Screening Colonoscopies Save Lives

Ursina Teitelbaum, MD, is a Penn Medicine assistant professor of medicine and medical oncologist specializing in gastrointestinal cancer, caring for older adults and symptomatic management of cancer patients.  In this first of two posts, Dr. Teitelbaum discusses the importance of colorectal cancer screening.

It is an exciting time to be a gastrointestinal oncologist, because of the array of advances in detection, prevention and treatment of colorectal cancers available today. 

In February, a study published in the New England Journal of Medicine reported the best evidence to date that colonoscopies, a colorectal cancer screening test, can actually prevent cancer deaths. Early detection has always been a goal of colonoscopy because colorectal cancers that are caught early are more amenable to surgical cure.  The premise of this study, however, was that the removal of precancerous polyps during colonoscopy might prevent the cancer from ever occurring. This prospect seemed to be realized by the finding of a greater than 50 percent decrease in death rate from colorectal cancer among patients who had a screening colonoscopy.

Decreasing the incidence of colon cancers in addition to detecting early colon cancers before they have an opportunity to spread is an incredible achievement in the existing screening programs.  Colorectal cancer is among the most common of all cancers diagnosed today, with more than 140,000 cases diagnosed annually in the United States. Roughly 100,000 cases are colon and 40,000 are rectal cancers.  These can be very lethal cancers, with more than 50,000 people dying yearly from colorectal cancer.

I work closely with gastroenterologists, surgical oncologists, radiation oncologists, and other medical specialties in the multidisciplinary care of colorectal cancer patients at Penn Medicine. All of us work relentlessly to bring the most aggressive and individualized care plans to every patient.  I also personally explain the rationale for each therapy and how to manage the side effects and symptoms of the cancer and the treatments for them.

Patients with early stage or locally advanced colon cancers often meet with me after their surgery to determine if they can benefit from postoperative (adjuvant) chemotherapy to enhance their chance for cure.  I like to call it an “insurance policy” for increasing the chances that the cancer won’t come back.  The chemotherapy regimens in this postoperative setting are quite tolerable and do not involve extreme nausea, fatigue, or hair loss.

But even when colon cancer has spread outside the original location and is considered stage IV cancer, there are many treatment modalities available including innovative clinical trials for colorectal cancer, biologic therapies and immunotherapies.  Penn uses advanced molecular profiling of every patient’s individual cancer to help personalize the therapy. 

In my next post, I will talk about how Penn Medicine takes a personalized approach to cancer treatment.

Learn more about the Abramson Cancer Center’s Gastrointestinal Cancers Program.

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Free Skin Cancer Screening in Philadelphia

Have you been screened for skin cancer?

May is Skin Cancer Awareness Month, and dermatologists at Penn Medicine want to spread the lifesaving message of early skin cancer detection and screening by offering free skin cancer screenings in Philadelphia.

Date: Saturday, May 19 2012
Time: 8 am to Noon
Location: Department of Dermatology at the Ruth & Raymond Perelman Center for Advanced Medicine, 3400 Civic Center Blvd., First floor, Suite 1-330S (South Pavilion), Philadelphia

Know the Facts about Skin Cancer

• More than 2 million non-melanoma skin cancers are diagnosed annually.
• Basal cell and squamous cell cancers are the two most common forms of skin cancer, but both are easily treated if detected early.
• Current estimates are that 1 in 5 Americans will develop skin cancer.
• Melanoma is the most common form of cancer for young adults aged 20 to 29.
• The American Cancer Society recommends a skin cancer-related checkup and counseling about sun exposure beginning at age 20.

Register for this free skin cancer screening sponsored by Penn Dermatology and Penn’s Abramson Cancer Center by calling 215-662-2737.

Appointments are required and space is limited.

Want to learn more about skin cancer and melanoma? Register for CANPrevent Skin Cancer, a free conference about skin cancer prevention sponsored by the Abramson Cancer Center.

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Why Laughter Really is Good Medicine

Christine Wilson, cancer survivor, shares her experiences from the Humor, Heart and Hope Symposium held this spring and sponsored by the Abramson Cancer Center and Cancer Support Community of Philadelphia.

Does the image of a roomful of 200 cancer survivors and caregivers doubled over in laughter seem unlikely?

At the Humor, Heart and Hope Symposium held this spring, there were a lot of laughs. The symposium, sponsored by the Penn’s Abramson Cancer Center and the Cancer Support Community of Philadelphia (formerly the Wellness Community), focused on the value of humor and its role in overcoming adversity.

The Positive Power of Humor

Joel Goodman, Ed.D, founder of The Humor Project, an organization whose mission is "to make a positive difference in the world by helping people to get more smileage out their lives and jobs," opened the program by talking about the positive power of humor.

Life, he said, throws all of us "pop quizzes," the unexpected events such as a cancer diagnosis or loss of a loved one that brings with them stress and anxiety. Even in the most difficult of times, Goodman says, humor is a "way of bumping us into the here and now," and "an ally against that stress."

