Esophageal Cancer Awareness Month

Proton Therapy for Esophageal Cancer

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Content and information provided by Rebecca Bergeron, RN, BSN, OCN Director of Clinical Services for Provision CARES Proton Therapy Knoxville

Spring is here, and as flowers and trees bring forth new life and color, we are reminded that positive change is possible. Likewise, innovative therapies that have emerged over the years are offering hope to not only have a stronger fight against cancer, but to reduce treatment-related problems during and after the fight. April is Esophageal Cancer Awareness Month and proton therapy is our spring season in cancer treatment.

Breast cancer awareness—know your options

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Sometimes people just get the genetic short end of the stick, but you’d never know Tammy Coleman was one of those people.

Her upbeat personality and contagious enthusiasm belie two heart attacks, a stroke, congestive heart failure and complications related to high blood pressure. And that was all before she was diagnosed with breast cancer—something that ran in her family.

Genetic testing revealed her as the recipient of a genetic mutation that made it highly probable she would develop ovarian cancer too, so within one day Coleman received a double mastectomy and complete hysterectomy.

She had to do chemo, and doctors recommended radiation as well. Because of her existing health problems, particularly related to her heart condition, specialists recommended proton therapy. The targeted nature of protons allow for the benefit of radiation therapy without the collateral damage to surrounding healthy tissue in heart and lungs.

Throat cancer patient high on proton therapy

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When Terry Vinson first felt a small grown the size of a pinkie fingertip on his neck, he dismissed it as a harmless cyst.

Even two weeks later, when it had doubled into the size of a thumb and then doubled again the following week, he had not yet sought medical help.

“I’m in medical sales,” Vinson says. “I should have known better.”

Red Journal shines beam on protons: Part 1

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The prestigious International Journal of Radiation Oncology-Biology-Physics, or Red Journal, has devoted an entire issue to the subject of particle therapy—bringing protons into the limelight of medical practice. It is the official journal of the American Society for Radiation Oncology.

Much of the nearly 600-page issue, nearly double the normal size, includes 75 articles ranging from clinical outcomes to commentary on a modality increasingly gaining recognition as a preferred option for treatment of tumors.

Dr. Oz spotlights need for insurance coverage

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CLICK HERE to watch the segment.

Nearly five years ago, 32-year-old Lindsay Rumberger was diagnosed with epithelioid hemangioendothelioma, a long name for a rare cancer that had originated in her liver and metastasized to her lungs. She underwent chemotherapy, but when a tumor close to her spine showed signs of growth, radiation was part of the recommended course. Because conventional radiation treatment threatened to cause peripheral damage to this most sensitive part of the body, her doctors recommended proton therapy instead. However, the insurance provider disagreed, calling the treatment “experimental” and refused coverage.

Fall Provision Proton Post delivers news, healthy tips

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The latest edition of Provision’s quarterly newsletter comes packed with news about our patients, treatment options and advice from Provision’s nutritionist on how to keep it healthy in the upcoming holiday season.

In honor of breast cancer month, we profile Mary Bagley, a Stage 3 breast cancer patient who was successfully treated at Provision—and through it all was able to carry on her busy lifestyle! And learn about a new group, the Proton Gals, formed to support women cancer survivors who have gone through or completed proton therapy We talk to Dr. Marcio Fagundes about the new hydrogel product that’s sparing prostate cancer patients the daily “balloon” encounter and protecting them from unwanted effects of radiation on sensitive organs. Get to know the smiling face and caring person of Kristin Coffield, Provision manager of patient services, and how she came to leave a career in five-star hospitality to care for cancer patients. Learn how Dr. Allen Meek came to start a farm but ended up helping start a proton cente. And read about all of the Kentucky patients who’ve became fans of, and advocates for, Provision Center for Proton Therapy.

Staying healthy is an important part of successful cancer treatment and cancer prevention, and in this issue we look toward the upcoming holidays. Thanksgiving, Christmas and New Year’s are always a challenging time to keep up an exercise routine and keep away from extra calories. That can be especially true for patients who are away from home. In this issue, Nutritionist Casey Coffey, talks about multiple ways to address the unhealthy temptations of the holiday season—as well as how to combat the extra stress the season can deliver. Below are some more suggestions for ingredient substitutions as well as simple, delicious recipes (some you can even prepare at your ‘home away from home’!)

