“Do not go where the path may lead, go instead where there is no
Transcription
“Do not go where the path may lead, go instead where there is no
11/17/03 1:29 PM Page 2 “Do not go where the path may lead, go instead where there is no path and leave a trail.” — Ralph Waldo Emerson [ 2 0 0 3 A N N U A L R E P O R T ] 147-216 MCG CC AR 03/mech 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM Page 4 C O N T E N T S From the Presidents . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 From the Committee Chair . . . . . . . . . . . . . . . . . . . . . 3 From the Lab to the Bedside Reaching Out to Our Community Head and Neck Tumor Board Formed . . . . . . . . . . . . . 5 Camp Rainbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Green Tea Research Uncovers Cell Pathways . . . . . . . . 6 Gynecologic Cancer Awareness Month . . . . . . . . . . . 13 Enhancements Underway at Prostate Cancer Support Group . . . . . . . . . . . . . . . . . 13 Georgia Radiation Therapy Center . . . . . . . . . . . . . . . 7 Prostate Cancer Awareness Week . . . . . . . . . . . . . . . . 13 Mobile MRI Acquired . . . . . . . . . . . . . . . . . . . . . . . . . 7 Breast Cancer Awareness Month . . . . . . . . . . . . . . . . 13 Gynecologic Cancer Prevention Center Expands . . . . 7 Lung Cancer Awareness Week . . . . . . . . . . . . . . . . . . 13 Two Programs Aim to Snuff Out Smoking . . . . . . . . . . 8 Tips for Tobacco Prevention . . . . . . . . . . . . . . . . . . . 13 Cancer Research Building Funding Obtained . . . . . . . 9 Great American Smokeout . . . . . . . . . . . . . . . . . . . . . 14 Interdisciplinary Research Building Addition Health Hotline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Nears Completion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Relay for Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Study Pursues Self-Destruction of Susan G. Komen Foundation Ultimate Drive™ . . . . . 14 Prostate Cancer Cells . . . . . . . . . . . . . . . . . . . . . . . . . . 9 National Oral Cancer Screening Week . . . . . . . . . . . . 14 Study Focuses on How Cancer Cells Spread . . . . . . . 10 Tour de Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 New Treatment for Ovarian Cancer Studied . . . . . . . 11 MCG Breast Cancer Support Group . . . . . . . . . . . . . . 15 Study Targets Natural Mechanism for Cell Death . . . 11 Share and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Star Wars Helps Locate Cancer Cells . . . . . . . . . . . . . 11 Sibling Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Cancer Registry Cancer Committee . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Cancer Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Multidisciplinary Cancer Conferences . . . . . . . . . . . . 18 Distribution by Site and Stage: 2002 Analytic Cases . . 20 Where the Patients Live: 2002 Analytic Cases . . . . . . 21 2002 Analysis: Ovarian Cancers . . . . . . . . . . . . . . . . 22 Statistical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Glossary . . . . . . . . . . . . . . . . . . . . . . Inside Back Cover Contact Us . . . . . . . . . . . . . . . . . . . . Inside Back Cover 1 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM Page 5 F R O M T H E P R E S I D E N T S Dr. Daniel W. Rahn Don Snell President President & CEO Medical College of Georgia MCG Health, Inc. The Medical College of Georgia (MCG) campus We have significantly enhanced our technological community is an academic medical center. We are capabilities. For example, we have upgraded and different from a community hospital. We conduct expanded our Intensity Modulated Radiation Therapy pioneering research that defines tomorrow’s medicine potential. We acquired an open, combination Positron and we apply those discoveries to today’s patient care. Emission Tomography/Computerized Tomography Our cutting-edge treatments go from the lab bench to scanner with simulation ability and we obtained the the patient bedside with warp speed instead of at a services of a mobile Magnetic Resonance Imaging unit. snail’s pace. From preventive care to early diagnosis to At a 1996 benefit for Georgetown University’s Center innovative treatment, we offer our patients one-stop for Breast Cancer Research, the late Princess Diana of shopping. Our highly trained, board certified physicians Great Britain said, “The story of breast cancer is no provide a multidisciplinary approach to comprehensive longer the story of death, but one of new, improved patient care. life.” That is our hope for all cancers. We are fighting cancer – all cancers – by contributing to the body of We recently recruited a number of world-class physicianknowledge and by demonstrating the effectiveness of a scientists. We attracted Dr. Thomas Wang and Dr. Daniel variety of treatments. Albo, nationally known surgical oncologists, from M.D. Anderson. Hematology/oncology physicians This report highlights our many efforts to prevent, Dr. Oscar Ballester and Dr. John Hiemenz joined our diagnose and treat cancer. And, perhaps more impor- faculty after spending a number of years at Albany tantly, this report tells of our initiatives to understand Medical Center/Moffitt. We have seven Georgia Cancer cancer and, therefore, control the course of the disease. Coalition scholars and a large cadre of MDs and Ph.D.s Sincerely, conducting cancer research. Dan Rahn 2 Don Snell 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M T H E Page 6 C A N C E R C O M M I T T E E C H A I R The American Cancer Society and the Georgia Hospital The quality of our oncology program was recognized in Association predict that there will be an estimated September 2002 when we received a three-year accredita- 1.3 million new cancer cases in the U.S. this year, tion from the American College of Surgeons. The surveyors of which more than 33,000 will be Georgians. awarded us a perfect score, which placed our program Approximately 565,000, or 1,500 a day, are expected to in the top quartile among nearly 1,200 programs. die. Cancer is the second leading cause of death, one of For the past several years, we have worked hard to forge every four, in the U.S. and Georgia. a collaborative educational, research and clinical partDo we stand a chance against such a powerful, nership between the Medical College of Georgia and mysterious and prevalent disease? Emphatically, yes. the University of Georgia. Our goal is to build on the The number of recent advances and the successful strengths of our respective institutions to secure National treatment protocols give me great confidence and Cancer Institute designation as a Comprehensive optimism. MCG has played a key role in cancer Cancer Center within eight years. We took a step in the research and in patient treatment, of which you will right direction this year when the state approved two learn more in the following pages. cancer designations for the region and us. First, the Georgia Cancer Research Center, a collaborative proposal from MCG and the University of Georgia, received provisional designation as