Enhancing early detection through an innovative diagnostic imaging technique

BY JAKE POINIER

W ith a family history that in-cludes a father with prostate cancer, a mother who had

breast cancer, and a brother who died of colon cancer — not to mention her own bout with breast cancer 24 years ago — Nancy Morton wasn’t taking any chances. “When I learned I had a very high calcium blood count, my family history told me to get checked right away,” she says. “If there was even a one percent chance of cancer, I wanted it out of there.”

Morton’s quick action, with the aid of an advanced diagnostic technique at Banner MD Anderson Cancer Cen-ter, saved her life. “When Nancy came to see me, she had high calcium levels, and some vague complaints such as tiredness, weakness and weight gain,” says Rob Schuster, M.D., chief of surgery at Banner Gateway Medical Center. “The most common cause for that is a problem with the parathy-roid, right around the thyroid gland, abnormally making calcium, but she had some previous tests that said the area was normal.”

Schuster examined her and ordered a type of diagnostic imaging that’s only available at Banner MD Anderson Cancer Center and its parent facility, The University of Texas MD Anderson Cancer Center in Houston. “A hypersecreting parathyroid can be very difficult to find radiologically,”

Don Schomer, M.D. diagnostic imaging section chief at Banner MD Anderson Cancer Center, uses highly sophisticated techniques including three-dimensional imaging to achieve the most precise diagnosis.

Imaging is everything

INSIDE2 Focused on early detection3 Ask the expert 4 Expressions of hope

6 ‘Flavor profiling’ helps in chemo treatment7 Steps of Hope Garden Project8 Events and classes

MARCH 2012

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2 MARCH 2012 CREATING HOPE

Most patients who come to Banner MD Anderson Cancer Center already have a diagnosis of cancer. But sometimes a person may have radiological or lab abnormalities, or even symptoms that raise suspicion, and they’re not sure where to go.

Banner MD Anderson’s new Suspicion of Cancer Clinic is targeted at precisely this type of early detection. “Our goal is to ex-pedite the workup and get them to the right physician, because oncologists are very specialized,” says David Edwards, M.D., section chief of internal medicine at the Banner MD Anderson Cancer Center and a part-time clinician working in the program.

The staff includes two general internists and one pulmonologist. The process operates on a similar principle to triage in an emergency room, starting with a conversation between the patient and a nurse clinical navigator. “If a patient already knows he has cancer, they’ll talk about how was it diagnosed, and what type of cancer it is,” said Edwards. “If someone has a spot on her lung, but hasn’t had a workup, the navigator will direct her to the appropriate physician. We even talk to ER physicians with a patient who they believe has cancer, but don’t have an official diagnosis.”

Patients can access the Suspicion of Cancer Clinic through their primary care physician or by calling Banner MD Anderson directly at 480-256-6444.

says Don Schomer, M.D., diagnostic imaging section chief at Banner MD Anderson Cancer Center. “With MRI and CT scans, they blend into other tissue, while nuclear medicine shows you their activity, but without very precise imagery.”

To overcome that, MD Ander-son is pioneering an innovative technique called biologic imag-ing — which combines nuclear medicine, a rotat-ing camera that provides tomo-graphic data, a CT scan, and a multiphase post-contrast study.

In layman’s terms, when you put those high-tech tools together, it’s an all-star team: They produce an incred-ibly precise 3-D image.

“In Nancy’s case, the images were absolutely remarkable,” Schuster says.

“It showed that the parathyroid gland was in a completely different location than we thought, near her spine. It also showed a large mass on her thyroid, which no one knew about.”

A biopsy revealed the mass to be cancerous. But the diagnostic test proved to be a double blessing, because armed with highly ac-curate information, Schuster was able to perform both the thyroid cancer and parathyroid operations at once through a minimal incision. “From a

surgical standpoint, we rely on these very advanced radiological tests to tell us where to go,” Schuster says. “Not only can we detect the tumors early, it helps us make surgeries as safe as possible and help patients get back to normal life sooner.”

Which is exactly the path Morton hopes to be taking. With the operation successfully completed, she recently re-ceived a radiation treatment that would remove any remaining cancer cells in her bloodstream, and was hoping to re-ceive a clean bill of health. “The doctors at Banner MD Anderson were fantastic and the technology was great,” she said. “The way I look at it is that a few hours of treatment can buy a lot more years.”

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An innovative diagnostic imaging study only available at Banner MD Anderson Cancer Center and The University of Texas MD Anderson Cancer Center in Houston provided Nancy Morton’s physicians the information they needed to diagnose and treat her thyroid cancer.

Focused on early detection

Not only can we detect the tumors early, it helps us make surgeries as safe as possible and help patients get back to normal life sooner.

