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There are many publications and sites that write about cancer. We want you to know we don’t produce the news items you can read in this section, they belong to the MD Anderson Cancer Center. This section only intents to inform you about what is out there.

However, we are working on the first edition of the Pink Ribbon Magazine as well as in the production of featured articles that will be published here.

 

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Reconstructive microsurgery: What patients should know

Sometimes our surgeons must perform life-altering surgeries to remove cancer. And, in many cases, cancer surgeries have the potential to dramatically change a patient’s physical appearance or lifestyle. But through reconstructive microsurgery, our plastic surgeons are often able to help patients return to their normal appearance or lifestyle.

Microsurgery allows surgeons to perform procedures that were once impossible, and they’re using these tools to improve surgery every day. In fact, each year, MD Anderson’s 21 plastic surgeons perform more than 1,000 microsurgeries to reconstruct patients from head to toe. Many of these surgeries are breast reconstruction, when surgeons use the patient’s tissue to create new breasts after a mastectomy. But surgeons may also use this technique for reconstructing other parts of the body.  

To learn more about microsurgery, we spoke with plastic surgeons Alexander Mericli, M.D., and Carrie Chu, M.D. Here’s what they had to say.

What is microsurgery?

Microsurgery gets its name because it refers to surgery performed using a microscope. During microsurgery, we use precise microsurgical instruments that allow us to reconnect very small blood vessels, nerves and lymphatic vessels with very tiny stitches – some thinner than a hair and difficult to see with the human eye.

We often use microsurgery in conjunction with other surgeries, such as tumor removal and reconstruction, to reconstruct complicated areas that otherwise wouldn’t be possible.

Among other things, we use microsurgery to:

  • reconstruct breast cancer patients’ breasts using tissue from their abdomen or other parts of their bodies
  • rebuild jaws using a bone from the leg, shoulder, arm or hip, or reconstruct tongues with skin and fat from the arm or leg
  • use muscles from other parts of the body to rebuild leg muscles so patients with orthopedic cancers can walk again
  • repair skin damaged by radiation therapy

Are there any downsides to microsurgery?

Considering the precise, detail-oriented nature of reconstructive microsurgery, such surgeries are often lengthy and may take an entire day. To help minimize the length of these complex surgeries, MD Anderson plastic surgeons may work together to reduce surgery time.

In the days following the surgery, your care teams will closely monitor the surgical site, so a three- to seven-day hospital stay is required. During your stay, our care teams will make sure that the relocated tissue is adapting well.  

What advice do you have for patients considering or preparing for reconstructive microsurgery?

If you have the right doctor, microsurgery doesn’t have to be scary. Be sure to pick a plastic surgeon who is experienced with microsurgery and performs these highly specialized surgeries often. At MD Anderson, for instance, all of our plastic surgeons have undergone specialty training in microsurgical reconstruction and are experts in this subspecialty.

What should patients ask their surgeons before reconstructive microsurgery?

Ask your plastic surgeon lots of questions. Make sure you discuss how the surgery will affect your daily life, both right after the surgery and in the years to come. (For example, if your surgeon uses tissue from your abdomen, you may experience a lift and tighter skin there, but you also will have limited use of that area until you recover fully.)

You may need physical therapy following surgery, so discuss what rehabilitation programs you’ll need and how to adjust your expectations following surgery.

And be sure to ask what side effects you may experience after surgery. These will vary depending on the what part(s) of the body the surgery is performed on.  

In 2015, MD Anderson plastic surgeon Jesse Selber, M.D., led the world’s first skull and scalp transplant. More recently, he led a team in performing a large soft tissue transplant, when a patient received a large piece of skin from her identical twin sister to help repair skin on her own back damaged by radiation. What’s next when it comes to innovation in microsurgery?

Now, surgeons are using microsurgery to help patients with lymphedema, a common cancer side effect that leads to swelling. During a lymphovenous bypass, surgeons improve the flow of fluid by redirecting it. This is made possible by a high-powered microscope that lets surgeons disconnect and reconnect vessels less than half a millimeter in size. The stitches are so small that they’re translucent and float on air.

Surgeons are also researching the use of 3-D imaging to develop microsurgical reconstruction plans before surgery, as well as looking for ways to reconstruct nerves that would restore sensation after surgeries like breast reconstruction.

Microsurgery gives plastic surgeons the freedom to use their creativity to best serve our patients. There’s no telling what the future may bring.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Chondrosarcoma survivor helps other patients find their strength

In early 2009, Hilary McQuiston-Fall was enjoying an active lifestyle full of outdoor activities in San Francisco, California. But when the 26-year-old fell while snowboarding, she realized something wasn’t right.

Doctors initially treated her for a broken tailbone, but months later, she was still dealing with pain and swelling. After a battery of tests, Hilary was diagnosed with chondrosarcoma in her right hip. Over the next six years, she received radiation therapy and went through several limb-salvage surgeries, but the cancer kept returning and spreading.

