Amy Gray Archives

Milton Marks Family Camp – A Respite from Brain Cancer

For the past three autumns, a small gathering has taken place in the wild beauty of Sonoma County, California.  There, doctors, nurses, musicians, therapists, and body workers, among others, have convened to offer support and respite to a unique group of people – families living with brain cancer.

But unlike many specialized family camps that focus on a child with cancer, this one flips that model – offering support to a family with a parent with cancer.  It is the only one of its kind.

The diagnosis of brain cancer is a catastrophic event in the life of a family.  The brain is the source of a person’s ability to communicate and interact.  Certainly a breast or prostate cancer diagnosis can be devastating for an individual and their family.  But the patient’s essential personality can remain intact throughout the grueling treatments.  That may not be the case in glioblastoma, the most virulent and fast-moving type of brain cancer.  And it is incurable.

Brain cancer can strike people in the prime of their life, when their children are young.  During the months of treatment, a patient’s ability to speak, reason, laugh, or interact may be affected adversely.  The sight of dad or mom deteriorating physically and mentally can cause immense suffering for the family.

In 2010, Abby Marks found herself living this life with her husband Milton Marks and their three young sons.  After Milton’s death in 2012, Abby came up with the idea of offering a place of respite and connection for families experiencing the impact of brain cancer.  Working with the University of California Medical Center’s (UCSF) Neuro-Oncology department, where Milton had received treatment and care, the camp launched in 2014.

The camp’s mission is to provide connection, community, and fun!  It is a camp, after all.  There are sing-a-longs at the campfire, art projects, music, ropes courses, swimming, and more.  The UCSF doctors and nurses that tend to these families can also attend, adding a new dimension to the patient/medical professional relationship.  There are therapists and body workers available, as well as a professional photographer to document this island of respite in the long haul of brain cancer.  Families leave with sense of connection to others living this unique journey.

The Camp is now gearing up for its fourth year.  A few families are returning.  Most are new.  All are looking forward to spending three days being cared for, understood, and encouraged as they navigate this difficult journey.

[Disclosure:  Amy Gray is the operations manager for the Milton Marks Neuro-Oncology Family Camp]



Why your cancer-creating habits can affect your children (and we’re not talking about second-hand smoke).

It’s hard enough being a parent.  There are no “Parenting for Idiots” books out there.  We just bumble along, trying our best to inoculate our children from our worst selves and influence them with our best.

But like many humans, we may hit the potato chips a bit hard, make exercise the last task on our ever-lengthening “to do” list, and find ourselves doing things we know may not be good for us.

But the science of epigenetics is now telling us that we’re not only influencing our own health but those of our children – genetically.

Here’s how it works.  Epigenetics looks at the way genes express or don’t express themselves as we age.  Those gene changes are thought to be influenced directly as a result of our nutrition and behavior, as well as exposure to toxins in our environment.  In a sense, it’s a hybrid of hereditary disease and lifestyle choices.

An experimental study was done by Stanford University scientist Anne Brunet and colleagues. They noticed that nematodes (a type of worm) had varying lifespans.  Some were exceptionally long-lived and passed that trait through three generations.  Others lived much shorter lives. Yet all the worms, both the old sages and the early departers, were genetically identical.

How is this possible?

The answer lies in epigenetics.  Some of the worms had experienced a change during their lifetimes that affected certain gene expressions that regulated lifespan.  They passed that gene expression through reproduction, even though it had not been part of their initial DNA makeup.

A human version of this can be found in the cases involving the synthetic estrogen compound  diethylstilbestrol (DES).  This was given to women in the 1950’s to prevent miscarriages.  Later it was discovered that DES mothers gave birth to DES affected daughters, increasing their risks for vaginal, breast, and ovarian cancers. Ironically, it also made DES daughters more prone to miscarriage.  The mechanism for this phenomenon is now believed to be epigenetics which facilitated the altered maternal DNA to be passed down to their daughters.

