MyGeorgetownMDFall 2012

A MedStar Georgetown University Hospital Publication

continued on page seven

“Greenlighting” Successful Kidney Cancer Treatment By Lynn Cantwell

IN THIS ISSUE

Page 2Because You Asked: “What Lies Ahead in Cancer Research?”

Page 3Getting Enough Sleep?

Page 4Ending Hip Dislocations and Improving Quality of Life

Page 5Welcome New Physicians

Gene Carter is comfortable with technology. After all, the retired finance professor and corporate board member began programming computers in the 1960s when they were the size of a room.

So, when MedStar Georgetown University Hospital urologist Keith Kowalczyk, MD, told Gene that he planned to remove his kidney tumor using a robot and dye that would light up his kidney, arteries and veins like a green glow stick, he was game. “I appreciate what technology can do,” says Gene. “The approach Dr. Kowalczyk described seemed prudent. It didn’t bother me at all.”

Gene learned that he had kidney cancer during a magnetic resonance imaging (MRI) study for an unrelated problem. The incidental discovery of kidney tumors is common. “Although sometimes there is pain or blood in the urine, kidney cancer does not usually present symptoms, and is

typically discovered during unrelated diagnostic procedures,” says Dr. Kowalczyk.

Dr. Kowalczyk uses a state-of-the-art procedure called robot-assisted partial nephrectomy with Firefly™ fluorescent imaging. He performs this procedure using the daVinci® Si™ robotic surgical system.

Partial nephrectomy is a surgery that addresses cancerous and non-cancerous tumors. With this procedure, the surgeon removes the kidney tumor and a small portion of surrounding tissue, but leaves the rest of the kidney in place. The American Urological Association 2009 clinical guidelines recommend partial nephrectomy as a standard treatment, when technically possible, in patients with small kidney tumors that have not spread. The addition of Firefly has made partial nephrectomy a possibility for patients who previously continued on page six

G Ardent travelers, Gene Carter and his wife, Rita Rodriguez, recently visited New Zealand. They traveled to Paris just a few weeks after his successful robotic kidney surgery.

Pancreatic Cancer Patient: “I Had the Right Doctors Doing the Right Things”By Leslie Whitlinger

At 71, Charlotte Robinson was a healthy woman, still working 30 hours a week at the Safeway in her southern Maryland town. Then chest pains sent her to the local ER.

Surprisingly, her heart turned out to be just fine, but other test results puzzled her physicians. While preliminary

G With the help of a team of pancreatic disease specialists, Charlotte Robinson is now back to work and enjoying her life.

Photo courtesy of the Carter Family

Photo courtesy of Charlotte Robinson

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First, the good news: Advances in detection and treatment over the years have produced an increased cure rate for some cancers and extended survival for others, most notably for breast and prostate. Just 40 years ago, a patient with a cancer diagnosis had few options and little hope. Today, there are close to 12 million survivors.

However, cure rates and extended survival are more problematic for patients with colon and pancreatic cancers. Approximately 60 percent of all colon cancer patients have a fighting chance against their disease; for patients with pancreatic cancer, survival rates plummet to 2 percent or less. A leading culprit is the number of variations in individual tumors. In colorectal cancer alone, researchers have identified more than 50 different mutations that can dictate how well a tumor responds to treatment. Complicating matters, digestive tumors can quickly develop a tolerance to today’s chemotherapies. Yet without other alternatives, we still apply the same treatments for everyone and hope for the best.

So the question becomes, how do we fight a smarter war against cancer?

At the Otto J. Ruesch Center for the Cure of Gastrointestinal (GI) Cancers, we believe the answer lies in individualized curative therapies or personalized medicine. Through a combination of advanced science, clinical studies and a patient-centered approach, we’re tackling the problem along the continuum, from the laboratory bench to the bedside (known as “translational research”).

Take colon cancer, for example. In a current study, we analyze various tumor mutations in the lab to discover which pathways they follow to grow; then we test how well different drugs

or combinations block each mutation’s progress. Next, we apply the new approach to patients with the same mutations to get real-life results.

Altogether, the Ruesch Center currently has 31 studies of various GI cancers underway examining new drugs, older drugs in novel combinations, chemotherapy/radiation therapies and other potential strategies to defeat or control cancer. See Page One for a story about how MedStar Georgetown specialists treated Charlotte Robinson’s pancreatic cancer.