a Cancer Center of Excellence. Second, the East Georgia Cancer Network, composed of Augusta and Athens hospitals and physicians, received designation as one of three Regional Programs of Excellence. Sincerely, Dr. W. Chris Sheils 3 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM Page 7 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 8 T H E L A B T O T H E B E D S I D E Head and Neck Tumor Board Formed PET/CT scan Each week a multidisciplinary Head and Neck Tumor Board, composed of specialists from head and neck surgery, medical oncology, radiation oncology, oral same morning, the group reconvenes with each patient surgery and speech pathology, meets and prospectively and schedules any appointments and interventions evaluates newly referred patients. Following those necessary to begin treatment. one-stop patient evaluations, the team reviews X-rays In addition to providing patients with access to multiple with radiologists and histology slides with pathologists. specialists in a single setting, the Tumor Board serves as All reasonable treatment options, including state-of-the- an excellent source for recruiting patients for clinical art protocols, are considered in a spirited discussion.That trials and testing new treatment modalities. Because of our pioneering nature, we offer innovative surgical techniques, including minimally invasive neck surgery. MCG Health System is the only institution in the South that offers thyroidectomy under local anesthesia and parotidectomy through a facelift incision that helps hide the scar. The Head and Neck Tumor Board is spearheaded by Dr. David J. Terris, a physician-scientist who joined MCG to head the newly created Department of Otolaryngology (head and neck surgery) after serving for many years as a physician leader at Stanford University. Dr. Terris In November 2002, 56-year-old Bill Matlock began to have trouble swallowing, especially solid food. His general practitioner referred him to Dr. David J. Terris, who diagnosed Matlock as having laryngeal liposarcoma, a tumor located in an unusual site in his larynx. In December 2002, Dr. Terris performed a partial laryngectomy to remove about half of Matlock’s voice box and reform his vocal was selected from among 39 candidates for the Gyrus Leadership Development Program of the American Academy of Otolaryngology, a new program designed to foster leadership qualities. cords using tissue and muscle from Matlock’s throat. Matlock’s 21-year-old daughter, Brenna, said that the news of her father’s cancer was unexpected. "We’re grateful that Dr. Terris was able to leave half of his voice box in place so that he still has a voice." Matlock (left) is pictured with Brenna (right), who is holding her daughter, Keeley. Dr. Terris is in the center. 5 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 9 T H E L A B T O T H E B E D S I D E Green Tea Research Uncovers Cell Pathways Cell Biologist Dr. Stephen Hsu, who helped identify He further found that P-57, a protein that helps regulate cancer-fighting properties in green tea, has traced the cell growth and differentiation, changes the behavior juncture at which healthy cells are shuttled to safety of healthy cells as polyphenols target cancer cells for and cancer cells are sentenced to death. destruction. This change of behavior protects the healthy cells. Dr. Hsu has been intrigued by the properties of green tea since observing that Asians – who typically drink green His latest, and perhaps most dramatic finding is that tea on a regular basis – have much lower cancer rates the polyphenols actually activate two separate path- than other populations. His research helped determine ways, one for normal cells and one for cancer cells. The that compounds in the green tea, called polyphenols, polyphenols seem to serve as a sentinel, separating cells help eliminate free radicals that can alter DNA, cause with P-57 from cancer cells, which lack P-57. Using mutations and lead to cancer formation. human cancer cells, he found that while the normal cells are shuttled to safety, the polyphenols destroy the mitochondria of cancer cells. Dr. Stephen Hsu Cell Biologist 6 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 10 T H E L A B T O T H E B E D S I D E Enhancements Underway at Georgia Radiation Therapy Center Gynecologic Cancer Prevention Center Expands The Georgia Radiation Therapy Center has undergone The Gynecologic Cancer Prevention Center has been in significant improvements and additions, enabling it to operation for three years. Due to its growing reputation, increase the types of services it offers to greater numbers the center saw an increase in the number of referrals of cancer patients throughout the region. from across Georgia and from much of South Carolina during the past year. The program provides women an Improvements include an upgrade to one of our four expert level of care that is unmatched in the Southeast. linear accelerators to provide Intensity Modulated Radiation Therapy (IMRT). IMRT gives cancer patients In addition to patient care, the center focuses on teaching the benefit of much more precise and focused radiation and research in the areas of cervical, vulvar and vaginal treatment. In addition, we have purchased an additional neoplasias. Dr. Daron Ferris, Director of the center, is also IMRT-ready accelerator. a co-investigator of several studies involving HPV vaccines, one of which made national headlines. The center has The Georgia Radiation Therapy Center has been also been extensively involved in the development expanded to house an open, combination PET and CT and evaluation of fluorescent and reflective spectroscopy scanner with simulation capability. The Positron Emission equipment used to diagnose and triage women with Tomography/Computerized Tomography scanner procervical neoplasia. The center’s tissue bank continues to vides the best diagnostic imaging technology available expand with the addition of an international for detecting cancers early, evaluating recurrence and collaboration with Chiang Mai showing the patient’s response to therapy. University, Thailand. Mobile MRI Acquired We recently acquired the services of a mobile Magnetic Resonance Imaging (MRI) unit, our third MRI. This unit helps us meet our growing patient demand by allowing us to perform an additional 30 procedures a week. 7 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 11 T H E L A B T O T H E B E D S I D E Two Programs Aim to Snuff Out Smoking Researcher Jeannette Andrews is conducting a pilot Dr. Martha Tingen, Associate Professor of Nursing study to test a community-based smoking cessation Science, who has focused on tobacco prevention in program targeting impoverished black women in children, designed Project GIFT to help reduce the Augusta-Richmond County. The program, funded by number of Georgians who smoke and are exposed to the American Cancer Society, began with a call for help secondhand smoke. Tobacco causes 87 percent of all from a guidance counselor at Jenkins-White Elementary