It must be noted the study of epigenetics is in its infancy.  Clear-cut examples of it, like noted above, are rare.  But scientists now have a new understanding that our lifestyle choices and exposure to environmental toxins can affect sperm and egg DNA, and thereby set up new generations for cancer risk in ways that cannot be explained through traditional genetic pathways.


How Your Lifestyle Can Affect Genes That Cause Cancer

There are two schools of thinking about cancer.  School one says that cancer is a hereditary disease, passed from generation to generation.  A good example of this are women who possess the BRCA1 and BRCA2 gene mutation.  Women with this mutation have a 70% lifetime risk of developing breast and/or ovarian cancer.  Angelina Jolie, for example, lost her mother and aunt to cancer and was subsequently found to have the same mutation.

The second school says that cancer can occur due to lifestyle choices.  A good example of this is cigarette smoking. It is the number cause of lung cancer, linked to 80 – 90% of lung cancer cases.

Recently, researchers at the Boston University School of Medicine have introduced another theory about the development of cancer.  They proposed that there are processes within our cells that activate certain sequences of DNA.  Those processes act as on/off switches for the development of cancer.

This idea is based on the evolving science of epigenetics. Epigenetics looks at the way genes express or don’t express themselves as we age.  Those gene changes are thought to be influenced directly as a result of our nutrition and behavior, as well as exposure to toxins in our environment.  In a sense, it’s a hybrid of hereditary disease and lifestyle choices.

Epigenetics is a normal process in our bodies.  For example, all of our DNA is the same, yet cells develop into liver cells, brain cells, muscle cells, etc. because of the way epigenetics turns on and off different cell processes.  But our lifestyle choices can impact the way genes express themselves as well.

Perhaps you’ve heard the expression “Sitting is the new smoking.”  The reason for this is due to research on lifestyle and cancer.  The results of dozens of surveys found that a sedentary lifestyle increases the risks of cancer, specifically colon cancer.  Subjects who spent most of their day sitting were 24% more likely to get colon cancer.  People who watched the most television had a 54% greater risk than those who watched fewer hours.  Uterine cancer was also affected by sitting; women who were the most inactive experienced a 32% great risk.  The female T.V. watchers fared worse; those who watched the most television has a 66% risk of developing uterine cancer.

In all these cases, it’s not the inactivity per se that causes cancer to develop.  It’s the processes of epigenetics that are affected by inactivity that can cause cancer.

It’s a complicated and exciting time.  Next month, more on how unhealthy habits are incorporated into our DNA and passed onto our children.


Can A Shot From Your Doc Prevent Cancer?

Vaccines for highly contagious childhood illness — such as diphtheria, measles, and the mumps — are, for many, an everyday part of pediatric health care.  Even though our kids may scream piteously as the needle goes in, many parents feel that it’s a good thing to protect their children from what were once very common illnesses.

Now this same concept is being applied to cancer.Amy Gray

Along with the growing interest in immunotherapy to treat cancer, there is now growing interest in the idea of preventing cancer through using the body’s own mechanisms to fight disease.  There are several vaccines that have gone through clinical trials and been approved by the FDA: Gardasil®, Gardasil 9®, and Cervarix®.  There are also several vaccines that work against Hepatitis B.

Gardasil®, Gardasil 9®, and Cervarix®were formulated to protect against the human papillomavirus (HPV) that can be spread through sexual intercourse.  Studies have shown that long-term exposure to HPV can cause cervical canceranal canceroropharyngeal cancer, and vaginalvulvar, and penile cancers. These vaccines protect against the human papillomavirus (HPV) taking up residence in the body.

Long-term exposure to Hepatitis B virus (HBV)  impairs liver function and can lead to liver cancer. So researchers have designated HBV as the target of multiple vaccines that protect against this infection.  Two vaccines, Engerix-B and Recombivax HB, target only Hepatitis B. Other vaccines such as Twinrix and Pediatrix protect against HBV and other harmful viruses. Clinical trials are underway to develop vaccines to prevent cancers of the bladder, brain, breast, prostate, and kidneys, among others.