– Dr. Rob Schuster, M.D.

BannerMDAnderson.com 3

A: The risk of developing colon cancer is influenced by key

factors that include genetic predis-position, some preexisting medical conditions and lifestyle.

STEP ONE: Ask your physician to evaluate

your risk based on your family history of

colon cancer and any preexisting condi-

tions you have that would increase your

likelihood of developing the disease. For

example, if a family member developed

colon cancer before age 50, or you have

an inflammatory bowel disease, such as

ulcerative colitis, you have a higher risk

of developing colon cancer.

STEP TWO: Get screened. If your risk is

low, start your colon cancer screen-

ings at age 50 and repeat every five

to 10 years. If your screening reveals

something that may be precancerous,

your doctor will specify more frequent

screenings. If your initial risk is medium

or high, your physician will recommend

that you start your screenings at a

younger age and with higher frequency.

If you’re already 50 or older and have

never been screened, start now.

STEP THREE: Talk to your physician

about taking certain supplements. Many

vitamins and medications have been

investigated for their ability to prevent

colon cancer. While, for many, the jury is

still out, you may consider taking 1,000 to

1,500 mg of calcium and one baby aspirin,

which is 81 mg, daily. It is important to

first consult with your physician, because

certain supplements may cause some

harmful side effects in some people.

STEP FOUR: Commit to a healthy lifestyle.

Eat a diet rich in fruits, vegetables,

vegetable oils and fiber. Avoid red

meat, processed foods and sugar, and

fatty foods.

Maintain a low body mass index

and stay physically fit.

Don’t expect to lower your risk by

following a healthy lifestyle for just a

few months. You really have to commit

to these lifestyle changes.

Meet Dr. Tomislav Dragovich

Tomislav (Tom) Dragovich, M.D., Ph.D. is chief of the section of hematology and medical oncology at Banner MD Ander-son Cancer Center in Gilbert, Arizona. His specialties are digestive tract can-cers including colorectal, esophageal, stomach, pancreatic and hepatobiliary.

WORK EXPERIENCE: Prior to joining Banner MD Anderson Cancer Center, Dr. Dragovich served as director of the clinical gastrointestinal cancer program, and associate professor of medicine in the Section of Hematology/ Oncology at the University of Arizona College of Medicine.

MEDICAL SCHOOL: University of Belgrade School of Medicine, Serbia.

INTERNSHIP AND RESIDENCY: University of Chicago Medical Center/Weiss Memorial Hospital.

POST-GRADUATE TRAINING: Ph.D. in Pharmacology, University of Illinois, Chicago.

FELLOWSHIP TRAINING: Hematology and Oncology, University of Chicago Pritzker School of Medicine

BOARD CERTIFICATION: American Board of Internal Medicine, Medical Oncology and Hematology.

How can I reduce my risk of colon cancer?Q:

askthe expertBY ANDREA MARKOWITZ

A: Colorectal cancer can be

cured with laparoscopic or

conventional surgery when it’s dis-

covered early. Catching it later may

require additional therapy such as

chemotherapy and radiation, and

the potential for being cured may be

reduced. It takes about 10 years to

develop colon cancer, so if you begin

your screenings at the appropriate

age for your risk level, your doctor has

a better chance of finding and remov-

ing potential precancerous lesions, or

polyps, when they’re still benign.

What is the most important thing I should know about colon cancer?Q:

for more info:

For more information about colon cancer visit bannermdanderson.com.

4 MARCH 2012 CREATING HOPE

From the Tree of Hope in the main lobby to the Lantern

of Hope that lights up the night sky, symbols of hope

abound at Banner MD Anderson Cancer Center.

But hope is more than a word at the cancer center. It is a

symbol of the empowerment patients have to participate in

their care. To our staff, HOPE stands for Helping Oncology

Patients to be Empowered. Our staff and physicians provide

patients and their loved ones with information, education

and support to help them find their own symbols of hope

throughout their cancer journey.

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1. The Tree of Hope was donated by the Cancer Center’s first CEO Pam Nenaber as a sym-bol of hope and compassion.

2. Patients and visitors are encour-aged to tie colored ribbons to

the Tree of Hope in recognition of those touched by cancer.

3. The Lantern of Hope lights up the night sky as a symbol of hope for those touched by cancer.

4. A visitor ties a ribbon on the Walk of Hope at Desert Botanical Gardens to honor someone touched by cancer.

5. Thousands of guests wrote messages of hope on brightly

colored ribbons along the Walk of Hope sponsored by Banner MD Anderson Cancer Center at Desert Botanical Gardens.