lung cancers in the state. School, where the counselor noted high rates of asthma and respiratory diseases – the effect of second-hand smoke – in the school’s pupils. The curriculum, taught by public school nurses, includes 15 classes of Life Skills training to help students learn to resist substance abuse and to live a healthy lifestyle. The culturally appropriate anti-smoking campaign Nearly 550 students and parents/guardians were recruited includes an advisory board to disseminate smoking- to participate in Project GIFT. prevention information to young people; a community message board in Barton Village to provide positive health messages; coordination with a federally funded WEED and SEED program to battle crime and cultivate Karlton Clay is a 17-year-old Davidson Fine Arts student who was first diagnosed community growth; and mentoring, tutoring and with leukemia in March 2002. His cancer is in remission. He is a very positive and optimistic young man and hopes to some day write movie, TV and stage parenting classes. Another element in the intervention scripts as well as books that incorporate the lessons he’s learned as a result of program is to employ adult women who have already having cancer. "We’ve had awesome treatment at MCG," said his mother, Sonya. stopped smoking to serve as community health advisors. His father, Kenneth, added: "The manner in which our caregivers explained the disease and the treatment plan helped us get a good understanding of These community health advisors assist with smoking- leukemia and helped to make it easier for all of us to accept." cessation programs for women living in the Barton Karlton is pictured with Dr. Michelle Brenner (left), a Pediatrician in Chapel school district. Hematology/Oncology, and his mother, Sonya (right). In a second program, MCG joined forces with the Georgia Division of Public Health to give Georgia youth the GIFT of a tobacco-free life. Project GIFT (Georgia’s Initiative to Fight Tobacco) is a statewide initiative targeting sixth grade classrooms in each of the state’s 19 public health districts. 8 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 12 T H E L A B T O T H E B E D S I D E Cancer Research Building Funding Obtained The Robert W. Woodruff Foundation, Inc. awarded a $2 million grant to support construction of a $46.9 million Dr. M. Vijay Kumar Molecular Biologist and Director of Research, cancer research building. We received $10 million in Section of Urology funding from the state of Georgia to plan, design and assist with the construction of the building. MCG also has submitted requests for federal support as a partial or complete match for state support. The balance of funding will be raised through philanthropic support of individuals and charitable foundations as well as support from the MCG Physicians Practice Group. The cancer research building is a key component of Study Pursues Self-Destruction of Prostate Cancer Cells MCG, the University of Georgia and the cities of Augusta Prostate cancer cells skilled at avoiding self-destruction are and Athens being a regional cancer center as well as the target of research by Dr. M. Vijay Kumar, Molecular MCG’s and the University of Georgia’s provisional Biologist and Director of Research for the Section of designation as a Center of Excellence through the Urology. He found that when hormone-dependent Georgia Cancer Coalition. cancer cells are treated with anti-hormone therapy, some manipulate their internal workings to avoid destruction. Interdisciplinary Research Building Addition Nears Completion Construction nears completion on the 94,000-square- He is exploiting the death pathways that all cells have in order to find a safe, effective way to get prostate cancer cells to self-destruct. foot addition to the Interdisciplinary Research Building. The addition will double the building’s available research space. Cancer research will be one of the major areas for study. Stem Cell Gene Transfer 9 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM F R O M Page 13 T H E L A B Dr. Thomas N. Wang Surgical Oncologist, Cancer Researcher, T O T H E B E D S I D E Since coming to MCG from the University of Texas M.D. Anderson Cancer Center, Dr. Wang has also and Georgia Cancer Coalition Distinguished Cancer Clinician and Scientist become interested in the potential for manipulating the immune system to target destruction of cancer. MCG researchers have identified a mechanism that enables the immune system to ignore a developing fetus, which is genetically foreign to the mother and should be rejected by her immune system. Mounting evidence indicates that some cancer tumors may also utilize this mechanism to escape attack. Dr. Wang is looking for ingenious ways to target tumors and cancer cells and Study Focuses on How Cancer Cells Spread eliminate the need for current therapies that don’t Why liver and pancreas cancer cells are so good at He is applying some of the new knowledge in a study invading healthy tissue is a question currently being looking at the lymph nodes of patients with pancreatic studied by Dr. Thomas N.T. Wang, Surgical Oncologist cancer, to see if he can identify a sentinel lymph node and Cancer Researcher, and Georgia Cancer Coalition where this cancer most typically spreads and whether Distinguished Cancer Clinician and Scientist. Pancreatic that node has unique characteristics that make it cancer, colorectal cancer that spreads to the liver and an easy place to spread. He is hopeful that identifying primary liver cancer are all extremely invasive. Dr. Wang the sentinel lymph node for pancreatic cancer could is studying the characteristics of these cancer cells also lead to better ways to stage pancreatic cancer, that allow them to invade structures so well. as it has for melanoma and breast cancer. This may differentiate between cells to kill all dividing cells. also help identify a tumor marker that will aid in diagnosing the disease. 10 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM F R O M Page 14 T H E L A B Dr. Sharad Ghamande Assistant Professor, T O T H E B E D S I D E Dr. Michael S. MacFee Chief of Gynecologic Oncology Gynecologic Oncology New Treatment for Ovarian Cancer Studied Dr. Sharad Ghamande, Assistant Professor of Gynecologic Oncology, is a principal investigator and Dr. Michael S. MacFee, Chief of Gynecologic Oncology, is a sub-investigator in an international study that adds Interferon gamma 1-b to the standard treatment protocol for women with late-stage ovarian cancer. The agent stimulates the immune system to identify and eliminate abnormal cells. Star Wars Helps Locate Cancer Cells A new cellular-imaging system based on technology developed by NASA as part of the U.S. Strategic Defense To ensure that the latest treatments under evaluation are available to all of its patients, Gynecologic Oncology became an affiliate member of the National Cancer Institute’s Gynecologic Oncology Group, which gives the doctors and their patients access to all NCI- Initiative, better known as