allowed us to identify better, more effective drugs.
Q: How do I know what cancer treatments are available to me?
A: Keeping up with the world of cancer research can be overwhelming. Start with your doctor, who can act as a gatekeeper to new information and connect you with other experts. Feel empowered to ask him or her:
- Do you know of any clinical trials nearby that might be right for me?
- Are there other specialists I should be seeing?
- What are the pros and cons of my treatment options?
- If you were in my shoes, which course would you take?
I think the key is to be evaluated by a multidisciplinary team. Medical oncologists, social workers, radiation oncologists, surgeons and nutritionists all play an enormous role in cancer care, and you’re doing yourself a disservice if you don’t seek your full range of options.
Seeing more than one doctor may sound stressful, but I actually hear the opposite from patients. They’re often relieved that they have an entire team looking out for their well-being.
Leisha Emens, M.D., Ph.D., at the Bloomberg~Kimmel Institute for Cancer Immunotherapy, is working to move the science of immunotherapy forward for faster and longer lasting treatment responses.
Navigating Head and Neck Cancer
June 13, 2017
In January 2016, a routine physical revealed a swollen lymph node on the left side of Matt Harcourt’s neck.
Although the 46-year-old father of three had no symptoms, a biopsy by a local ear, nose and throat specialist near his home in Bethesda led to a diagnosis of squamous cell carcinoma of the oropharynx, or head and neck cancer.
When he reached out to his friends for advice, they suggested seeing someone affiliated with Johns Hopkins Medicine.
His first appointment was with Wojtek Mydlarz, a Johns Hopkins head and neck surgeon who practices at Suburban Hospital in Bethesda.
On the same day, Harcourt also saw Brandi Page, a radiation oncologist who specializes in head and neck cancer at the Johns Hopkins Kimmel Cancer Center radiation oncology practice in Bethesda.
Nicholas Farrell, a medical oncologist in private practice in Bethesda, was also on the treatment team.
Mydlarz suspected that Harcourt’s cancer originated in his left tonsil, a hypothesis confirmed by a physical exam and biopsy. A PET scan revealed that the cancer had spread to some of the lymph nodes in Harcourt’s neck, making it less ly that surgical treatment would be curative without the addition of radiation and chemotherapy.
Mydlarz shared the case at head and neck tumor board conferences at Suburban Hospital and The Johns Hopkins Hospital, where team members discuss complicated cases. “Every head and neck cancer patient benefits from the expertise of all the Johns Hopkins specialists, whether they receive treatment locally or in Baltimore,” Mydlarz explains.
In early June, Harcourt began a seven-week course of daily radiation and weekly chemotherapy. Page used cutting-edge radiation technology to ensure his treatments were delivered with pinpoint accuracy. “Our goal is to avoid as many side effects of treatment as possible,” she says.
“Our specialized radiotherapy staff, which includes a speech and swallow therapist as well as a clinical social worker and dietitian, works hard to ensure the best short- and long-term outcomes. It’s so important to have all of these care components available in one place close to home.
For Harcourt and all of Suburban’s cancer patients, another benefit of staying close to home is the support of oncology nurse navigator Barbara Doherty. “On day one, Barbara introduced herself as ‘the person to go to when you don’t know where to go’ and that she is,” Harcourt says. “There wasn’t a question she couldn’t answer on the spot. Her expertise was invaluable.”
Today, all indications are that Harcourt’s treatment was successful, although he is still adjusting to the effects of the radiation on his voice, salivary glands and sense of taste. He is hopeful these side effects will improve in time and that he will soon be declared “cancer free.”
“While having cancer is a terrible experience, I can’t say enough great things about everyone involved in my care,” says Harcourt. “The physicians, nurses, and radiation and oncology technicians made the whole thing more bearable because of their knowledge and professionalism. They all chose this profession because they care about people and it shows.”
A Successful Series of Procedures for Patient with Laryngeal Cancer
April 18, 2018
In the fall of 2011, retired journalist Alfred Friendly Jr. was diagnosed with stage 1 laryngeal cancer. At the time, doctors in Washington, D.C., assured Friendly that the tumor was small and radiation would take care of it. “They were wrong,” he says.
In the spring of 2012 Friendly was experiencing some throat and ear pain, and looked to Johns Hopkins for a second opinion. That June, head and neck surgeon Christine Gourin found he had a recurrence of the lesion; the cancer was now a stage 2 laryngeal cancer of the epiglottis.
