Conquering Colon Cancer - Renown Health

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Renown institute foR canceR 14 Feature WRITTEN by MIKALEE byERMAN Is it in the genes? answers about cancer can be found through genetic testing I t’s not often that a spellIng mIstake In an InstRuCtIon manual Can Cause dangeRous Results. But when the “instruction manual” is the genes that comprise a human being, then one spelling mistake can be catastrophic. In fact, it can cause cancer. this is the analogy made by genetic counselors whose work involves trying to discover a patient’s genetic predisposition for hereditary cancer syndromes. while only 10 percent of cancers are hereditary, people at high risk for hereditary cancers — those with a significant family history or who have cancers that have been diagnosed at an early age — can be genetically tested to determine a way to manage their health. Brandy smolnik, ms, a Reno-based genetic counselor, describes discovering hereditary cancer as looking for the spelling mistakes in our personal instruction manuals. “when there are mistakes, a gene doesn’t work properly, and cancer can result,” smolnik said. the mistakes, she noted, are called mutations. and while genetic testing is far from perfect, it can give a patient peace of mind — or the answers they’ve long wondered about. smolnik described 60% of cancers as “sporadic,” meaning there is an age and environmental influence; 30% are familial, where several genes and the environment can play a role; and only 10% are hereditary, meaning a single gene mutation is at fault. genetic testing only covers the cancers in this last category. “primarily we are looking for hereditary breast and ovarian cancer syndromes, including male breast cancer, and Renown joURneY hereditary colon cancer syndrome which can include cancers of the colon, uterus or pancreas,” she said. genetic counselors also assist with developing a plan to maintain health and screenings appropriately. the testing process typically starts with a patient who discusses cancer concerns with a primary care physician. that doctor may refer the patient to a practice like smolnik’s, who works with Robert nathan slotnick, md, phd, a medical geneticist at perinatal associates of northern nevada and medical director of genetics at Renown Institute for Cancer. “Brandy and I work together every day,” dr. slotnick said. “we talk about our patients’ concerns and develop a course of action. this is the best way — to have a genetic forum with a doctor and counselor working together very closely on behalf of the patient.” Before beginning the genetic testing process, a patient should spend time investigating his or her own background and history. “the details make all the difference,” dr. slotnick said. “those who come to us with a lot of information about their own family — when their mom was diagnosed, at what age grandma died of breast cancer, etc. — that gives us more to work with. many of our patients also educate themselves through their own research on the Internet or talking with family members.” genetic testing itself involves a simple blood draw followed by the complex part: a two- to four-week wait. “Before we test, I’ll sit down with patients and discuss the family history, assess the situation and then explain the process,” “reality is so much better than denial.” Mary Moffitt, after undergoing genetic testing for breast cancer smolnik said. “and regardless of the results, I’ll always meet with the patient in person to offer support and explain what happens next.” that level of personalized service is what provides comfort to patients like mary moffitt. the 57-year-old minden resident sought answers from smolnik and dr. slotnick concerning her three bouts with breast cancer that started at age 32. “my mother died at 58 from breast cancer,” she said. “my sister was diagnosed at 40. so I talked to my doctor about my concerns, and he asked if I wanted to know if I carry the gene. that led me to dr. slotnick and Brandy.” But her initial genetic testing — the most common variety, called a BRCa 1 and 2 test — came back negative. smolnik, not satisfied with the result, contacted other genetic counselors throughout the country seeking alternative suggestions. the outcome: a positive result in a test for a rare condition called Cowden syndrome. “this diagnosis gave me the answers I’ve been waiting for since 1983,” moffitt said. “now that I know I have this syndrome, a lot in my life makes sense. the testing itself has been such a wonderful experience. “Reality is so much better than denial,” she said. now we can move forward with answers instead of more questions.” after a history of multiple surgeries for cancer, moffitt says the time she spent going through genetic counseling has been refreshing and rewarding. “Brandy is such a great listener, and she really spent time trying to understand my history and explaining options,” she said. “she left me to make my own decisions. I only wish I had done the genetic testing Patient mary moffitt discusses her genetic testing results with brandy smolnik, ms, a reno-based genetic counselor. sooner, as I’m just relieved to have the answers.” ■ r. Nathan slotnick, mD, PhD R. Nathan Slotnick, MD, PhD, is Medical Director of Genetics at Renown Institute for Cancer and a Perinatologist at Perinatal Associates of Northern Nevada. Dr. Slotnick has a master’s degree in Molecular Genetics from the University of Washington and a doctorate degree from the State University of New york, buffalo. He earned his medical degree from the University of Pittsburgh. Dr. Slotnick completed his residency and Fellowship training at University of California San Francisco. renown.org 15