Goodman encouraged the audience to find humor in everyday life and to "invite the childlike perspective," the ability see the situation as an eight year old would. Tell jokes, or if you can't remember them, find buttons or bumper stickers that are funny, or just spend five minutes a day looking for the humor that is all around you--and learn to laugh at yourself.

Goodman finished by asking the audience to read the words he wrote, OPPORTUNITY ISNOWHERE. Depending on your perspective, that phrase can be broken down as Opportunity is Nowhere, or...Opportunity is now here.

Laughter is Good Medicine

Leslie Gibson, RN, a cancer survivor, spoke about laughter as good medicine, and the body of research that supports the idea that laughter has physical as well as emotional benefits.

She said studies show laughter can improve heart function and reduce blood pressure, and that laughing affects the same part of the brain that responds to chocolate, caffeine, opiates and sex.

Gibson recalled her own childhood in which she was teased by her peers because she was in her words, "short, fat, and wore glasses," and the words of a kind shoe repair man, who urged her to get the kids to laugh with her--not at her. To cope with her own diagnosis of thyroid cancer, she played jokes on her surgeons and her husband to, in her view, humanize the situation.

Gibson concluded her talk by saying, "Laughter doesn't cure, but it does help us find the hope. We need to look for the magic in every day, in everything that is around us. Don't let cancer take away the joy in life."

Balancing Stress with Humor

Humor Project Co-Director, Margie Ingram, picked up on that theme in her talk on HUMOResilience and how to tickle stress before it tackles you. She began by urging the audience to "optimize optimism." We all need to seek what she termed, "intentional balance." A diagnosis of cancer threatens that balance by putting us onto a high stress plane for an extended period of time--a situation that triggers both negative physical and emotional responses.

Humor helps us come down from that high stress plane--gives us time to relax and recover.
The final speaker, Michael Pritchard, put into practice what the previous speakers had advocated--he made the audience laugh at him and at themselves. An accomplished professional comedian as well as a writer and social worker, Pritchard began by saying that "Fear is the little dark room where negatives are developed," and quoted Gandhi's maxim that there is "more to life than just increasing the speed."

Sometimes, Pritchard said, we have "to let our souls catch up," and humor provides those opportunities. He brought the audience to laughter with his perfect characterizations ranging from crying infants to teenage boys and girls engaged in phone conversations. He ended by saying that "Humor heals the human spirit as well as the body."

Learn more about The Humor Project.

Learn more about the Cancer Support Community and its many programs for patients and caregivers.

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How to Eat Well With Head and Neck Cancer

After a head or neck cancer diagnosis, pain caused by the tumor or from surgical procedures or treatment can make chewing and swallowing difficult. 

Altering the consistency of your food and carefully selecting food items can make a big difference in your ability to eat and aid in making sure your body receives adequate calories, protein and other nutrients. 

It is important to maintain good nutrition during this period to aid recovery and healing as well as prevent complications that may impact treatment. 

Excessive weight loss during treatment and recovery may result in frequent hospitalizations and poor outcomes. For this reason, it’s important to choose foods that require little to no chewing and that don’t cause choking.  The food may not look as appealing as you are used to, but with the right seasonings, it still can be very flavorful.  In addition, sprinkling dried herbs such as parsley can enhance the eye appeal and taste.

Dietitians work closely with speech and swallowing therapists to determine patients’ nutritional needs and appropriate food and liquid consistencies. Those with head and neck cancer should seek support from a registered dietitian to make they are receiving the proper nutritional needs during treatment.

Learn more about nutrition programs at the Joan Karnell Cancer Center, or how to meet with a registered dietitian at the Joan Karnell Cancer Center at Pennsylvania Hospital.  Learn about nutrition services offered at the Abramson Cancer Center.

Watch videos to learn more about head and neck cancer treatment options offered at the Abramson Cancer Center.

Watch for upcoming recipes on this blog that are modified for smooth creamy textures.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center. Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology. Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of integrative therapies.


She conducts cooking programs and group counseling sessions for cancer survivors.

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Cancer and Older Adults: Meeting a Unique Challenge

Dana Marcone DeDonato, MSW, LSW, is a geriatric oncology social worker at the Joan Karnell Cancer Center at Pennsylvania Hospital and is the coordinator for the Living Well Program.

According to the Administration on Aging, older adults make up the fastest growing segment of the population.. Older adults are more likely to have chronic illnesses that can affect their functioning and their ability to handle stress. These include heart disease, impaired kidney function, memory, vision and hearing loss, as well as poor nutrition and appetite, which may lead to unintended weight loss.
And cancer affects older adults more than any other age group.

Older adults face unique psychosocial issues when confronted with a cancer diagnosis. These issues can be overwhelming for patients and families and can have a negative impact on their well-being and the ability to successfully manage their cancer care.

The Joan Karnell Cancer Center at Pennsylvania Hospital recognizes that older adults with cancer may require specialized care to support them and their families and has created the Living Well Program to meet their needs. The Living Well Program helps older adults use the coping skills they have developed through years of living to help them face cancer with strength, dignity and the ability and desire to make decisions about their own health care goals and treatment.