Gourin performed a supraglottic (partial) laryngectomy on Friendly, who had worked internationally for Newsweek and the New York Times and had written speeches for members of Congress and the president of the World Bank during his career.
During the operation, Gourin removed all of Friendly’s larynx except for the vocal cords, as well as nearby lymph nodes in case the cancer had spread.
“Some people who have recurrence of a tumor after radiation end up needing a total laryngectomy, so we were lucky because his voice is very important to him that he was able to have this procedure,” says Gourin. “It’s a difficult surgery.
You have to be not only in good health but also in good physical shape to have it, because by removing the larynx above the vocal cords, you’re removing some mechanisms of the larynx that protect against aspiration and you have to be fit enough to handle that.
Not everybody is a candidate, but fortunately, he was.”
Head and neck surgeon Christine Gourin peformed a supraglottic laryngectomy followed later by a Montgomery tracheal cannula to save patient Alfred Friendly Jr.’s voice and air way function.
Following surgery, Friendly worked with speech language pathologist Donna Tippett to relearn to swallow. While Friendly did well initially, a few months later he had developed exercise intolerance. It was bothersome when he played tennis, and while walking his dog he often had to stop and catch his breath.
Gourin observed during an examination that Friendly had developed posterior glottic stenosis as a consequence of the radiation. “While he still had a good voice, he couldn’t open up the vocal cords as widely when taking deep breaths of air,” Gourin says. She then recommended a Montgomery tracheal cannula, designed for patients with Friendly’s exact medical problem.
“I’m a huge fan of these and don’t think they’re used enough,” she says. “Un a standard tracheostomy, the part of the cannula that goes in the airway is very small, so it’s self-retaining…
The cannula itself is made of a soft rubber or soft plastic, un the hard plastic of a trach tube.
Because there isn’t a portion that extends into the airway, they’re easier to take care of—and they don’t have to be held in place with straps or ties.”
Since that procedure, Friendly has resumed his active lifestyle, traveling, speaking publicly and staying physically fit. He recently celebrated his 80thbirthday.
Gourin says she was nearly brought to tears watching a recent video of Friendly addressing a group of journalism fellows at American University, because retaining his voice was so important: “I’m just so thrilled that this worked out for him.”
For more information or to refer a patient, call 443-997-6467 or see https://www.hopkinsmedicine.org/otolaryngology/specialty_areas/head_neck_cancer_surgery_center/.
Esophageal Cancer Treatment | Johns Hopkins Medicine in Baltimore, Maryland
Being diagnosed with esophageal cancer can be scary, but the experts at Johns Hopkins can help.
Research suggests patients who receive treatment at a center performing a high number of esophageal cancer surgeries typically will see better results — our surgeons perform between 60 to 100 surgeries each year.
Our esophageal cancer treatment team, comprised of highly-specialized gastroenterologists, surgeons, medical oncologists, radiation oncologists, and therapy and nutrition experts, treat the highest number of esophageal cancer cases in the region.
Using technologies proven to provide an accurate diagnosis, our experts are then able to offer state-of-the-art treatment methods developed from research completed here. Our researchers interact daily with clinical practitioners to convey the latest findings, which results in more effective care and advanced practice for chemotherapy, surgery, and radiation therapy.
The cancer specialists at Johns Hopkins focus on each patient's cancer and can tailor proven, personalized therapies not available elsewhere. As the only comprehensive National Cancer Institute designated cancer center in Maryland, you will find the widest range of treatments and clinical trials at Johns Hopkins and doctors who translate their research into action for each patient. Our skilled surgeons offer minimally invasive and robotic surgery procedures — a minimally-invasive esophagectomy — that are not available at other area centers.
Time is of the essence, so we offer access to a team of specialists during a one-day consult at our Thoracic Oncology Multidisciplinary Clinic. To expedite diagnosis, appointments for endoscopic ultrasound testing (the technology we use to determine the stage of the cancer) are scheduled as soon as possible.
Whether you're looking for esophageal cancer diagnosis, treatment, clinical trials, or a second opinion, our world-renowned team of experts will provide the best care available. Schedule an appointment today.
What is esophageal cancer?
An esophageal cancer diagnosis refers to the development of cancer in the muscular tube which connects the throat to the stomach (the esophagus). Esophageal cancer is a rare and complex tumor which should be treated by a combination of highly-specialized gastroenterologists, surgeons, medical oncologists, and radiation oncologists.
There are two main types of esophageal cancer:
- Adenocarcinoma — The most common type of esophageal cancer, adenocarcinoma develops in the glandular tissue in the lower part of the esophagus (near the stomach).