Happy reading!

 

Individual Protein Cheesecake

Filling
6oz Chobani plain 0% Greek Yogurt
1/2 Tbsp Jell-O sugar-free instant pudding mix – cheesecake

Crust
1/2 cup fiber bran cereal
4 Tbsp water
1 Tbsp unsalted almond butter
1/4 tsp stevia
1/4 tsp cinnamon
1/8 tsp nutmeg

Add the cheesecake flavored pudding mix into the yogurt and stir until well combined. Set yogurt mixture aside. In a food processor or blender, grind the bran to a fine texture. In a small mixing bowl, add the ground bran with all dry ingredients, (stevia, cinnamon, and  nutmeg) and mix evenly. Then add the almond butter and water and stir until it becomes moist and sticky. If the batter is still crumbly, add additional water in 1 tsp increments until desired consistency is achieved. Pour the crust mixture into a small 4in circular pan. Pack the crust along the bottom and sides of the dish to create a pie shape. Pour the filling on top of the crust and smooth evenly along the top. Refrigerate for at least 20 minutes and enjoy cold.

 

Apple Pie Parfait

1 small fuji apple
6 oz Chobani 0% Honey Greek Yogurt
1/2 cup cooked chilled quinoa
2 Tbsp walnuts
1/4 tsp cinnamon

Cook quinoa to package instructions and refrigerate beforehand. Chop the apple into small chunks. Place apple chunks in a microwave safe bowl, and sprinkle with cinnamon. Cover with saran wrap and microwave for 1-1.5 minutes until apple becomes soft. Stir and set aside. In a glass jar, layer half of the yogurt along the bottom, followed by half of the quinoa, walnuts, and apple mixture. Repeat layers to create a parfait and store in the refrigerator or enjoy warm.

Keep reading to find more recipes, plus healthy ingredient substitutions!

Proton Therapy Extremely Effective for Esophageal Cancer

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When Bill Garland learned of his esophageal cancer, he knew nothing about proton therapy except that his doctors highly recommended the treatment. And he fully expected to suffer the same kind of side effects as traditional radiation—fatigue, site burns, loss of appetite. But Garland says he felt good most of the five weeks he underwent proton therapy, even though he was taking chemotherapy at the same time.

“I got the biggest surprise of my life—it didn’t bother me at all,” Garland, 80, says. “At church, there’s five men who’ve got cancer of different kinds. I was almost hesitant to tell them how I really felt, because they felt so bad.”

Garland discovered his cancer after being admitted to the hospital for internal bleeding. A tumor at the base of his esophagus turned out to be the culprit, and Knoxville medical oncologist, Tracy Dobbs, MD, recommended Provision Center for Proton Therapy, where he was treated with protons by Allen Meek, MD, board-certified radiation oncologist. “The esophagus is a difficult organ to treat with radiation therapy since it is so close to the heart, lungs, and spine,” said Dr. Meek. “Proton therapy allows us to only target the cancer cells, sparing surrounding tissues.”

“Because of (other) health issues, he was not going to be a candidate for surgery,” says Inez Garland, Bill Garland’s daughter-in-law, who accompanied him to doctors appointments as well as some of his treatments. “He did exceptionally great with everything,” she says. “He didn’t get nauseated, didn’t have any burns. He never had to get on liquids or anything. The people were so nice, everybody made us feel comfortable,” Inez Garland says.

The treatments ended in October, and Bill Garland is free again to enjoy his life and family of four children, 12 grandchildren and eight great-grandchildren.

“It really worked for me,” he says. “I tell everybody about proton.”

If you or a loved one has been diagnosed with esophageal cancer, Provision is here to help. Please call 1-855-566-1600 to speak with one of our Care Coordinators or visit ProvisionProton.com.

Esophageal Cancer Facts *

According to the American Cancer Society, more than 16,000 Americans are diagnosed with esophageal cancer each year. It affects men much more often than women. Middle-aged men who are overweight with a history of acid reflux (heartburn) seem to be at the highest risk. Because the disease often has no symptoms in the early stages, it is usually detected at a more advanced stage that is more challenging to treat.

The esophagus is a foot-long tube that carries food and liquids from the mouth to the stomach. Its lining has several layers. Esophageal cancer begins in the cells of the inside lining. It then grows into the channel of the esophagus and the esophageal wall.