Star Wars, helps MCG Health System pathologists locate cancer cells. We are the first in the region to use the ChromaVision Automated Cellular Imaging System to detect, count and classify abnormal cells based on color, size and shape. sponsored clinical trials. This new technology can locate a single tumor cell among 10 million normal cells and track numbers of Study Targets Natural Mechanism for Cell Death As cells take their first steps toward becoming cancer, a gene called p53 often realizes something is amiss and causes wayward cells to self-destruct. Dr. Andrew C. Phillips, Molecular Biologist and Georgia Cancer Coalition cancer cells to determine if the disease is proliferating. It can also measure the quantities of certain proteins expressed by cells, important in determining the efficacy of cancer drugs and a patient’s prognosis. Pathologists can then provide oncologists with a comprehensive report that will assist in their clinical decision-making. Distinguished Cancer Scientist, is working to understand The system is being primarily used to detect breast cancers, how that self-destruction, called apoptosis, happens. His but also has applications for gastrointestinal tumors, goal is to find the genes involved in apoptosis that may be which have a well-recognized set of tumor markers. lost or mutated in cancer, so that more effective and less toxic cancer treatments that target these genes can be found. 11 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 15 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 16 R E A C H I N G O U T T O O U R C O M M U N I T Y Camp Rainbow Prostate Cancer Awareness Week Each year, we host Camp Rainbow, a free summer camp Prostate Cancer Awareness Week was commemorated for children with cancer or a rare blood disease. The in September by Urologic Oncologist Dr. James A. Brown, weeklong camp is held at Camp Twin Lakes in Rutledge, Georgia Cancer Coalition Distinguished Cancer Clinician Ga., and allows children to enjoy a break from and Scientist. Dr. Brown provided community education hospital stays and physician visits. through the news media about detection methods and encouraging men over 40 to get examined and tested. To help raise funds, the MCG Children’s Medical Center hosted the ninth annual Camp Rainbow Benefit Open Horse Show at the Hippodrome Horse Complex in North Breast Cancer Awareness Month We teamed with the American Cancer Society to offer Augusta. The show was open to equestrians of all ages. educational literature, videos and demonstrations. Classes included English, Western, Championship and Cancer Center Nurse Manager Kim Cheely also used Exhibition, with awards for first through sixth place. the news media to tell women about the risk factors As a prelude to the camp, T-Bonz Restaurant hosted and the importance of early detection through the Annual Teen Night for Camp Rainbow participants. mammograms and self-examinations. After having a free steak dinner, the campers visited Funsville for an evening of fun and games. Lung Cancer Awareness Week Oncologist Dr. Andre Kallab provided public education Gynecologic Cancer Awareness Month about early detection and screening examinations Dr. Michael MacFee, Chief of Gynecologic Oncology, through the news media. He also encouraged smokers commemorated Gynecologic Cancer Awareness Month to quit and asked nonsmokers not to start. in September by issuing diagnostic and prevention tips through the news media. He encouraged women to Tips for Tobacco Prevention help prevent, detect and treat gynecologic cancers by Dr. Robert Pendergrast, Director of Adolescent Medicine, getting an annual exam and having a pap smear. prepared an article in which he encouraged parents to use the American Cancer Society’s annual Great American Smokeout as an opportunity to begin a dialogue with their adolescent children about the dangers of smoking. 13 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 17 R E A C H I N G O U T T O O U R C O M M U N I T Y Left: We recognize that children, regardless of their health, need to be children, so we provide our pediatric oncology patients with ample opportunities to forget about their health and focus on having fun. Right: MCG Health System Mammography Technicians Kellie Bedenbaugh and Andrea Phommachanh were just two of the participants of The BMW of North America, Inc. Ultimate Drive for the Susan B. Komen Breast Cancer Foundation. Great American Smokeout The Ultimate Drive™ Free tobacco cessation and prevention information was Nurse Gita Giddens and Marketing Specialist Kate Wicker available as we took part in the American Cancer Society’s served as Co-chairs of The BMW of North America, Inc. national initiative to help people quit smoking. The Ultimate Drive for the Susan B. Komen Breast Cancer public was invited to stop by information tables staffed Foundation held at Taylor BMW, for which we helped by health care professionals who answered questions raise nearly $7,000. The Ultimate Drive is a nationwide about how smoking affects the body and offered guide- breast health awareness campaign where participants are lines on how to quit successfully. invited to test drive a new BMW. For each mile driven, BMW contributes $1 to the Foundation on behalf of Health Hotline the driver. Urologic Oncologist Dr. Martha Terris participated in the Tamika Weaver, Senior Administrative Secretary in Health Hotline co-sponsored with The Augusta Chronicle, Cardiology, was honored as a “Local Hero” at the event. in which members of the public called in to have their Weaver was diagnosed with breast cancer at 27. Now health questions answered. Prostate cancer (risk factors, 29, she has been an active volunteer with the Breast diagnosis, surgical treatment, seed implants, hormone Cancer Support Group for the past two years. Weaver treatment and nutritional therapies) was among the also served as a team captain during the 2002 and 2003 topics covered by Dr. Terris. American Cancer Society Relay for Life fund-raisers, and Relay for Life is a volunteer with the American Cancer Society Reach to Recovery program. Each year, we actively support the American Cancer Society’s Relay for Life of Richmond-Columbia County. In 2003, our faculty, staff, students, cancer patients and family members raised $20,708.11. Andy Anderson, Director of Materials Management, and Shawn Vincent, the Administrative Director of our Comprehensive Cancer Center, served as event Chair and Co-chair, respectively. 14 National Oral Cancer Screening Week The Ear, Nose and Throat Department offered free screenings for head, neck and oral cancers, which are more prevalent in the South. 