Using vaccines to protect and prevent cancers is just beginning.  It is showing great promise as research shows the interrelationship of various viruses and cancer development.


How Cancer Can Be Diagnosed Instantly with a Smart Scalpel

Amy GrayIf you’re a cancer patient who has been told you need to “go under the knife,” here’s some helpful news.

Cancer surgery is often prescribed to diagnose a particular tumor or remove it if it’s found malignant. But often cancer surgery is exploratory and the diagnosis of a tumor found in the course of surgery can take a half an hour or more. This all goes on while you are under general anesthesia, which is not easy on the body.

Additionally, if a diagnosis is made during surgery and the tumor is removed, there is a chance that not all of the tumor is found during the initial surgery.   For example, 20% of breast cancer patients undergoing lumpectomies must return to the surgery table at a later date because the surgeons weren’t able to find the clear margin of the tumor.

All this time spent in surgery and under anesthesia can add stress to an already stressful situation.

To address both these situations – that is, quick diagnosis of tumors and thorough removal of the tumor during surgery – the iKnife presents a high tech option.

The iKnife was introduced as a surgical tool in 2013. Dr. Zoltan Takats, of Imperial College London in the United Kingdom, noticed then when the iKnife cut into the body, a stream of smoke was released as the incisions in the tissues were cauterized to prevent further bleeding. He had the idea of pairing the iKnife with a technique called rapid evaporative ionization mass spectrometry (REIMS). REIMs measures the way light is refracted by the chemical output in the smoke. In other words, each cells, cancer or otherwise, has a unique “smoke signal.” This smoke can be quickly matched to a database of over 3000 different cancer cells. The result: cancer diagnosis can be made on the spot during surgery, within 1 -3 seconds.

The iKnife is also helping in determine the margins of the tumor as the surgery is happening. Using the same smoke signals, the surgeon can detect with amazing precision when he or she is cutting into healthy tissue and thereby determine a clear margin of the tumor.

Dr. Katas tested the iKnife diagnosis technique with 81 of his surgery patients. He found a 100% correlation between the traditional slower lab results with the instantaneous iKnife analysis.

The iKnife is already in use at Imperial College in London. Clinical trials are underway using the iKnife in breast, colon, and ovarian surgeries.



Liquid Biopsy Is the New Frontier in Cancer Diagnosis

When my husband was diagnosed with very early stage prostate cancer, it was determined that the best course of action was “watchful waiting” – that is, monitoring the cancer at six month intervals using biopsies of the prostate. It sounded reasonable.

What was not mentioned was the excruciating ordeal of prostate biopsy. Each time he went in for one, it took all day because of the side effects of blood clotting and Amy Grayblocking of the urethra. This led to catheterization as well as pain. After his third one he said, “Let’s just cut the damn prostate out. It’s gotta be better than these biopsies.”

Wouldn’t it be great to have the same information gleaned from a drop of blood?

Thanks to Dr. Dennis Lo, a researcher in Hong Kong, this technology may soon be available. He developed a technique called the “liquid biopsy,” which has shown great success in detecting liver and other cancers before they are symptomatic. He does this with a gene sequencing machine that analyzes the DNA in a person’s blood. Since dying cancer cells shed their DNA into the blood stream, a liquid biopsy can detect the presence of a cancer on a cellular level. This technology is already being used in China as part of prenatal monitoring, as the fetus sheds cells into the mother’s bloodstream during pregnancy.

Early detection of cancer has been behind the great improvement in cancer treatment over the last few decades. For example, one of the main reasons for the decline in colorectal cancer is the more frequent use of colonoscopies. For greater efficacy in early detection, liquid biopsy is being looked at with great interest by American researchers and companies as well. Eric Topol, a professor of genomics at the Scripps Research Institute, stated that this technology, will become the “stethoscope for the next 200 years.” A San Diego company, Illumina, which builds fast gene-sequencing machines, is excited about the market potential of as much as $40 billion. It manufactures these devices, some of which are as small as a cell phone, and the devices could be used in clinical trials very shortly.