“They believe it started in my iliac crest and took over my right side. It was growing over my leg, it was involved in my sciatic notch, femoral nerves — just everywhere,” explains Hilary.

In 2015, her local doctor recommended she undergo a hemipelvectomy, a procedure that removes part of a patient’s pelvis and can include amputation of the leg.

Through her research, she discovered MD Anderson’s Orthopaedic Oncology department has experts that specialize in this complex surgery.

Confidence in MD Anderson’s expertise

Hilary made contact with Dr. Justin Bird and spoke over the phone for weeks with his physician assistant, Jillian Chamberlain. Hilary vividly remembers when Dr. Bird called her with his final recommendation: an external hemipelvectomy, which would include amputation of her right leg.

After a few weeks of careful thought and more research, she was ready to commit to the surgery and trust Dr. Bird’s experience and expertise.

“Dr. Bird was very nice and patient with my decision-making. But I said, ‘No, I want to do it. Schedule me as soon as you can,’.”

In March 2016, she underwent the 15-hour surgery led by Dr. Bird and plastic surgeon Dr. David Adelman. The right side of her hip and a portion of her right sacrum were removed. Parts of her lower spine were also shaved off. Although the surgery was long and intensive, Hilary knew she was in capable hands.

Building strength through physical therapy

Following surgery, Hilary was able to walk with a walker around the ICU floor within days. Working closely with MD Anderson’s physical therapists, she went through several months of intense physical therapy and conditioning.

“I didn’t go through all of that so I could sit home on my couch. I wanted to get back to doing what I enjoyed doing beforehand,” Hilary says.

She was eager to continue the active lifestyle that she loved and worked hard to develop core strength so that she could get back into CrossFit, a favorite activity of hers prior to surgery. With the help of special crutches, she was able to start hiking trails in California six months later.

A light for other patients

Following one of her physical therapy appointments, Hilary was asked if she could offer some advice to a patient who was struggling after surgery.

“They were finding it hard to get motivated to really do physical therapy. And I understand, physical therapy is hard and it hurts, but it’s so worth it,” Hilary says.

Since then, MD Anderson’s care teams have connected several other hemipelvectomy patients with Hilary.

 “Hilary selflessly offers support and recommendations from personal experience to patients who have also undergone an external hemipelvectomy. Her positive attitude and influence as a role model have proven to be a light for others during potentially the most difficult time of their life,” says physical therapist Taryn Thomas.

For Hilary, counseling patients on the unique, day-to-day challenges following a hemipelvectomy is now just a way of life. “It’s tough and that’s the way it is — but if you keep a positive attitude, do your physical therapy and make adjustments in your life, there’s always a way to make it work,” she tells patients. “Trying to make it work is frustrating, but it is rewarding at the end. Everything you loved doing before, you’re going to be able to do again.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Q&A: Understanding our Cancer Genomics Laboratory Moon Shot platform

MD Anderson’s Moon Shots Program™ is designed to reduce the time it takes to move promising cancer discoveries into the clinic, where they can help patients the most. The program focuses resources around 13 cancer types, called Moon Shots™, with the goal of using the knowledge we gain to advance treatment of all types of cancer.

But how do researchers make cancer discoveries? And how do they know which discoveries are the most likely to have a major impact for patients? That’s where the Moon Shots Program’s Cancer Genomics Laboratory platform comes in.

We spoke with Maggi Morgan, scientific manager, to learn more about the platform and how it impacts cancer research and treatment. Here’s what she had to say.

What is the Cancer Genomics Laboratory?

The Cancer Genomics Laboratory platform is a research lab that drives discovery and understanding of how tumors grow, spread and evolve. Our team provides researchers with data that may, in the future, guide personalized cancer treatment strategies and has the potential to make a significant impact on the detection, management and treatment of cancer.

What is genomics, and how is it used in cancer research?

Your complete set of DNA is called your genome. Almost every cell in your body, including a cancer cell, contains a copy of the 3 billion DNA base pairs, or letters (A, T, G and C), which string together to make up the genome. Genomics is the detailed study of these sequences of DNA that make up the genome.

Cancer is caused by small changes in sequences of DNA. These changes are called mutations, which accumulate over time and can turn a healthy cell into a cancerous cell.

We use genomics to characterize the mutations that lead to cancer, or its progression, to help us find new ways of detecting, monitoring and treating cancer.

How does the platform support the Moon Shots Program?

Our platform specializes in a sophisticated technique called “next-generation sequencing,” which we use to determine the exact order of the DNA base pairs of healthy and/or cancerous cells.

The sequencing information gathered from this powerful technique can help researchers find mutations, genes and pathways that may be linked to cancer. This knowledge allows them to focus their efforts on specific cancer-related genes that may be able to be exploited to help us detect cancer earlier and treat it more effectively.

To date, we’ve sequenced the genomes of more than 7,500 patient samples, some of which were collected from patients before, during and after their participation in Moon Shot™ clinical trials. We’ve also published our findings so that this information can be accessed by cancer researchers around the world.