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 18 R E A C H I N G O U T T O O U R C O M M U N I T Y Tour de Georgia Sibling Day The Cancer Center was a sponsor of the inaugural Tour Siblings want their sick brother or sister to get better, de Georgia. The event is a six-day professional cycling but often they feel left out because of the amount of race sanctioned by the International Cycling Union. attention focused on the sick child. Many times, they Proceeds of Tour de Georgia benefited the Georgia Cancer simply don’t understand what their sick sibling has to Coalition, a public/private partnership that coordinates endure. Annually, we host Sibling Day to provide siblings the development of world-class, comprehensive cancer of children with cancer the opportunity to visit the control programs. clinic and learn about hospital and treatment routines. Breast Cancer Support Group The Breast Cancer Support Group meets the first Thursday of each month. For further information, contact Nurse Gita Giddens at 721-1467. Share and Care Each year, MCG Health System invites children recently diagnosed with cancer and their families to participate in a weekend retreat to share their experiences in a relaxed, nonclinical environment. Special programs are offered to help parents understand the challenges that await them and the treatments their children will face. While parents engage in support groups, the children and their siblings enjoy fun activities. Twenty-nine-year-old Tamika Weaver was diagnosed with breast cancer at 27. She underwent a mastectomy on her right breast with reconstruction in September 2001. She did not require chemotherapy treatment. “At any age, it is devastating to learn that you have breast cancer, but particularly so when your life is just beginning. I was lucky to find compassionate, state-ofthe-art care at MCG.” 15 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 19 C A N C E R W. Chris Sheils, MD Cancer Committee Chair Radiation Oncology Christine Gourin, MD Otolaryngology-Head and Neck Surgery Oscar Ballester, MD Medical Oncology Richard Hessler, MD Pathology James A. Brown, MD Surgery/Urology Shannon Horne, RN Children's Medical Center Patient Care Services Lee Bultman Social Work Services Kim Cheely, RN, BSN, OCN Patient Care Services Katrina Fortier Quality Management 16 Deborah L. Humphrey Public Relations Melissa H. Jarriel, RHIA, CTR, CHP Health Information Management Services C O M M I T T E E Angela Lambert, RN Hospital Administration Michael MacFee, MD GYN Oncology James Rawson, MD Radiology Carolyn Sanders, CTR Registry Services David Terris, MD Otolaryngology-Head and Neck Surgery Roger A. Vega, MD Pediatric Hematology and Oncology Shawn Vincent Comprehensive Cancer Services Miriam Whaley, RHIA, CTR Registry Services Marilyn Yarmon, RHIA, CTR Georgia Radiation Therapy Center Karen Yeh, MD Surgery Oncology 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 20 C A N C E R R E G I S T R Y The Cancer Registry collects data about each cancer The resulting data illustrates statewide and nationwide patient diagnosed or treated at our inpatient and trends in cancer incidence, and helps clinicians and outpatient facilities. Established in 1985, the Cancer researchers evaluate the effectiveness of different types Registry now has more than 14,200 cases in the database. of treatment. A Registry Services Administrator and a Registry Services In 2002, the registry staff accessioned 870 new cases, Specialist II, both of which are Certified Tumor Registrars, 786 of which were diagnosed or received first course staff the MCG Cancer Registry. Their work begins when treatment here. More than 4,500 cases are under a new patient is diagnosed or referred. The registrars active follow-up. The registrars also coordinated our collect the demographic, tumor, staging, treatment Multidisciplinary Cancer Conferences and bimonthly and follow-up data that forms the complete picture of Cancer Committee meetings, assisted in preparations for each patient’s cancer experience. Completed cases are the American College of Surgeons Commission on Cancer submitted to the Georgia Comprehensive Cancer accreditation survey, contributed to this Annual Report, Registry and to the National Cancer Data Base, a joint and reported data to clinicians and administrators. project of the American Cancer Society and the For more information about our activities or the cancer Commission on Cancer of the American College of information we collect, please call (706) 721-1768. Surgeons. In both of these larger databases, our data is combined with data from other submitting facilities. 17 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 21 M U L T I D I S C I P L I N A R Y C A N C E R C O N F E R E N C E S MCG Health System and Augusta Veterans Administration professionals meet weekly to discuss challenging cancer cases during multidisciplinary cancer conferences. These conferences are held on Wednesdays at 3:30 p.m. in our fourth floor Amphitheater. The conferences review the medical, surgical and radiation oncology perspectives of each case, which are correlated with the radiologic and pathologic findings. This provides an ideal forum for rendering a multidisciplinary opinion, promotes American Joint Committee on Cancer staging, and serves to educate the medical staff. In 2002, comprehensive cancer conferences were held under the direction of Karen Yeh, MD. A total of 109 cancer cases were presented at the conferences with an average attendance of 17 medical professionals. The multidisciplinary group included hematology/ oncology, surgical oncology, surgery, radiation therapy, pathology, radiology, nursing oncology, and allied health representatives and students. In addition, more than 90 departmental cancer conferences were held during 2002. Multidisciplinary cancer teams reviewed each of the cases to determine treatment options and to discuss patient outcomes. Current Management of Ovarian Cancer William Hoskins, MD Mercer University Savannah, Ga. Dendritic Cell-Based Cancer Vaccines Jim Mulé, Ph.D. Director, Tumor Immunology Program of the Comprehensive Cancer Center University of Michigan Medical Center Ann Arbor, Mich. Acute Chest Syndrome In addition, the following cancer-related lectures and seminars were presented. 18 Iris Buchanan, MD Pediatric Hematology/Oncology Morehouse School of Medicine Atlanta, Ga. STAT Activation in Acute Myeloid Leukemia: A Model for Targeted Molecular Therapy Kenneth Stuart Zuckerman, MD Professor of Internal Medicine, Biochemistry & Molecular Biology & Interdisciplinary Oncology; Director, Division of Medical Oncology & Hematology University of South Florida and H. Lee Moffitt Cancer Center & Research Institute Tampa, Fla. Oncogene Expression Cervical Cancer Feng Wang Johanning, MD Research Assistant Professor, Department of Medicine, Division of Hematology/ Oncology University of Alabama at Birmingham 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 22 M U L T I D I S C I P L I N A R Y G-rich Olignucleotides: Activity, Mechanism, and How They Led to a New Molecular Target Paula Bates, Ph.D. Assistant Professor, Department of Medicine James Graham Brown Cancer Center University of Louisville Radiation-induced Genomic Instability William F. Morgan, Ph.D. Professor and Director, Radiation Oncology Research Laboratory University of Maryland Baltimore, Md. New Treatment Modalities in Pancreatic