Renown institute foR canceR 16 Feature WRITTEN by bRANDI SCHLoSSbERG kid-centric children’s infusion center eases the treatment process for young patients L ong hospItal vIsIts aRe not muCh fun foR anyone, let alone ChIldRen and teens. But young patients requiring infusion therapy, such as chemotherapy or a blood transfusion, must spend hours at a time receiving treatment. Renown joURneY to make that time as enjoyable as possible, Renown Institute for Cancer and pediatric services is excited to open the Children’s Infusion Center in spring 2009. located in the sierra tower near pediatric specialty Care, the new center will offer both comfort and convenience as caroline Hastings, mD, medical Director of Pediatric Hematology and oncology at renown institute for cancer, visits with young patient Heather Pauly. “if these kids are going to be with us for four or eight or 10 hours at a time, we need to have a place that meets their needs. This space is set up so they won’t feel like they’re in a hospital all day.” Caroline Hastings, MD, Medical Director of Pediatric Hematology and Oncology well as double the current capacity for children’s infusion treatments. opening the Children’s Infusion Center further confirms Renown’s reputation as a leader in pediatric cancer care and hematology. It’s the only hospital in northern nevada that offers comprehensive care for childhood cancer. Renown officials report that nearly 350 children currently are living with cancer or blood disease in northern nevada. Infusion therapy for these patients often takes place two or three times a week, and each session typically lasts one to eight hours or longer. “we want the Children’s Infusion Center to be a feel-good place,” said Caroline hastings, md, medical director of pediatric hematology and oncology at Renown Institute for Cancer. “we want to accommodate a range of young patients who need to be at the hospital for extended periods of time, without actually being admitted.” to help build the new Children’s Infusion Center, Renown received a $25,000 grant from the keaton Raphael memorial, a nonprofit group dedicated to supporting local children with cancer and their families. Creating a healing environment was key. the new Children’s Infusion Center will provide young patients with a dedicated area to recieve their treatment. Colors, furniture and artwork were all designed with the children in mind. the center features an open layout that allows the staff to better interact with and observe patients, dr. hastings said. Comfortable chairs will add to the nurturing atmosphere. toys, games, books, blankets, stuffed animals, a craft table, reading corner, tv screens, dvd players, movies and video-game consoles provide distractions. “If these kids are going to be with us for four or eight or 10 hours at a time, we need to have a place that meets their needs and is comfortable,” dr. hastings said. “this space is set up so they won’t feel like they’re in a hospital all day.” a large donation to the keaton Raphael memorial, made by the family of a young patient who passed away, was used to add these kid-friendly amenities to the Children’s Infusion Center, including an array of books. “In memory of that child, who was an avid reader, we’re creating kylee’s korner, a library inside the Children’s Infusion Center,” dr. hastings said. Leading technology, close to home the Children’s Infusion Center serves kids and teens with all types of cancer including leukemia, as well as those with tumors, blood, kidney or lung disease and other major illnesses. treatment for these conditions often includes infusion therapy, a method of giving drugs or fluids. “some forms of infusion therapy are for the actual treatment of the cancer, such as chemotherapy,” hastings said, “and others may be treating the side effects, like antibiotics or fluids for infection or dehydration.” according to lizzie dalton, executive director of the keaton Raphael memorial, approximately 45 new childhood cancers are diagnosed in northern nevada each year. “once the Children’s Infusion Center is here, it will help us get a better grip on what the numbers actually are for childhood cancer in nevada,” she said. ■ If you wish to support the Children’s Infusion Center and other forms of care for childhood cancer at Renown, please contact the Renown Health Foundation at 775-982-5545. caroline Hastings, mD at Renown Institute for Cancer Caroline Hastings, MD, is the Medical Director of Pediatric Hematology/oncology at Renown Regional Medical Center. She also serves as Director of Pediatric Hematology/oncology Fellowship for Children’s Hospital & Research Center oakland, where she practices as pediatric hematologist/oncologist and pediatric neurooncologist. She received her graduate education at the University of California, Davis School of Medicine. renown.org 17
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