We support all of the Moon Shot teams and multiple platforms, including the Adaptive Patient-Oriented Longitudinal Learning and Optimization (APOLLO). We also work alongside a bioinformatics team to ensure that the sequencing data we provide is used appropriately and to its maximum potential. All of this data is stored in a “big data” warehouse so that it can be accessed and used by cancer researchers throughout MD Anderson.

How does the platform contribute to our mission of ending cancer?

The platform helps uncover the underlying changes in the genome that drive the growth and spread of cancer. The data we collect may inform new avenues for cancer detection and treatment.

For example, by sequencing the DNA in a tumor before and after treatment, researchers may be able to learn how cancer adapts and potentially becomes resistant to treatment. Researchers may be able to apply this knowledge to improve treatment options, or develop new treatment strategies. We’re currently performing studies like this in collaboration with the Breast Cancer Moon Shot™ team.

Where do you see the platform in five years?

Currently, the gold standard for getting high quality genomic sequencing data is through fresh biopsy tumor tissue. These biopsies are usually collected through a surgical procedure, which adds risk and discomfort for the patient.

I think it’s feasible that minimally-invasive methods of collecting tumor samples, such as liquid biopsies, will be available in the near future. Minimally-invasive biopsies will give our platform the ability to characterize a tumor’s genome through a simple blood draw. This may enable us to use non-invasive methods to screen for early-stage cancers, monitor how patients respond to treatment and help explain why some cancers are resistant to certain therapies.

Is there anything else you want patients and caregivers to know?

I would like patients and caregivers to know that I am not only an MD Anderson employee, but a former caregiver. I also have a family member still being treated by one of our Moon Shot doctors. Having walked in the caregiver footsteps, I strive every day to make a difference in MD Anderson’s mission to end cancer. Everyone within the platform, and the Moon Shots Program as a whole, is driven to help our patients because of their own personal connections to cancer and MD Anderson.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Proton therapy by night: A granular cell cancer survivor’s story

When I was diagnosed with granular cell cancer in May 2017, my doctors at MD Anderson recommended surgery, followed by six weeks of proton therapy.

It never occurred to me that I could receive treatment at night, so when my first proton therapy session was scheduled for 10:30 p.m., it freaked me out a little bit. Was that a typo? Why was I being seen so late?

I called my care team, and they confirmed the time slot was real. It was also the soonest I could get in, so I kept the appointment. And I quickly discovered that there are many benefits to receiving treatment at night. That’s why I was OK with the remainder of my treatments being in the late night hours, too.

Calm, quiet … and zero traffic

The MD Anderson Proton Therapy Center is a very busy place. Demand is so high that patients are seen there from 4 a.m. until midnight daily. And as you can imagine, the center is busiest during normal business hours.

But by 10:30 at night, it is calm and peaceful, and doesn’t feel like an ordinary clinical environment. And while navigating the Texas Medical Center even outside of rush hour is no picnic, by 10:30 p.m., traffic is practically nonexistent. Even the freeways are a breeze.

Distracting myself with adventures

Another good thing about scheduling your treatments at night is you have the entire day to work, rest or explore Houston, which is what I did.

I really came to love Houston’s parks, museums, leafy streets, and varied districts during my six-week stay — even in the sweltering summer heat. (Solution: hydrate, hydrate, hydrate!)

My family and I walked through Hermann Park’s beautiful gardens at dusk, took a day trip to Austin, rode the ferry from Galveston Island to the Bolivar Peninsula and drove on the beach, took in a movie at the old-time River Oaks Theater, watched the bats fly out at dusk from underneath the Waugh Street bridge, paused for reflection in the Rothko Chapel, visited a cat café, explored Rice Village and The Woodlands, ventured toward Cajun country, and enjoyed the amazing variety of restaurants and coffeehouses that dot the city.

Going on these adventures kept me from dwelling on cancer, so I highly recommend that other patients do the same, if they feel well enough. The bonus was that after I’d finished my treatment for the night, I could go straight home and get into bed, then sleep late the next day if I wanted to.

The biggest benefit: MD Anderson’s caring staff

For me, the biggest benefit to scheduling my treatments so late was night nurse Dexter Allen. From day one, he made me feel so welcome and comfortable. Dexter joked, laughed, dispensed hugs and dispelled fears. And his attitude made a huge difference in how I faced cancer and my radiation treatments.

I also fell in love with the kindness and sense of humor of my Gantry 3 team at the Proton Therapy Center. The radiation technicians are very sympathetic to patients’ fears, but firm. More than once, they gave me a few additional minutes to compose myself before snapping down the head and neck mask I had to wear for every treatment. And on my final day, the technician who first locked me down came in on his day off to do the honors. That type of kindness stays with you for a lifetime.

I highly recommend MD Anderson. Its Proton Therapy Center has the most amazing and compassionate care team. And if you can go at night, do it. You might just be lucky enough to meet Dexter.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

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