WOM N WOM N - Mount Sinai Hospital

WOMAN TO WOMAN VOLUNTEERS
TELL THEIR DIAGNOSIS STORIES TO
SECOND-YEAR MEDICAL STUDENTS
DR. KALIR’S
EXCITING RESEARCH
Dr. Tamara Kalir, Associate Professor of
Pathology and Course Director of “Sexual
and Reproductive Health and Disease,”
had wanted to include a patient panel in her course
to heighten awareness of, and sensitivity to, the
patient’s point of view. As
soon as Woman to Woman
began, Dr. Kalir worked
closely with Arden Moulton,
the Woman to Woman
Program Coordinator, to
organize the details.
In my interview with
Dr. Kalir, she expressed
deep appreciation for all
the survivor volunteers
who participated in the
past five years, including
Valerie Goldfein, the late
Silvana Keegan, Vivian
Port, Joyce Manheimer,
Jane Lury, Joan Brown,
Pamela Herman Elliott,
Nancy Irizarry, and Linda
Newson.
“The student response
has been very positive,” she
said. “Conventional teaching
is intellectual; patients’
stories are a contribution to
the emotional component
of learning. Everybody has
a different story. Each one
is so individual. In the classroom, we present
standard medical teaching and the Woman to
Woman panel follows. This allows us to drive the
intellectual points home emotionally.”
Survivor volunteers tell their stories so that
students can hear firsthand not only how difficult
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(Left To Right) Nancy Irizarry, Pamela Herman Elliott,
Joyce Manheimer, and Dr. Tamara Kalir.
Nancy Irizarry, Survivor Volunteer, speaking with
a medical student after panel presentation.
it is to confront a cancer diagnosis, but also, in
the case of ovarian cancer, how difficult it can be to
diagnose it correctly and quickly.
“Because ovarian cancer is such a difficult
clinical diagnosis, it is important to consider it in
the differential diagnosis,”
Dr. Kalir said. “A delayed
diagnosis may negatively
impact prognosis.”
Many in the class will
become primary care physicians,
and we hope that
our personal stories will
remain with the students.
The students were told
about the survivor volunteers’
symptoms and their
experiences with missed
diagnoses and insensitive
doctors. Medical students
heard about our feelings
of confusion and fear,
sadness and anger. One of
the women related how
she was engaged to be
married when diagnosed
at age 36. Another
described how she had
just finished chemotherapy
for breast cancer
when she was diagnosed
with both uterine and
early-stage ovarian cancer.
Another volunteer told of gastrointestinal problems
that her doctors did not recognize as symptoms of
ovarian cancer. Yet another told how she was given
her diagnosis abruptly and without compassion. Dr.
Kalir sums it up perfectly when she says, “We want
them to be humanitarians as well as good scientists.”
Dr. Kalir herself is an excellent role model for the
students. She’s also an excellent teacher. I know that
because she explained so clearly to me the exciting and
original ovarian cancer research she’s working on with
Drs. Peter Dottino, Stave Kohtz, and Yayoi Kinoshita.
Funded by the Gynecologic Cancer Research Fund in
the Division of Gynecologic Oncology, the research
is designed to help doctors better understand what
causes ovarian cancer at the molecular biology level
and to discover new therapies to offer patients. What is
so innovative is that they are focusing on “the nuclear
membrane pore complex.”
The pore is a multiprotein structure that forms
a hole in the double-layer membrane of the nucleus
of a cell (all body tissue is made up of hundreds
of thousands of cells, and the nucleus is like the
command center for the cell). The pore is important
in information exchange between the nucleus and
the rest of the cell (the cytoplasm). The pore can be
considered a gateway of information exchange.
Because of the role it plays, it seems that it should be
Schematic diagram of a nuclear pore, showing the
doughnut shape with pore (opening) in the center.
Nuclear pore seen with an electron
microscope, magnified 200,000 times.
critical in regulating cell growth in the development of
cancer, since cancer is a dysregulation of growth. The
hypothesis is that in cancer, the pore might not be
bringing correct information to the cell.
“Recently, we discovered that the pore appears to
be a critical regulator of cell growth in the G1 phase
of the cell cycle,” Dr. Kalir explained. “We are looking
at one of the proteins within the pore complex
called NUP 62 that sits in the center. It holds the pore
intact.” Dr. Kinoshita has developed ovarian cancer
cell lines that are deficient in this protein and their
pores are larger. These cells grow differently than
other cancer cells.
“This type of research holds promise for developing
new drug therapies for ovarian cancer,” explained
Dr. Kalir. “For example, if one protein in the pore
complex is either abnormal or missing, we might be
able to replace that protein.”
Since there are over 200 proteins in the pore, there
are many possible approaches to try.
Let’s hope that the initial discovery involving
NUP 62 will provide the key to unlocking very
important information for everyone awaiting a
breakthrough in ovarian cancer research. Dr. Kalir
and her team may have made a promising start
toward that goal. —VIVIAN PORT
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