Cancer: From the Laboratories to the Clinics Thomas N. T. Wang, MD, Ph.D. Surgical Oncologist and Molecular Pathobiologist Medical College of Georgia Augusta, Ga. Thrombospondin-1 in the Regulation of the Plasminogen/Plasmin System and Tumor Cell Invasion Daniel Albo, MD, Ph.D. Fellow, Surgical Oncology MD Anderson Cancer Center Houston, Texas Current Issues in the Management of Breast Cancer Karen A. Yeh, MD Associate Professor and Service Chief, Surgical Oncology Medical College of Georgia Augusta, Ga. Restoring the TGF-beta Tumor Suppressor Pathway in Cancers Brian Law, Ph.D. Research Assistant Professor, Vanderbilt-Ingram Cancer Center Vanderbilt University Nashville, Tenn. A Novel Hormonal Approach for Breast Cancer Patricia V. Schoenlein, Ph.D. Associate Professor, Cellular Biology & Anatomy Medical College of Georgia Augusta, Ga. and Andre M. Kallab, MD Assistant Professor, Hematology/Oncology Medical College of Georgia Augusta, Ga. Programmed Cell Death and Cancer: An Overview Baldev B. Singh, Ph.D., BDS Professor, Oral Biology and Maxillofacial Pathology Medical College of Georgia Augusta, Ga. Descriptive Epidemiology of Cancer Information in the Mass Media Laurie Hoffman-Goetz, Ph.D. Professor, Department of Health Studies and Gerontology University of Waterloo Ontario, Canada C A N C E R C O N F E R E N C E S Biology and Targeting of Prostate Cancer Metastasis Leland Chung, MD Professor of Urology, Hematology/Oncology & Biochemistry & Director of Molecular Urology and Therapeutics Winship Cancer Institute, Emory University Atlanta, Ga. Caloric Restriction Reduces Angiogenesis and Growth in Experimental Brain Cancer Thomas N. Seyfried, Ph.D. Professor of Biology Boston College Chestnut Hill, Mass. Hormonal Therapy of Breast Cancer Cells Induces Two Distinct Cell Death Pathways: Autophagocytic Versus Apoptotic Cell Death and Strategies to Improve the Hormonal Therapy of Breast Cancer Patricia Schoenlein, Ph.D. Associate Professor, Department of Cellular Biology & Anatomy Medical College of Georgia Augusta, Ga. A New Way to Observe Induction of Oral Cancer Cell Death Stephen Hsu, Ph.D. Assistant Professor, OBMP, School of Dentistry Medical College of Georgia Augusta, Ga. New Horizons in Cancer Gene Therapy: Development of Anti-angiogenic, Immunomodulatory, and Oncolytic Gene Transfer Vectors Nori Kasahara, MD, Ph.D. Assistant Professor, Institute for Genetic Medicine & Departments of Pathology & Biochemistry University of Southern California, Keck School of Medicine Los Angeles, Calif. Minimally Invasive Surgical Approach to Urologic Oncology James A. Brown, MD Assistant Professor, Urology, School of Medicine Medical College of Georgia Augusta, Ga. Bone Marrow-derived Endothelium Regulate Tumor Responses to Ionizing Radiation Richard Kolesnick, MD Head, Laboratory of Signal Transduction and Member, Sloan Kettering Institute, Molecular Pharmacology & Chemistry New York, N.Y. Probing the Phosphoproteome in Cancer Cells Satya Saxena, Ph.D. Scientist, Proteomics and Molecular Biology Program Lovelace Respiratory Research Institute Albuquerque, N.M. Induction of Apoptosis in Prostate Cancer Cells by Activating TRAIL Pathway Vijay Kumar, Ph.D. Associate Professor, Urology, School of Medicine Medical College of Georgia Augusta, Ga. 19 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM D I S T R I B U T I O N Site of Cancer Total 0 B Y I Page 23 S I T E II III A N D IV Unknown† Lip Tongue Salivary Glands Floor of Mouth Gum and Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Buccal Cavity & Pharynx 2 10 4 5 8 4 6 3 8 1 0 0 0 0 2 0 0 0 0 0 0 3 0 0 3 0 0 0 0 0 0 2 1 1 0 0 1 1 0 1 1 2 0 0 0 0 0 0 0 0 1 2 3 4 3 4 5 2 8 0 0 1 0 0 0 0 0 0 0 0 Buccal Cavity & Pharynx 51 2 6 7 3 32 1 Esophagus 13 Stomach 7 Small Intestine 4 Colon Excluding Rectum 38 Rectum & Rectosigmoid 18 Anus, Anal Canal & Anorectum 1 Liver & Intrahepatic Bile Duct 9 Other Biliary 2 Pancreas 8 Other Digestive Organs 1 Digestive System 101 0 0 0 3 0 0 0 0 0 0 3 3 1 0 3 2 1 0 0 1 0 11 4 0 1 9 3 0 3 0 1 0 21 2 0 0 7 2 0 2 0 0 0 13 1 3 0 12 5 0 3 1 6 0 31 3 3 3 4 6 0 1 1 0 1 22 0 2 0 0 0 2 14 1 0 3 7 0 0 4 21 0 0 5 46 0 2 1 5 0 Nasal Cavity, Middle Ear & Accessory Sinuses Larynx Lung & Bronchus Pleura Trachea, Mediastinum & Other Respiratory Organs 2 17 93 1 S T A G E : 2 0 0 2 A N A LY T I C Site of Cancer Total Prostate Testis Penis Male Genital System 77 7 2 86 0 0 1 1 0 5 1 6 60 1 0 61 8 1 0 9 9 0 0 9 0 0 0 0 Urinary Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs 17 24 1 1 10 0 1 0 2 12 0 0 1 1 0 0 1 5 0 0 3 4 0 0 0 2 0 1 43 11 14 2 6 7 3 Urinary System 0 I II C A S E S III IV Unknown† Brain Other Nervous System Brain & Other Nervous System 28 1 0 0 0 0 0 0 0 0 0 0 28 1 29 0 0 0 0 0 29 Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma Lymphomas 10 27 37 0 0 0 1 4 5 2 6 8 2 1 3 4 11 15 1 5 6 Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Acute Myeloid Leukemia Other Myeloid Leukemia Other Acute Leukemia Multiple Myeloma Blood & Bone Marrow 7 3 2 12 2 1 9 36 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 3 2 12 2 1 9 36 Thyroid Other Endocrine (Including Thymus) 18 0 10 2 3 1 2 1 0 0 0 0 0 1 2 0 0 0 0 0 2 114 2 17 10 25 51 9 Endocrine 20 0 10 2 3 1 4 Bones and Joints Soft Tissue (Including Heart) Bones, Joints & Soft Tissue 1 8 9 0 0 0 0 2 2 1 3 4 0 2 2 0 0 0 0 1 1 Eye & Orbit 2 0 0 0 0 0 2 Other & Unknown Site 30 1 1 3 0 2 23 Melanomas-Skin Other Nonepithelial Skin Skin (Excluding Basal & Squamous) 31 2 12 0 10 0 6 0 2 0 1 0 0 2 Total 2002 Analytic Cases 786 55 134 170 112 167 33 12 10 6 2 1 2 68 9 12 25 16 5 1 30 40 3 23 7 21 3 127 1 0 0 0 1 12 0 14 13 19 0 2 1 4 1 40 7 5 0 3 2 4 0 21 7 7 2 11 0 1 2 30 1 5 0 6 1 0 0 13 1 4 1 1 2 0 0 9 Respiratory System Breast Cervix Uteri Corpus Uteri Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Female Genital System* 20 † Includes primary sites that do not have an AJCC staging scheme * Excludes In-Situ Cervical Carcinoma 148 147-216 MCG CC AR 03/mech 11/17/03 W H E R E 1:30 PM T H E Page 24 P A T I E N T S L I V E : 2 0 0 2 A N A L Y T I C C A S E S The Medical College of Georgia Cancer Registry accessioned 786 analytic patients in 2002. Total GA . . . . . . . . . . . . . . . 666 Total SC . . . . . . . . . . . . . . . . 118 Other states . . . . . . . . . . . . . . 2 Georgia Appling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Atkinson . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bacon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Baldwin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Barrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Bartow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Berrien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Bulloch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Burke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Butts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Camden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Candler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Carroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Chatham . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Cherokee . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Clarke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Cobb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Coffee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Colquitt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Crawford . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Crisp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Decatur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DeKalb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Dodge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dougherty . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Douglas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Elbert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Emanuel . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Evans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Forsyth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Franklin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Fulton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Gilmer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Glascock . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Glynn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Gordon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Greene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Gwinnett . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Hancock . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Hart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Houston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Jackson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Jeff Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Jefferson . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Jenkins . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Lamar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Laurens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Lincoln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Lowndes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 McDuffie . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Madison . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Mitchell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Monroe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Morgan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Murray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Muscogee . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Oconee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Oglethorpe . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Peach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pierce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Putnam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Quitman . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Randolph . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Richmond . . . . . . . . . . . . . . . . . . . . . . . . . 188 Screven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Spaulding . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Stephens . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Sumter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Talbot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Taliaferro . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Tattnall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Telfair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Terrell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Thomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Tift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Toombs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Treutlen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Troup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Twiggs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Upson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Walton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Ware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Warren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Washington . . . . . . . . . . . . . . . . . . . . . . . . 19 Wayne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Wilkes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Worth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 South Carolina Abbeville . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Aiken . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Allendale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Barnwell . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Beaufort . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Berkeley . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Edgefield . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Florence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Greenwood . . . . . . . . . . . . . . . . . . . . . . . . . . 3 McCormick . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Newberry . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Pickens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Saluda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Spartanburg . . . . . . . . . . . . . . . . . . . . . . . . . 1 Spartanburg Pickens Union Murray Florence White Gilmer Newberry Stephens Greenwood Abbeville Saluda Franklin Hart Gordon Cherokee Forsyth Hall Madison Elbert McCormick Edgefield Barrow Clarke Oglethorpe Lincoln Aiken Wilkes Gwinnett Oconee Cobb Columbia alton Walton DeKalb Dekalb Greene Fulton McDuffie aliaferro McDuffie Taliaferro Barnwell Morgan Richmond Douglas arren Warren Allendale Putnam Hancock Glascock Carroll Burke Butts Jef ferson Jefferson Spaulding Baldwin ashington Washington Jenkins Screven Lamar Monroe Johnson Emanuel Troup Upson Twiggs Bulloch Crawford Candler Laurens Talbot reutlen Treutlen Peach Houston Evans Chatham oombs Toombs Muscogee Tattnall Dodge Bartow Jackson Sumter elfair Telfair Crisp Berkeley Beaufort Jeff Davis Appling ayne Wayne Terrell Quitman Randolph Worth Dougherty Coffee ift Tift Berrien Mitchell Decatur Atkinson Pierce Glynn Ware Camden Colquitt Thomas Bacon Lowndes 21 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM 2 0 0 2 Page 25 A N A L Y S I S : O V A R I A N C A N C E R S During 2002, 24 new cases of epithelial ovarian cancer Fifty percent of the patients had a family history of some were diagnosed or received their primary treatment kind of cancer. Three patients had a family history of here. In the United States there are approximately ovarian cancer and two had a family history of breast 23,000 new cases of ovarian cancer per year. cancer. Those patients with family pedigree analysis suggestive of BRCA mutations were referred for genetic While the overall survival rate has minimally increased counseling. One patient with a history suggestive of over the past 10 years, the progression free interval has Lynch II syndrome was also