A large part of the research equation, however, depends on patient involvement. We need patients to

partner with us to find the very best therapies for their unique condition. Yet fewer than 5 percent of cancer patients nationwide participate in clinical trials, which slows the accumulation of data. As a result, the trip from “test tube” to “tried and true” takes about 17 years in the United States today.

Our mission is to shorten that time frame, so more people can benefit more quickly from new knowledge and discovery.

Toward that end, this winter’s Third Annual Ruesch Symposium seeks to demystify the research process and encourage more people to become partners in the battle. From donating an extra blood or tissue sample to trying a brand new drug, every patient who participates in a clinical trial helps take us one step closer to improving cancer care. Moreover, those in the test group might have a good response to the new agent, improving their survival or quality of life.

By convening key representatives, the Ruesch Symposium strives to change the outlook for GI cancer patients today and tomorrow. Symposium participants include representatives from diverse areas:• Academia and research• Pharmaceutical and insurance

companies• Public policy• Patient advocacy• General public

Together we can develop new therapies and provide new hope to people who have cancer.

Because You Asked: “What Lies Ahead in Cancer Research?”By John L. Marshall, MD, Professor and Chief, Division of Hematology/Oncology; Director, Otto J. Ruesch Center for the Cure of

Gastrointestinal Cancer, MedStar Georgetown University Hospital

“Fighting a Smarter War Against Cancer” SymposiumEmpowering Patients Through Clinical Trials

November 30 - December 1, 2012Georgetown University Hotel & Conference Center

If you or a loved one has been affected by cancer, this two-part symposium will provide you with answers to some of the most pressing questions regarding clinical trials, cancer-related policies, and the future of personalized medicine.

To register or receive additional information about this symposium series, visit rueschcenter.org/symposium2012.

G With advances in clinical research and genetic counseling, we are unlocking the mysteries of cancer.

“Because You Asked” focuses on topics suggested by our readers. If you want to suggest topics for future issues of this newsletter, please email them to torneyd@gunet.georgetown.edu.

3

Getting Enough Sleep?By Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar Georgetown University Hospital

Good sleep is crucial to our health and well-being. Our bodies and minds “heal” while sleeping. Immune function, growth, and protein synthesis are all directly related to

restful sleep. For many, lifestyle choices and requirements

lead to a reduction in quality sleep. For

others, sleep problems, including insomnia and sleep disorders,

are to blame.

We see the effects of poor quality sleep in the emergency department

nearly every day. When people can’t sleep, they are more prone to accidents and injuries. The National Highway Traffic Safety Administration estimates that 100,000 motor vehicle accidents each year can be attributed to driver fatigue. Lack of sleep is also associated with depression, seizures and a host of metabolic changes including weight gain.

Sleep medications can help in the short term, but many patients

complain about the side effects. Patients often report feeling “groggy” the day after taking a sleep aid. In many cases, sleep can be improved with relatively simple lifestyle changes. Yet, committing to these changes can be very difficult. If the following steps do not help, it may be time to see a sleep specialist: • Create a sleep sanctuary. The

idea is to create a comfortable space dedicated only to sleeping. Keep the television and the computer out of the bedroom. Engage in a quiet activity like recreational reading before bed.

• Avoid caffeine, nicotine, and alcohol. Taking stimulants late in the day can have a negative effect on sleep quality. Smokers are at greater risk of disorders such as sleep apnea (see sidebar below). While alcohol might bring on an initial feeling of drowsiness, it actually interferes with Rapid Eye Movement (REM) sleep. This is the critical stage of the sleep cycle associated with learning and memory.

• Set a regular bedtime. This one is challenging for shift workers including physicians, military personnel, long-haul truck drivers, and public safety workers. Even if you must be up late, try to reset

your internal clock by going to sleep and waking up at the same time each day. Irregular sleep cycles are associated with increased risk of cardiovascular disease, cancer, and bipolar disorder. Such risks can be reduced by creating a predictable sleep routine.

• Exercise daily. People who are overweight are more likely to have sleep problems. Exercise helps relieve muscle tension and burn excess energy.