For many older people, maintaining independence is an issue of paramount importance. However, their disease or treatment may interfere with their ability to function independently and may impact their decisions and desires about treatment. Additionally, the social networks of older adults may be diminished, as a result of death and illness, which can lead to loneliness, isolation and depression.
The Living Well Program at the Joan Karnell Cancer Center provides expert symptom management and support for older adults with cancer.

For some older adults, decisions about how to pay for treatment may be just as important as decisions about the treatment itself. Many older adults live on fixed incomes and may not be able to afford the additional expenses incurred as a result of illness like medical bills, prescriptions and transportation costs.

In addition to planning for their future, it can be helpful for older adults to think about the goals of their cancer care, which can include getting rid of the cancer, living longer, reducing cancer-related symptoms and maintaining function and quality of life. It is important they to talk to their doctor about their goals and expectations for the future so that treatment plans can best meet their needs and help achieve their goals.

National standards for cancer care in older adults(1)have been developed and emphasize the importance of multidisciplinary teams to help address some of the unique issues that have been detailed above. For more information about the Living Well Program, please contact Dana Marcone DeDonato at 215-829-6379 or dana.marcone@uphs.upenn.edu.

(1)Hurria, A., Denlinger, C.S., Extermann, M., Holland, J.C., Karlekar, M.B., McKoy, J., … Walter, L.C. (2012). National Comprehensive Cancer Network: Senior adult oncology: Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 10(2), 162-209.

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Treating Pain In Cancer Patients

Tanya Uritsky, Pharm D, is a clinical pharmacy specialist in pain management and palliative care at Penn Medicine. In this blog, she discusses the role of pain management in cancer care. 

I wear a button on my lab coat that has the word “pain” encircled with a red line through it. I wear it because I am affectionately known as the “No Pain Girl.”

Patients I meet almost always comment on this button and request one of their own. Although these buttons only come in large batches, which tend to be pricey, I know that these patients consider the thought of “no pain” to be priceless.

But another common response to my button is, “No pain, no gain.” I am aware that most of the time this statement is made in casual conversation on an elevator or in a stairwell, but over the past year and a half at Penn, I have found it means so much more than a casual interaction. 

Treating pain in patients with cancer is, for me, associated with providing relief when pain prevails despite great effort.  I’ve created relationships filled with hugs, tears, and unbelievable gratitude and affection in the face of such affliction and uncertainty.

Pain is often a symptom that opens a door for me. The presence of pain is frequently associated with other consequences that can be physically apparent, like nausea or vomiting. Sometimes it may not be so obvious, like depression or anxiety. In treating pain, adverse effects of the drugs can create other symptoms that need to be addressed. Patients may question the meaning of the pain, leading to very real fears such as “Is my disease worse? Will I ever work again?”

I recently made a friend. She is my patient, but our relationship over the past few months makes her seem more like my friend.  When I recently saw she was returning for a potentially curative treatment, I couldn’t resist the opportunity to stop by her room.

When I did, she immediately started to cry. I thought, “What did I do?” Before I could complete that thought, she jumped up and hugged me. She said: “Tanya, you were able to do what no one has been able to do in 10 years. With your help, I was able to live again. Thank you.” 

This is the reward for treating pain in patients with cancer – restoring quality of life and functionality.  It is so much more than medications.  It is a therapeutic relationship.  It is a bond of trust.  It is listening when patients do not feel that they are being heard. 

With all of the medications, the adverse effects, and the treatments, it can be easy to get wrapped up in it all.  But with pain, like the button I wear, there is so much more than meets the eye. What I have come to realize is that what can be gained from the interaction with these patients, is what is truly priceless.

Learn more about Penn’s Symptom Management and Palliative Care Program.
Learn more about cancer pain management on OncoLink.

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Revolutionizing Head and Neck Surgery with TORS

Transoral robotic surgery (TORS) was invented and developed by the pioneering team of Bert W. O'Malley, Jr., MD and Gregory S. Weinstein, MD at Penn Medicine

TORS uses the state-of-the-art da Vinci® Surgical System, which allows surgeons better access to the areas of the throat for the removal of cancers and benign lesions via a minimally invasive robotic approach.

Surgeons benefit by having improved access to the tight confines of the throat and patients benefit in the short term with a faster and easier recovery and, in the long term, by outstanding cancer results and improved swallowing results compared to alternative treatments.

Benefits of TORS can include:

• Quicker return to normal activity
• Shorter hospitalization
• Reduced risk of long-term swallowing problems (most commonly seen with chemoradiation or traditional open surgery)
• Fewer complications compared to traditional open surgery
• Less scarring than traditional open surgery
• Less risk of infection
• Less risk of blood transfusion when compared to open surgery
• No routine use of tracheostomy during surgery

In this video, Drs. O'Malley and Weinstein explain the TORS procedure, and how Penn Medicine is revolutionizing care for patients with head and neck cancer.

TORS patient, Cynthia Miller along with other Penn patients discuss how the TORS procedure changed their lives.

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