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6 MARCH 2012 CREATING HOPE

BY GREMLYN BRADLEY-WADDELL

Chemotherapy is a wonderful

tool in the war against cancer,

but as most folks know, it has

some less than wonderful side effects

like hair loss, fatigue and nausea.

And an overwhelming majority of

patients also suffer from “taste acu-

ity,” says Heather Metell, executive

chef at Banner MD Anderson Cancer

Center and Banner Gateway Medical

Center in Gilbert.

“Food doesn’t taste like it’s sup-

posed to,” she says, explaining that

taste buds – like cancer cells – are a

type of cell that grows quickly. Just the

type that an anti-cancer treatment

such as chemo is created to destroy.

As a result, Metell says, patients of-

ten find their food tastes odd: metallic-

like, too salty, too sweet or just plain

tasteless. And taste can vary from day

to day; one day, foods taste sweet; the

next, they don’t. But because maintain-

ing one’s weight and strength is vital to

be able to continue and finish chemo

treatments, it’s that much more impor-

tant to make sure one is getting enough

sustenance, adds registered dietitian

Monika Baxter, who also works at the

cancer center.

All of this got Metell to thinking.

And one of her first thoughts was in-

stead of sending food up to a patient’s

room and finding out later that the

food tasted wrong, why don’t we go up

to their room first and ask what they

can taste? Then, a meal can be tailored

to their specific needs. So, that’s what

Metell’s staff began doing. Armed with

samples of vanilla pudding, peanut

butter and lemon yogurt – foods that

typically register to most folks as

sweet, savory and sour – they meet

one-on-one with patients, often before

chemotherapy treatments have begun,

to determine what they can taste and

how it tastes. Then, if a patient can

detect sourness, for example, Metell

might whip up a lemon crème sauce

to put atop halibut. If another patient

can taste sweetness, a protein-packed

Chocolate Diablo smoothie may be

added to the menu.

Metell calls the process “flavor pro-

filing,” and believes she and her staff

may be the only ones in the country

doing this kind of thing in a hospital

setting. They began this “very moth-

erly approach,” as she calls it, after the

cancer center opened in September

2011 and have worked with about 25

people thus far. Metell is also collecting

data and trying to improve upon the

method every day.

“So far, it’s been working out pretty

well,” Metell says. “It’s challenging but

pretty rewarding when you get some-

one nourished.”

‘Flavor profiling’ helps in chemo treatmentExecutive chef tailors’ meals to patients’ taste, nutritional needs

Profile: Executive Chef Heather Metell

Heather Metell has always felt at home in the kitchen, whether it was the one in her childhood home or a more commer-cial variety.

“I was washing dishes at a little inn at 12 years old,” says the executive chef, who now oversees a staff of about 50, including dietitians, cooks and dishwashers, at Banner MD Anderson Cancer Center and Banner Gateway Medical Center in Gilbert.

Originally from Massachusetts, Metell made her living for years in the kitchens of some of the finest East Coast resorts. And while she ditched the country-club atmosphere and its stressful demands when she moved to Arizona – she yearned for a more relaxed lifestyle, one in which she didn’t have to put in “90 hours a week” – the elegant and refined approach to food she had mastered during her years on the resort scene is evident in the menu offerings she now serves up for patients.

“It’s been a bit of a challenge to make the food taste good without salt or fat,” says Metell, whose culinary passion is making sauces. “But we’re probably one of the only hospitals that makes its own veal demi-glacé.”

Metell calls the process ‘flavor profiling’ and believes she and her staff are the only ones in the country doing this kind of thing in a hospital setting.

BannerMDAnderson.com 7

The healing courtyard outside

the main lobby of Banner

MD Anderson Cancer Center

symbolizes the journey patients and

their families often travel.

Leave your legacy at Banner MD

Anderson Cancer Center by purchasing

a personalized tile or plaque for the

healing courtyard. Engraved tiles, or

Steps of Hope, will surround the “To-

getherness” sculpture on the west side

of the garden, and individual plaques

can be placed on or near sponsored

trees or benches throughout the garden.

Contact Banner Health Foundation at

602-747-GIVE (4483) to learn more.

Banner Health Foundation secures

and stewards charitable gifts to help

Banner Health achieve its nonprofit

mission of making a difference in peo-

ple’s lives through excellent patient care.

The Foundation is seeking charitable

contributions for a wide range of pro-

grams designed to support patients and

their families. Contact us to learn more

about ways you can support Banner

MD Anderson, or to get involved in the

Foundation’s Cancer Has Met Its Match

fundraising campaign.

STEPPING THROUGH THE HEALING COURTYARDThe Healing Courtyard was designed

to represent the cancer journey

through desert landscaping and artistic

elements. Three separate areas offer

quiet places for reflection.