G Brendan Furlong, MD, offers perspective on what we can do to get the right amount of sleep each night.

Photo by Laura Brickley

G Exercise helps relieve muscle tension and burn excess energy.

To schedule an appointment with a sleep specialist, call MedStar Georgetown M.D. at 202-342-2400.medstargeorgetown.org/sleep

When to Call in the Sleep ExpertsSometimes, lifestyle changes are just not enough to get a good night’s rest. According to the National Heart, Lung, and Blood Institute, approximately 18 million Americans suffer from obstructive sleep apnea, a serious sleep disorder that interferes with breathing during sleep, and narcolepsy, a serious disorder of the central nervous system that leads to extreme daytime sleepiness. Restless leg syndrome (RLS) is another common sleep disorder. Patients with RLS experience an uncontrollable urge to move their legs at night to avoid unpleasant sensations below the knee.

Most sleep disorders can be treated effectively, but they require the intervention of a sleep specialist. If you or a loved one is still lying awake night after night — even after trying the above tips — it may be time to schedule an appointment with a sleep disorder specialist.

G From fatigue at work to weight gain, quality of sleep can impact various aspects of your life.

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Master of disaster. That is how Tom Curley’s orthopaedic surgeon referred to Brian Evans, MD, a fellow orthopaedist and director at MedStar Georgetown Orthopaedic Institute. Dr. Evans earned this nickname because of his success in the surgical correction of difficult orthopaedic problems.

Tom, a 59-year-old consultant and avid golfer, initially struggled with joint pain in his knees. Football injuries from his teens and twenties caused pain for years until 1998 when he had both knees replaced. However, a year ago, an MRI revealed that the natural cushioning in Tom’s right hip joint had worn away and the bones in the joint were rubbing together. Tom needed a hip replacement (see sidebar below).

Tom returned to the orthopaedic surgeon who performed his knee replacement surgeries to have his hip replaced. Unfortunately, about six weeks after the surgery (performed at another hospital), his hip began to dislocate. “If I straightened my leg or turned my toe in, my hip would come out of the socket,” he said. Eventually, in excruciating pain, Tom had to wrestle his hip back into place as many as 20 times a day. The operation also left him with uneven leg lengths.

A program such as MedStar Georgetown’s, and a surgeon like Dr. Evans, were exactly what Tom needed.

Surgically correcting hip replacements that have not achieved the desired result has emerged as one of Dr.

Evans’ specialties. “Over the last ten years or so, I have seen a lot of cases where things have gone wrong and needed fixing,” says Dr. Evans who performs about 180 hip replacements and an equal number of knee replacements a year. “About half of my patients are referred to me by other orthopaedic surgeons,” he notes.

According to Dr. Evans, Tom’s problems with his hip replacement occurred because the ball device was a bit too small for his leg. “His initial implant probably felt secure to his surgeon when it went in, but it was somewhat small,” says Dr. Evans. “It became loose and sank down into the bone, which created the shortening and instability. As a result, it was coming out of the new cup.”

Dr. Evans discussed his plan and approach with Tom. “Dr. Evans said there was no question: The hip had to come out, but he wouldn’t know if both the top and bottom of the hip needed to be changed until he opened me up,” says Tom.

“When performing these types of surgeries, we want to do as little work in the bones as possible, especially in the pelvis,” says Dr. Evans. “You lose bone, which is already limited, every time you operate. I hoped that I would be able to leave the cup alone.”

However, Tom’s hip required two surgeries to fix the problem. “Initially, it looked like the cup was in the pelvis securely,” says Dr. Evans. “I put a larger implant in the thigh and left the upper

Ending Hip Dislocations and Improving Quality of Life By Lynn Cantwell

They took wonderful care

of me, and the education was

great. I can walk better now

than I have in 30 years.

Tom Curley, orthopaedics patient

Replacing the Hip Joint

The hip joint is a “ball and socket” joint. The ball is the head (top) of the femur (thigh bone), and fits into a socket formed by the pelvis. The joint is cushioned by fluid and cartilage, and protected by the muscles that move it. Usually, when a hip needs to be replaced in an adult, it is because the cushioning is gone and the patient is in pain.