- Squamous cell carcinoma — Squamous cell carcinoma develops in the cells (known as squamous cells) which form the top layer of the lining of the esophagus. Un adenocarcinoma, which occurs in the lower part of the esophagus, squamous cell carcinoma may occur throughout the entire length of the esophagus.
What are the symptoms of esophageal cancer?
Esophageal cancer symptoms may not be noticeable in the early stages. In later stages of esophageal cancer, symptoms may include:
- Difficulty or painful swallowing
- Pain in the throat or back
- Severe weight loss
- Hoarseness or chronic cough
- Blood in stool
What causes esophageal cancer?
While the exact cause of esophageal cancer is unknown, a number of factors significantly increase the risk of developing adenocarcinoma or squamous cell carcinoma, including:
- Alcohol — A number of studies have shown the more alcohol you consume, the greater the risk of developing squamous cell carcinoma.
- Barrett's esophagus — Barrett's esophagus, a condition in which the esophagus' squamous cells turn into cells not usually found in humans (called specialized columnar cells), is a well-established risk factor for adenocarcinoma of the esophagus. The risk of developing adenocarcinomas because of Barrett's esophagus is estimated to be 10 times higher than the normal population.
- Gastroesophageal reflux disease (GERD) — GERD, defined as recurring heartburn, has been linked to a greater risk of esophageal cancer (specifically adenocarcinomas) due to the high levels of acid reflux in the esophagus.
- Smoking — Several studies indicate, as with alcohol consumption, smoking may increase the risk of developing squamous cell carcinoma. The combination of alcohol consumption and smoking greatly increases the risk of developing esophageal cancer.
- Nutrition — Iron, riboflavin, and vitamin A deficiencies have been associated with an increased risk of developing squamous cell esophageal cancer.
Locations and Appointment Information
Johns Hopkins specialists not only provide outstanding integrated care, but they also discover and innovate to advance cancer care. They offer clinical trials, which approach esophageal cancer from molecules and genetics, to customize care for patients.
By using state-of-the-art surgical equipment designed to make smaller incisions, lower the risk of infection, shorten your hospital stay, and speed up recovery time, our team of world-renowned esophageal cancer experts — located in several convenient locations — can get you on the road to recovery.
From diagnosis to recovery, our physicians will facilitate every aspect of your treatment.
Call 410-933-5420 to schedule an appointment at one of our treatment centers today.
Convenient locations include:
- The Johns Hopkins Hospital
- The Johns Hopkins Bayview Medical Center
- Howard County General Hospital (endoscopic ultrasound testing only)
Meet Our Team
Linkedin Pinterest What is Head and Neck Cancer Cancer
The oropharynx consists of the structures in the back of the throat, including the base of tongue, palatine tonsils, posterior pharyngeal wall and soft palate.
There are many different types of cancers of the oropharynx, however the vast majority are squamous cell carcinomas. Squamous cell carcinomas can be divided into two types, HPV-positive and HPV-negative.
There are about 15,000 new cases of oropharyngeal cancer each year, with the vast majority being HPV-positive.
More information about HPV-positive squamous cell carcinoma
What are the symptoms of oropharyngeal cancer?
Symptoms of oropharyngeal cancer include:
- Neck mass
- Difficulty swallowing
- Muffled voice quality
- Ear pain
- Throat pain or sore throat
- Lump or mass in the back of the throat
How is oropharyngeal cancer diagnosed?
Many patients with oropharyngeal cancer initially present with a neck mass. Any adult with a neck mass for more than two weeks should see an otolaryngologist for an evaluation.
An evaluation consists of a complete head and neck examination, including looking into the throat and voice box with a small scope that is passed through the nose to allow the physician to see if there are any suspicious masses.
A fine-needle aspiration biopsy, a procedure that places a small needle into the neck mass to extract cells, is performed under local anesthesia.
This allows a pathologist to evaluate the cells under a microscope to determine the cause of the neck mass.
Oftentimes the pathologist is able to determine whether the mass is cancerous or benign, and if cancerous, the type of cell the cancer comes from. A complete workup involves imaging, which may include a MRI, CT scan or PET scan.
Oropharyngeal cancer treatment
Treatment for oropharyngeal cancer depends on a number of factors, including but not limited to: type of cancer, size of the tumor and location of cancer, speech and swallow function and overall medical condition of the patient.
Treatments include surgery, radiation and chemotherapy.