The liquid biopsy is not a one-size-fits-all cancer detection system. As each cancer has unique DNA markers, part of the research is to identify those markers and apply them specifically.

As far as my husband is concerned, the day cannot come too soon when a liquid biopsy is available for his type of prostate cancer. Luckily his cancer seems to be in remission, and his biopsy schedule has been reduced. Perhaps by the next rodeo, he’ll be able to have a blood draw and call it a day.


Comparing Cancer Treatment to Bug Control

When farmers try to manage insects in their crops, they figure out what dose of pesticide yields the best results. They do this based on understanding which bugs are the most harmful to their crops and what level of poison best combats them. This analogy may send shivers up the spines of organic eaters out there, but it does have relevance to the way chemotherapy is used in treating cancer.Amy Gray

It turns out that not all cancer cells (i.e. insects in the crops) are equally harmful within a tumor.   Some are much more aggressive. When a broad-based chemo is used to kill all the cancer cells, it often leaves behind the most resistant ones, allowing them an opportunity to take over the tumor.

A quick look at evolution explains this phenomenon. Dr. Robert Gatenby, chair of radiology and co-director of the cancer biology and evolution program at Moffitt Cancer Center and Research Institute, says “We tend to think of cancers as a competition between the tumor and the host, but at the level of the cancer cell, cancer cells are mostly competing with each other,” he says. Competition within a tumor reflects a basic evolutionary principle, one which cancer cells utilize as well as normal cells.

Given this theory, Gatenby and his team wondered about the perfect level of chemotherapy that would repress the more aggressive cells, rather than encourage them to overtake the less aggressive cells. In the experiment, they took cells from two different breast cancers and grew them in mice. The mice were then treated to two separate chemo protocols. Group One mice were given lower-dose chemo and then skipped sessions if their tumors shrunk. Group Two mice were given continuous but gradually lower doses of chemo.

The researchers were surprised that 80% of the Group Two mice showed better response in reducing cancer growth. Some of the tumors disappeared completely.

This research is in its early stages and requires quite a bit of personalized chemotherapy analysis. One fly in the ointment – patients have to overcome the mindset that cancer treatment kills all cancer cells. They have to be content with the knowledge that not all cancer cells need to leave the body in order for a treatment to be successful.

In other words, leave the ladybugs and kill the locusts.



The New Version of “The Fantastic Voyage”

In 1966, a science fiction film was released about a team of scientists who shrank themselves into molecular sized particles in order to heal a colleague from withinAG his body. Crazy, no?

Well, since then, we’ve seen the development of nanotechnology, a new tool where disease fighting mechanisms are released into the body. Their size? About 100 to 10,000 times smaller than human cells. These smart little machines travel through a patient’s body to the site of a particular problem. Not surprisingly, a very big use of nanotechnology is in the diagnosis and treatment of cancer.

Nanotechnology and cancer detection and treatment is a match that, in the past, was only imaginable in science fiction. Cancer initially happens in formerly undetectable ways at a molecular level. Nanotechnology has the capacity to rapidly detect cancer-causing cells, also at the molecular level. Through the application of molecular contrast agents, nanotechnology can not only detect changes in cells potentially leading to cancer, but can also monitor treatment to ensure that a cancer patient is receiving the correct medicine. Understanding and treating cancer on such a profoundly targeted area of the body can also lead to greater development of individualized therapies.

At this point, most cancer patients receive some combination of surgery, radiation, and chemotherapy, all of which can have distressing side effects. The promise of nanotechnology is that the field of targeted treatment, already in process, can be accelerated even more. And as early detection is one significant tool in cancer treatment and cure, nanotechnology can certainly be an important tool in that arena.