A total hip replacement involves replacing the ball and the socket (see illustration). The head of the femur is removed and a new one (ball) is inserted into the top of the thigh. The ball fits into a cup (socket) that is placed in the pelvis.

MedStar Georgetown Orthopaedic Institute

MedStar Georgetown Orthopaedic Institute has the area’s largest and most experienced team of orthopaedic surgeons who provide expert care at four trusted area hospitals: • MedStar Georgetown University Hospital • MedStar Montgomery Medical Center • MedStar St. Mary’s Hospital • MedStar Washington Hospital Center

Ball Socket

part alone. Unfortunately, the hip was still not stable and began to dislocate again once Tom started playing golf. We had to go back in and replace the rest of the joint.”

Today, Tom’s legs are the same length and his hip is stable. He is walking everywhere and has been since three weeks after the surgery. “I can’t drive until six weeks after the surgery, so I walk instead,” says Tom.

Grateful to the entire team at MedStar Georgetown, Tom appreciated that in addition to fixing his hip, they drilled into him the

precautions he needs to take to ensure his joint heals properly and maintains its stability. “They took wonderful care of me, and the education was great. I can walk better now than I have in 30 years.”

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Photo courtesy of the Curley Family

Prostate Screenings and Lecture

MedStar Georgetown’s Department of Urology is dedicated to providing men who have prostate cancer accurate diagnosis and effective treatment options. With a team of experienced urologists, oncologists, and surgeons, patients have access to a full range of knowledgeable and compassionate experts — all available at one location.

Join our experts at our free prostate screening and lecture event:

Saturday, September 22, 2012MedStar Georgetown University Hospital

Free Screenings: 8:30 a.m. - 12:30 p.m., Martin Marietta Conference Room Lecture and Q&A: 10:15 - 11:15 a.m., Gorman Auditorium

Attendance is free, but registration is required. Call 202-342-2400.

Common Questions Answered in Our Ask-a-Doc Online Library Visit MedStar Georgetown’s Ask-a-Doc library and watch videos of our knowledgeable and compassionate doctors who answer questions about various healthcare topics. For example, you can watch a series of videos of Dr. Keith Kowalczyk who answers commonly asked questions about kidney cancer:

• What are the treatment options for kidney cancer?• What is robotic surgery?• Who performs robotic surgery, the robot or the

doctor?• How has robotic surgery improved the treatment for

kidney cancer?• What are the advantages of robotics in kidney surgery?• Who is a candidate for robotic surgery? To view our Ask-a-Doc videos, visit medstargeorgetown.org/askadoc.

To schedule an appointment with an orthopaedic surgeon, call MedStar Georgetown M.D. at 202-342-2400. medstargeorgetown.org/orthopaedic

Welcome New PhysiciansWe are pleased to introduce doctors who have recently joined the MedStar Georgetown team.

GastroenterologyMark Mattar, MD

General Internal MedicineLisa Roshetsky, MD

Hematology-OncologyJamie Koprivnikar, MD

NephrologyWen Shen, MDJudith Gordon-Cappitelli, MD

Obstetrics & GynecologyTara Kelly, MDAlex Vaclavik, MD

Orthopaedic SurgeryWilliam Postma, MD

To schedule an appointment with one of our knowledgeable and compassionate physicians, call MedStar Georgetown M.D. at 202-342-2400. medstargeorgetown.org/findadoc

Tom Curley is pleased that MedStar E Georgetown doctors were able to replace his hip and get him back on the golf course with his daughter, Christine.

Keith Kowalczyk, MD, urologist, answers questions about kidney cancer and treatment options.

Photo by Larry S. Glenn

6

would have required total kidney removal.

However, the predominant treatment for kidney tumors is still to remove the entire affected kidney. A popular way of performing this procedure is with laparoscopic or minimally invasive surgery. Laparoscopic surgery means the patient has a few tiny incisions, experiences less pain and bleeding and is usually in the hospital for just one night.

Despite laparoscopic kidney removal’s relative ease on the patient, “research shows that partial nephrectomy for the treatment of small renal tumors is associated with better outcomes, including cancer survival, over other treatments, even if it can’t be done laparoscopically,” Dr. Kowalczyk says.