Our team specializes in both open and minimally invasive robotic surgery, the most advanced techniques in head and neck radiation and the newest chemotherapy options.
Usually one treatment modality is used for early stage cancers (either radiation or surgery) and combined treatment modalities are recommended for advanced stage cancers (surgery and radiation).
Scientists are currently investigating immunotherapy for head and neck cancers.
This treatment approach, which has been effective in other types of cancer, uses drugs and vaccines to harness the immune system’s natural ability to fight cancer.
A few immunotherapy drugs have been approved for second-line therapy in some advanced head and neck cancers, and investigators are looking into whether a combination of immunotherapy and radiation could improve outcomes.
Hopkins staffers support push from people living with incurable cancers urging more research
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Tom Smith hesitated to buy light bulbs guaranteed for up to 10 years, thinking they'd outlast him. Terry Langbaum debated filling a prescription for a $13,000-a-month drug that keeps cancer from worsening for three months on average and carries six pages of warnings.
“There are so many of us living with cancers that can't be cured,” Langbaum said. “We study the treatments but we don't study what it's to be the person going through treatment.”
Millions of people live with metastatic cancer — disease that has spread through the body and is considered incurable. They are surviving longer as treatments improve, often seeing cancer subside and flare again and again. Now many are pushing to be included more widely in research and to have it focus more on the patient's point of view.
“It's really about time that happened,” said Dr. Elizabeth Jaffee, deputy director of Johns Hopkins University's Sidney Kimmel Cancer Center. Patients should be asked what side effects and risks they'll accept, “not just treated as research subjects,” she said.
Jaffee is president of the American Association for Cancer Research, and its annual meeting this week in Atlanta featured many talks on the need for involving patients more in metastatic cancer research.
Smith is a doctor and palliative care chief at Hopkins who is being treated for metastatic prostate cancer. Langbaum is a Hopkins administrator who developed three other cancers from radiation treatments for her first one 37 years ago.
Smith and Langbaum wrote about their experiences Wednesday in the New England Journal of Medicine.
Guidelines on how cancer survivors should be monitored later in life often assume the disease is in remission rather than still being treated, they wrote.
Many patients now live for years with advanced cancer: Sixteen percent of people with widely spread lung cancer survive five years.
Patients wonder if they should have genetic testing, how they'll deal with the cost of treatment and whether their doctors can keep up with the latest discoveries.
“We could also use some guidance even on seemingly irrelevant health decisions,” such as whether it's worth it to be tested for other medical conditions or to take a cholesterol-lowering medicine “when you don't even know if you should take a chance on purchasing airline tickets for a summer vacation,” Smith and Langbaum wrote .
Smith said hormone therapy and dozens of radiation treatments for his prostate cancer caused extreme fatigue. A marathoner, he said he “went from somebody who could run 50 miles, or 26 miles, to somebody who gets short of breath going up the stairs.”
“I've got terrible sleep, hot flashes every 45 minutes,” mood swings and depression, he said. Last summer, “I actually admitted myself to the hospital so I wouldn't kill myself.”
A good psychiatrist, help from his family and a support group, and a new antidepressant have helped.
When she was 34, Langbaum was treated for Hodgkin lymphoma with radiation that led to breast and stomach cancers in later years. Two years ago, doctors found an unusual and inoperable soft tissue cancer called a sarcoma between her throat and windpipe. She said she has lived “in this constant fear of the other shoe dropping.”
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Billy Foster, a jazz pianist and radio show host from Gary, Indiana, who spoke at the Atlanta conference as a patient advocate, talked about the uncertainty cancer patients live with. Foster had a cancerous kidney removed in 1996, but in 2007 learned the disease had spread to his lungs, liver and brain.
“They say if you go five years, you're kind of in the clear,” but that's often not true, Foster said. He joined a study testing an experimental drug that helped him for five years until the company abandoned it.
“It wasn't working for enough people but it was saving my life,” Foster said. His doctor persuaded the company to keep making the drug for him for another year, long enough for a new drug to come out that seems to be keeping his cancer in check.
Several studies are examining “what allows some people to live a very long time with incurable cancer,” said Dr. Mark Burkard, who is leading one at the University of Wisconsin in Madison for breast cancer. Around 750 women have given extensive details on their treatments and lifestyles, and tumor samples are being analyzed for genetic clues.
Langbaum and Smith say they are focusing on living. She filled the prescription she'd been debating. He bought the long-lasting light bulbs.
“I figured, even if I can't enjoy them, the next person who lives in our house might,” he said.