How available is nanotechnology for the average cancer patient? Several new nanotechnology drugs have passed the clinical trial stage and are on the market, including Doxil® and Abraxane®. Doxil® has been approved in treatment of AIDS-related Kaposi’s sarcoma, breast cancer, ovarian cancer, and other solid tumors. Abraxane® is being used in the treatment of advanced breast cancer, advanced non-small lung cancer, and advanced pancreatic cancer. Many other nanotechnologies are in the pipeline as well.

Chalk one up for science fiction predicting real life inventions! I’m still waiting for the transporter myself.





Running From Cancer – And Towards Lower Risks

As you head out for your run, walk, or swim of the day, it’s good to know that in addition to the widely known cardiac benefits, exercise also brings documented results in lowering cancer risks. A recent study from researchers at the National Cancer Institute and the American Cancer Society found evidence that the current recommendation of moderate-intensity activity, now a little more than 20 minutes a day, is also a key component of cancer prevention. Steven C. Moore, Ph.D. noted, “Leisure-time physical activity is known to reduce risks of heart disease and risk of death from all causes, and our study demonstrates that it also associated with lower risks of many types of cancer.”

This may not be news to many because there have been literally hundreds of studies linking physical activity and cancer risk. This new study took a much larger look at the data, pooling information on 1.44 million Americans and Europeans ages 19 – 98 and followed the data for a median of 11 years. What stood out particularly was the reduced risks for breast, colon, and endometrial cancers.

Most studies targeting breast cancer show that physically active women have a lower risk of developing this kind of cancer. Depending upon the study, the risk reduction varies widely, between 20 to 80 percent. Activity starting in adolescence is found to be the most beneficial; however, that doesn’t let older ladies off the hook. No matter when an exercise program is started, active women enjoy reduced breast cancer risks when compared to sedentary women.

It is also estimated that daily sessions of moderate physical activity has a protective effect against both colon and endometrial cancers, from 30 to 40 percent reduced risk. One overarching question on all these studies is how does exercise reduce cancer risk? There seem to be a number of mechanisms in place including the lowering of hormone levels and insulin growth factors, improving the immune response, and reducing the time certain organs are exposed to potential cancer-causing substances. Exercise also seems to lower inflammation, which could play a role in cancer development. So, tie up those walking/running/cross training shoes and have a go at it! No matter how you look at it, exercise provides significant benefits on many levels in cancer prevention.

Sources: prevention/risk/obesity/physical-activity- fact-sheet#q4 releases/increased-physical- activity-associated- lower-risk-13- types-cancer

Heading Off Cancer Growth on the Cellular Level

Cancer cells are like all the cells in our body, in that they need certain basic building blocks – amino acids – in order to reproduce. There are 20 amino acids found in nature. The amino acid serine is often found in abundance in patients with certain types of breast cancer, lung cancer, and melanoma. The overproduction of this amino acid is often required for the rapid and unregulated growth characteristic of cancer.

Scientists at the Scripps Research Institute (TSRI) wondered if there was a way to take advantage of the relationship between cancer cell proliferation and serine. Amy GrayThey examined a large library of molecules -numbering 800,000 – to find an enzyme that inhibited serine production. After much research, the group found 408 contenders that could possibly work. This list was again narrowed down to a smaller set of seven, ending with one promising candidate. This molecule, 3-phosphoglycerate dehydrogenase (PHGDH), seemed to inhibit the first step in a cancer cell’s use of serine to reproduce itself.

Luke L. Lairson, assistant professor of chemistry at TSRI and principal investigator of cell biology at the California Institute for Biomedical Research remarked, “In addition to discovering an inhibitor that targets cancer metabolism, we also now have a tool to help answer interesting questions about serine metabolism.”

What does this mean for cancer patients in the future?

Discovering an enzyme that inhibits serine production means that a key process in cancer cell proliferation can be slowed down or even stopped.   Interfering with cancer cell metabolism could be a pathway to treatment. Potentially, adding the molecule PHGDH to cancer cells disturbs the basic need of cancer cells to divide and reproduce rapidly. Obviously this finding points to years of further research and drug development. But discovering this key relationship between serine over-production and a molecule that slows it down could be a model for new cancer treatments in the future.