“We know that you can live with onlyone kidney,” says Dr. Kowalczyk. “Thisknowledge has led to living kidneydonation and has benefittedcountless people on the nationalorgan donor list. But patients withkidney cancer are different thankidney donors. They will do better andbe healthier in the future if we cansave as much of the kidney aspossible.”

The urology team at MedStar Georgetown uses the kidney-sparing surgery whenever possible. “Robotic

surgery offers a clear-advantage in kidney surgery,” says Dr. Kowalczyk. “Surgeons can see their work in 3D, and the tiny robotic arms offer more dexterity and precision in reaching difficult areas. This results in a faster surgery, smaller incisions, less blood loss, and less pain. The patient can usually go home in one day, and it requires much less pain medication.

“With Firefly, I will attempt a partialnephrectomy for much larger tumorsthat would not be prudent using otherapproaches,” says Dr. Kowalczyk.

The use of Firefly imaging during a robot-assisted procedure improves the safety and results of the procedure even more. Because surgeons can see everything more clearly, this technique increases the surgeons’ chances of removing only the tumor in cases that might result in loss of the entire kidney using alternative methods.

With Firefly, a dye called indocyanine green (ICG) is injected into the blood. The dye lights up “firefly green” through a specialized camera. “With

this technology, we can see the exact blood supply for both the kidney and the tumor, and distinguish between the cancerous and healthy tissue,” says Dr. Kowalczyk. “It shows us where we should — and shouldn’t — cut. The process allows us to avoid additional renal arteries during the procedure, remove the entire tumor and its edges and ensure that the kidney’s blood supply has been thoroughly restored when we are finished.”

Gene, a husband, father and avid traveler who has no interest in slowing down, feels that he got the best treatment combination. “Although I am still recovering from the surgery, if I had a more invasive procedure, it would have been much more difficult,” he says. “I got to keep my kidney and avoid the pain of a big operation.”

“Greenlighting” Kidney Cancer Treatment continued from page one

G Gene Carter poses with his “honorary nephew,” Tate Aldridge, nearly 2, on his 70th birthday. Minimally invasive kidney surgery allowed Gene to get back to life with a shorter hospital stay.

To learn more about kidney cancer treatment using daVinci with Firefly, call MedStar Georgetown M.D. at 202-342-2400, or visit medstargeorgetown.org/fireflyvideo to view a video about the procedure.

Risk Factors for Kidney Cancer

Established Factors• Cigarettesmoking• Obesity• Highbloodpressure• Familyhistoryofkidneycancers

Source: National Cancer Institute, http://www.cancer.gov/cancertopics/wyntk/kidney/page4

Photo Courtesy of the Carter Family

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evidence pointed to a pancreatic mass, it defied detection.

That’s when Charlotte’s doctors sent her to MedStar Georgetown University Hospital, which cares for more people who have pancreatic disorders than any other hospital in the area. Through its Pancreatic Disease Program, specialists in imaging, gastroenterology, medical oncology, radiation medicine, and surgery work together to provide accurate diagnoses and state-of-the-art treatments. At its hub is a program coordinator/nurse navigator who helps patients and families with all aspects of care from coordinating appointments with multiple specialists to advising about their care and potentially beneficial clinical studies.

Such a comprehensive, multidisciplinary approach is essential for pancreatic disease, which can quickly get worse without the right intervention.

A gastroenterologist with the Pancreatic Disease Program, Dr. John Carroll — the first of many specialists involved in Charlotte’s care — performed an endoscopic ultrasound that pinpointed the tumor. Tissue samples and a follow-up CT scan confirmed it was pancreatic cancer.

It was then up to Dr. Lynt Johnson — MedStar Georgetown’s chair of surgery, director of hepatobiliary surgery, and a renowned pancreatic specialist — to break the news.

“I burst into tears,” Charlotte says. “I was sure I was going to die, and kept asking Dr. Johnson, ‘How did I get this?’”

While there’s no sure answer to her question, Dr. Johnson was sure of one thing: He wasn’t about to give up on his new patient.

“Charlotte’s cancer was advanced but also localized, which means that the tumor remained exclusively within or right around the affected organ,” Dr. Johnson explains. “Normally, that would have made her a prime candidate for surgery, but her tumor’s growth pattern complicated the situation.”