WATER GARDENThis area includes three low decora-

tive water walls that gently trickle

water along stone fountains to create a

tranquil environment to symbolize the

beginning of the cancer journey.

ZEN GARDENThis area, located in the middle of

the courtyard, features benches for

relaxation and stepping stones through

a seasonal garden of wildflowers that

for more info:

Follow us on Facebook: Facebook.com/bannermdanderson

BANNER MD ANDERSON CANCER CENTEROn the campus of Banner Gateway Medical CenterU.S. 60 and Higley Road in Gilbert

Schedule an appointment: (480) 256-6444Check out our website bannermdanderson.com

form the “Journey of Hope.” This path

is a symbol of the cancer journey, with

the stepping stones and large boulders

resembling challenges patients and

their families may face along the way.

TOGETHERNESS GARDENThis area, located in the back of the

courtyard, is designed for patients and

their families to gather and reflect on

their journey as they look upon the

Togetherness Sculpture. You enter this

garden through a narrow doorway

which symbolizes hope and victory

at the conclusion of treatment. The

Togetherness Sculpture features three

stones that symbolize those who made

the journey. The tallest piece repre-

sents the survivor; the next, family,

and the last, friends.

Steps of HopeBecome a Lasting Part of the Healing Courtyard

PRESORT STD

U.S. POSTAGE

PAID

LONG BEACH, CA

PERMIT NO.1677

To schedule an appointment, call 480-256-6444

Dates: Tuesday afternoons beginning May 1st and ending June 5th 2012.Time: 4-5pmRegister: Call 602-230-CARE to register. There is no cost for this program but weekly attendance is required.

Preventing Skin Cancer & Melanoma in the Valley of the SunTHURSDAY, MAY 3, 6 P.M.Featuring two of Banner MD Anderson’s melanoma experts: Dr. Mark Gimbel, surgical oncologist and Dr. Jade Homsi, medical oncologist. Learn how to protect your skin, signs and symptoms of skin cancer, latest treatments for melanoma.

Banner Gateway Medical Center, 1900 N. Higley RoadRSVP: 602-230-2273

Wellness classesBanner MD Anderson Cancer Center offers a variety of classes and support groups to assist cancer patients, survivors and their support teams. These classes are free and open to the public. Classes are held at Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Drive, Gilbert, AZ, 85234.

Cancer Survivorship Support Group4 P.M., SECOND TUESDAY OF EACH MONTHA therapeutic support group led by licensed social workers to encourage hope and healing for all cancer survivors. Support is welcome to attend but please no children under 16 years of age.

Special EventsA Multi-Disciplinary Approach to Breast CancerTUESDAY, APRIL 17, 6 P.M.Hear from Banner MD Anderson’s breast cancer experts in the specialties of mammography, medical oncology, surgery and radiation oncol-ogy. These physicians will discuss the latest innovations in the prevention, screening and treatment of breast cancer.

Banner Gateway Medical Center, 1900 N. Higley RoadRSVP: 602-230-2273

Mindfulness-Based Stress Reduction 6-WEEK COURSEDevelop tools to begin or enhance your mindfulness practice. Class benefits include relaxation, stress reduction, and mind/body awareness. Open to all current cancer patients and cancer survivors.

Dates: Friday mornings starting on April 20th and ending May 25th 2012.Time: 8-9:30amRegister: Call 602-230-CARE to register. There is no cost for this course but weekly attendance is required.

Weight Management Strategies for the Breast Cancer Survivor 6-WEEK PROGRAMA weight management program for the breast cancer survivor that provides strategies for weight loss/maintenance, physical activity and stress reduction. Will stress the importance of lifestyle on cancer reoccurrence. This class is not open to patients currently undergoing treatment for cancer.

Journey to Wellness Group4 P.M., THIRD WEDNESDAY OF EACH MONTHA wellness education group led by a registered dietitian and exercise physiologist that promotes healthy lifestyles. A different topic is discussed every month. Please check our website for topic updates at www.bannermdanderson.com.

Monday Morning Meditations9 A.M. EVERY MONDAY MORNINGTake a moment to relax and breathe with us. In the Healing Garden or in the Learning Center.

Chair Yoga10 A.M. EVERY MONDAY MORNINGA calming yoga that stretches our bodies safely while relaxing our minds. Yoga is done sitting in the chair or standing behind the chair for assistance.

Gentle Yoga4 P.M. ON EVERY THURSDAYYoga aimed at releasing the tension in your muscles and mind.

For questions, contact the Health and Wellness Coordinator at Banner MD Anderson Cancer Center at 480-256-4141.

Events and Classes