The End of Trial and Error As a Drug Delivery Model?

As researchers discover that cancers can be specifically targeted with a particular drug, the question then arises – which medication works best for a unique individual with a particular cancer?  Researchers at the Fred Hutchinson Cancer Research Center and the company Presage Biosciences have created a device called CIVO™ to answer that very question.

In the past, oncologists have made their best guess as to which medication protocol would work on a particular cancer, based on data from animal models, clinical trials, and their medical expertise. In this scenario, only one drug can be tested at a time. Researchers know that there is considerable variation between how a drug affects a tumor in different individuals. The end result — a patient can be treated with no positive effect on treating the cancer, but they experience uncomfortable side effects of the medication nonetheless.

The CIVO™ device can change that model.

CIVOUsing up to eight tiny needles, a patient’s tumor is injected with multiple drugs that have been shown to have an impact on that particular cancer. The drug amounts are miniscule compared to what could be delivered to a patient for treatment purposes. The patient will in all likelihood not experience the painful side effects of a full dose of the medication. The test subjects also report little pain during the injection process.

In one to three days, doctors remove a piece of the tumor and examine it in the lab. They can then see which medication killed the cancer cells, slowed their growth or was ineffective. That piece of information can work wonders for doctors trying to determine the best drug protocols for their patients. And potentially patients will not have to suffer needlessly while undergoing a treatment that may not ultimately work well.

CIVO is has been used on animal subjects and is now part of a human study as well as a collaboration between Presage, the Seattle Cancer Care Alliance (SCCA) and the Fred Hutchinson Cancer Research Center, with funding support from the National Cancer Institute (NCI). Researchers are hopeful that this new technology will shine a brighter light on what drugs work best on which cancers in certain individuals. That will be welcome relief for patients who have just been diagnosed with cancer and are anxious about medication side effects.



Can the Apple Watch Be the Next New Thing in Cancer Treatment?

Apple watches are cool devices for checking email on the go and staying in touch. But researchers at MD Anderson Cancer Center wondered if they could also be a useful tool for helping breast cancer patients with their treatments.   This past December, a study was launched in collaboration with Polaris Health Directions who provided Polestar™, a health management app.

Participants in this trial will use the Apple Watch to answer questions about their symptoms, treatment side effects, and mood. The watch will also monitor physical activity, quality of sleep, and heart rate. The end result of all this monitoring? First, researchers hope to more accurately monitor each patient’s health during treatment, intervening earlier if needed. Secondly, cancer patients are undergoing huge lifestyle changes. The Apple Watch and Polestar app can help patients remembering drug ingestion schedules, and connect them with other patients who are experiencing similar challenges.

Cori McMahon, PsyD, director of Behavioral Medicine at MD Anderson at Cooper, “I think a huge piece of addressing the uncertainty felt by cancer patients is advancing their health literacy. When patients are able to monitor their own behaviors, they are able to better understand the correlations between those behaviors and how they are feeling, and even change those behaviors to improve their quality of life.” The hope is that cancer patients will feel more in charge of their medical journey. That has shown to increase positive thoughts and feelings – a definitely non-technological but time-proven aid to battling illness.

Across the pond, researchers at King’s College Hospital in London are also utilizing Apple watches and related apps in their own study. Cancer patients familiar with “chemo mind” will recognize the difficulty in keeping track of medication schedules. Thanks to a nifty feature on the Apple watch called the Taptic Engine, the cancer patient is gently reminded to take his or her medication by a soft pat on the wrist. This feature also monitors body temperature which helps doctors head off possible side effect complications quickly.

Both of these studies are concerned with patients feeling more in control of their disease management. As more cancers move from acute to chronic, lifestyle changes become very important in managing the disease. Thanks to products like the Apple watch and associated apps, patients can become more active drivers of their health – and surf the net as well!