A sphincter, a special muscle that relaxes to let food in or out, is on each end of the esophagus. The one at the top lets food or liquid into the esophagus. The one on the bottom lets food enter the stomach.

Acid Reflux Raises Risk

This sphincter also prevents stomach contents from refluxing (coming) back into the esophagus. If stomach juices with acid and bile come into the esophagus, it causes indigestion or heartburn. Reflux and gastroesophageal reflux disease (GERD) are the medical names for heartburn.

If you have reflux for a long time, the cells at the end of the esophagus change to become more like the cells in the intestinal lining. This is called Barrett’s esophagus, and it is a pre-malignant condition. This means it can become esophageal cancer and needs to be watched closely.

Esophageal Cancer Types

The types of esophageal cancer are named after the cells where they begin.

Adenocarcinoma is the most common type of esophageal cancer in western societies, especially in white males. It starts in gland cells in the tissue, most often in the lower part of the esophagus near the stomach. The major risk factors include reflux and Barrett’s esophagus.

Squamous cell carcinoma or cancer, also called epidermoid carcinoma, begins in the tissue that lines the esophagus, particularly in the middle and upper parts. In the United States, this type of esophageal cancer is on the decline. Risk factors include smoking and drinking alcohol.

This is the most common type of esophageal cancer worldwide. In other countries, including Iran, northern China, India and southern Africa, this type of esophageal cancer is much more common than in the United States.

* (Esophageal Facts Source: mdanderson.org)

Dr. Meek Discusses Radiation Options for Breast Cancer

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Radiotherapy, surgery and chemotherapy are the mainline treatments for patients with breast cancer. As a treatment modality, radiotherapy has many roles to offer these patients.  These include treatment of the breast after a partial mastectomy in order to conserve the breast and treatment of the chest area after a total mastectomy in order to decrease the chance of the cancer recurring in that area.  In both these situations radiation may also be given to the lymph node regions around the breast in order to prevent a relapse in these sites.  Many studies have demonstrated that radiotherapy given in these settings decreases the chance of the cancer recurring and increases the probability of cure for the patient. Another role for radiotherapy is in treating recurrences of breast cancer, either in the chest area or elsewhere in the body known as metastasis.  Radiotherapy is very effective at remitting these secondary lesions and relieving associated symptoms leading to an improved quality of life.

Along with surgery and chemotherapy, radiotherapy is becoming more targeted, providing more punch to the cancer cells and less to the normal cells.  This is partly due to improved diagnostic imaging which provides us better localization of targets for the radiotherapy and partly due to improved technology in radiotherapy which allows us to conform the dose of radiation to these targets more precisely.  The goal in developing a plan of radiotherapy for a patient is to develop the plan with the maximum therapeutic ratio, namely the ratio of the dose to the cancer target to the dose delivered to normal tissues.

Compared to conventional x-ray therapy, proton beam radiotherapy generally provides a greater therapeutic ratio.  This is due to the fact that whereas x-rays will travel the entire thickness of the part of the body they are aimed at, protons will only travel a limited distance in the body depending on their energy.  The energy imparted to a proton and its direction of travel can be very precisely set and thus the range of the proton beam in the body can be carefully limited.  In breast cancer this allows us to thoroughly treat the breast or chest area and the lymph nodes while substantially limiting the dose of radiation to the heart and lung compared to x-ray therapy.  This will lead to decreased heart and lung disease later in the patient’s life.  With more and more patients being cured of their breast cancer, reducing these preventable medical conditions becomes even more important.  As proton beam radiotherapy becomes more generally available, more and more patients will be able to take advantage of this safer treatment option. Proton beam has a more limited role in treating patients with metastatic breast cancer, though frequently is considered when a patient needs retreatment of a previously radiated area.  Because the volume of tissue receiving this second course of radiotherapy can be better limited with proton beam, it can be the less risky treatment option for these patients.

To find out if proton therapy is right for you, contact Provision Center for Proton Therapy at (865) 862-1600 or visit www.ProvisionProton.com

 

Dr. Allen Meek is Medical Director of Provision Medical Group and a board-certified radiation oncologist practicing at Provision Radiation Thearpy and Provision Center for Proton Therapy.  Dr. Meek was recognized as a 2012 U.S. News and World Report “Top Doctor” and one of the Best Doctors in America® for 2014.