referred. significantly lengthened. Survival rates were related to the stage of disease. The survival rates for our patients The majority of patients were in the sixth and seventh over the past five years are: Stage I – 95 percent, Stage II – decades of life. There was no apparent difference in 72 percent, Stage III – 42 percent and Stage IV – 19 percent. survival by race. As would be expected, 75 percent of the cancers presented at an advanced stage. Michael S. MacFee, MD The majority of cases with advanced disease were treated Professor and Vice Chairman, with surgery and chemotherapy. The three cases treated Department of Obstetrics and Gynecology by surgery alone were tumors of low malignant potential. Two patients with Stage IV disease elected palliative care only. 22 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM 2 0 0 2 Page 26 A N A L Y S I S : O V A R I A N C A N C E R S Ovarian Cancers 2002 Survival by Stage at Diagnosis 1997-2002 12 10 100% 8 80% Percent Surviving Number of Cases Stage Distribution 6 4 2 0 I II III IV Stage I Stage II NA/Unknown 60% Stage III 40% 20% Stage IV Stage at Diagnosis 0% 1 2 3 4 5 Years Survival Age at Diagnosis Treatment Modality by Best Stage 10 9 Stage II Stage III Stage IV TOTAL 0 2 0 0 1 2 0 2 10 2 0 4 2 5 16 0 2 1 4 0 12 0 6 1 24 No Treatment Surgery Only Surgery & Chemotherapy Surgery, Chemotherapy, Hormone Therapy TOTAL 8 Number of Cases Stage I 7 6 5 4 3 2 1 0 30-39 40-49 50-59 60-69 70-79 80-89 Age Range 5 Family History of Cancer No 50% 4 3 2 Yes 50% Race AfricanAmerican 21% Other 4% Caucasian 75% vic al Co lon En do m et ria l Le uk em ia Ov ar ian Pr os ta te St om Un ac kn h ow nT yp e Ce r Br ea st 1 0 Br ain Number of Patients Patients with Family History of Cancer Type of Cancer 23 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 27 S T A T I S T I C A L S U M M A R Y According to the American Cancer Society (ACS), an diagnosed in 2002, remaining one of the top 10 sites of estimated 1,284,900 new cancer cases were diagnosed cancer for both males and females. In agreement with in the United States in 2002. Cases diagnosed in ACS statistics, the incidence of colorectal cancers Georgia accounted for an estimated 31,600 of these among MCG patients under age 50 was evenly divided cases, with MCG Health System reporting 2.5 percent between genders. Among MCG patients age 50 and over, of Georgia’s cases. colorectal cancer was more frequently diagnosed in men, with males accounting for 57.1 percent of the cases. Lung and bronchus, prostate and breast cancers were the cancers most frequently diagnosed and treated at The cancer patient volume at MCG continued to MCG Health System in 2002, in agreement with the increase, with more new patients from both Georgia and state and national estimates. The percentages of MCG South Carolina. Patients came from 92 Georgia counties patients with leukemia, cervical cancers and uterine to be diagnosed or treated at MCG, representing over cancers were higher than for the corresponding United 57 percent of the total counties in Georgia. South States and Georgia estimates. Carolina patients represented about 15 percent of the 2002 caseload, coming from 14 different counties in The ACS predicted 148,300 new colorectal cancers that state. would be diagnosed in the United States in 2002, accounting for 11.5 percent of all cancers. At MCG, colorectal cancers accounted for 7.1 percent of cancers 2002 Incidence Percent Most Frequent Cancer Sites for 2002 MCG GA Female Bronchus & Lung 16.0% Prostate Gland Breast 14.0% SITE Male US 18.0% Bone Marrow 12.0% Skin (Melanoma) 10.0% Corpus Uteri 8.0% Cervix Uteri Colon Brain 6.0% Lymph Nodes 4.0% Kidney 2.0% Ovary Vulva Ut ia er in eC e Ut rv er ix in eC o Co r No p lon us nHo & Re dg c tu kin m ’s L ym ph Ur om in ar a yB lad de r a om ke m Le u st ta te lan Me Pr os Br ea ale Fe m Lu n g& Br on ch us 0% 24 Reference: American Cancer Society Cancer Facts and Figures 2002 (www.cancer.org) Thyroid Gland Bladder 0 20 40 60 80 100 147-216 MCG CC AR 03/mech 11/17/03 1:30 PM Page 28 G L O S S A R Y Analytic Case Cancer cases initially diagnosed and/or treated at MCG. Summary Stage In-Situ – A neoplasm that fulfills all the microscopic criteria for malignancy except invasion. Non-Analytic Case A patient initially diagnosed and treated elsewhere receiving subsequent care at MCG. Reference Date The date after which all eligible cancer cases must be included in the MCG Cancer Registry database. This date is January 1, 1985. Tumor Grade A method used to describe a tumor’s resemblance to the normal tissue from which it arose. Grade 1 – Well differentiated Grade 2 – Moderately differentiated, intermediate differentiation Grade 3 – Poorly differentiated Grade 4 – Undifferentiated, anaplastic Neoplasm Abnormal growth, such as a tumor. Localized – Neoplasm is confined to the site of origin. Regional – A neoplasm that has spread by direct extension to immediately adjacent organs or tissue and may have metastasized to regional lymph nodes or organs, appearing to have spread no further. Distant – A neoplasm that has spread beyond immediate adjacent organs or tissues by direct extension and may have developed either a secondary or metastatic tumor. Unknown – A neoplasm whose stage cannot be determined from the medical record or from a medical authority. TNM Stage A staging system developed by the American Joint Committee on Cancer (AJCC) that takes into account the tumor (T) size and/or depth of invasion, lymph node (N) involvement and distant metastases (M). For each applicable site, a combination of T, N and M elements gives a classification of Stage I, II, III, IV or unknown. A higher stage usually suggests a less favorable prognosis. References: American Cancer Society, National Cancer Institute, National Cancer Data Base, American Joint Committee on Cancer C O N T A C T U S For Patients: For more information on our Comprehensive Cancer Program or to schedule an appointment, call 706-721-CARE (2273) or 1-800-736-CARE (2273). For Physicians: Specially trained Health Referral Specialists answer calls 24 hours a day, seven days a week, and connect you directly with the MCG physician you request or the on-call physician. MCG Physicians Direct 1-800-733-1828 You can: • Reach MCG physicians’ offices to arrange appointments • Consult with faculty physicians • Follow up on patient status • Access clinical studies and receive research updates • Access other MCG professional programs and services, including continuing medical education and the medical library On the Web: MCGHealth.org MCG Transfer Direct Emergency Communications Center 1-877-561-5600 Our experienced paramedics will: • Arrange emergency patient transfers • Arrange helicopter transport • Stay on the line while you speak with an attending physician or specialist • Handle your request for the Pediatric Transport Team 147-216 MCG CC AR 03/mech 11/17/03 1:29 PM Page 1 1120 15th Street | Augusta, GA 706-721-CARE (2273) | 800-736-CARE | MCGHealth.org Medical College of Georgia Health System