The mass had encroached upon the main artery in the pancreas that leads to the small intestines, making surgery — the only possible cure for the disease today — dangerous.

Fortunately, MedStar Georgetown’s pancreatic clinicians and researchers had recently developed and tested a new combination therapy with encouraging results. In the clinical trial, researchers administered a highly targeted form of radiation therapy, called CyberKnife, along with full-strength chemotherapy, to try to make inoperable tumors operable.

“Previously, chemo had to be diluted during traditional radiation therapy for pancreatic cancer because the two treatments together were too much for patients to tolerate,” says MedStar Georgetown’s Keith Unger, MD, a radiation oncologist who participated in the study and a member of Charlotte’s medical team. “But diluting the chemotherapy sacrificed some of the combined therapy’s effectiveness. By incorporating CyberKnife into the treatment, radiation sessions can be reduced from 28 to just five days, allowing us to safely maintain chemotherapy at full strength,” says Dr. Unger.

Based on the findings — presented at the 2011 annual meeting of the American Society of Therapeutic Radiation and Oncology — the Pancreatic Disease Program now routinely uses the CyberKnife/chemotherapy treatment for a specific set of tumors.

Medical oncologist and clinical study leader, Dr. Michael Pishvaian, was also one of Charlotte’s physicians. He says the new combination “delivers a one-two punch to the tumor, giving patients a fighting chance at surgery and a cure.”

The approach worked for Charlotte. Six months after her diagnosis, the tumor had shrunk away from the blood vessels, allowing Dr. Johnson — an experienced surgeon who has operated on more than 500 complicated and rare pancreatic cancers — to remove the entire tumor. Charlotte was home one week later.

Today, Charlotte has no evidence of cancer and, thanks to her pancreatic team, is eager to get back to work.“I had the right doctors at the right time, doing the right things,” she says of the experience.

“I Had the Right Doctors Doing the Right Things” continued from page one

To schedule a pancreatic disease evaluation or request a free brochure, call MedStar Georgetown M.D. at 202-342-2400. medstargeorgetown.org/pancreas

G Using a combination of chemotherapyand CyberKnife treatment, CharlotteRobinson currently has no evidence ofpancreatic cancer.

Photo courtesy of the Robinson Family

They’re great, candid and really

know what they’re doing. I’d

highly recommend MedStar

Georgetown to anyone.

Charlotte Robinson,pancreatic cancer patient

medstargeorgetown.org

NON-PROFIT ORG.U.S. POSTAGE

PAIDWASHINGTON, D.C.

PERMIT NO. 2457

MyGeorgetownMD, published quarterly, shares the latest health news with our community. To start or stop receiving this newsletter, please call 202-444-6815 or email torneyd@gunet.georgetown.edu.

Please submit your comments to:Karen Alcorn, Editor202-444-4658 or via email: kma5@gunet.georgetown.edu

MedStar Georgetown University HospitalAdministration • 3800 Reservoir Rd., NWWashington, DC 20007-2113

Richard Goldberg, MD S. Joseph BrunoPresident Chairman of the Board

Kenneth A. Samet, FACHE President and CEO, MedStar Health

Editors Managing EditorKaren Alcorn Benjamin WaxmanAngela T. Wilson

WritersLynn CantwellBrendan Furlong, MDJohn L. Marshall, MDLeslie A. Whitlinger

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Learn How DBS Can Reduce or Eliminate Parkinson’s Disease Symptoms

MedStar Georgetown is Washington, D.C.’s, only hospital designated as a National Parkinson Foundation Center of Excellence. Our comprehensive team of neurologists, neurosurgeons, and other specialists offers advanced treatment that can reduce or eliminate Parkinson’s disease symptoms.

One such treatment is deep brain stimulation or DBS. This innovative surgery uses a pacemaker-like device to stimulate the brain, reduce symptoms, and help many people who have Parkinson’s disease improve their quality of life.

Join us at a free educational lecture to learn more:

Saturday, October 20, 2012Crowne Plaza Tysons Corner 1960 Chain Bridge Road, McLean, VA 22102

Program: 10:00 - 11:30 a.m.Reception & Refreshments: 11:30 a.m. – 12 p.m.

Attendance is free, but registration is required. Call 202-342-2400.