Archive for February, 2013

New Lung Cancer Screening Detects Tumors at Earliest Stages

New guidelines published in the Journal of National Comprehensive Cancer Network (NCCN) recommend that certain high-risk groups can benefit from lung cancer screening with low-dose CAT scan. The guidelines were developed after a study sponsored by the National Cancer Institute and published in the New England Journal of Medicine indicated that screening can reduce lung cancer mortality by 20 percent.

“This is good news because chest X-rays are inadequate at picking up lung cancer at an early stage,” says Rudy Lackner, MD , a thoracic surgical oncologist at The Nebraska Medical Center. “A CAT scan, on the other hand, can detect lung cancer nodules in stage 1a when the cure rate can be as high as 90 percent or more. However, currently only about 25 percent are found in the earliest stages. Approximately 75 percent of lung cancer cases are found in stages 3 and 4, when cure rates drop to 5 percent and lower.”

The guidelines recommend that individuals ages 55 to 74 that have smoked a 30-pack history should be screened. This is equivalent to a half pack a day for 60 years, one pack a day for 30 years or two packs a day for 15 years.

Because of these new recommendations, some of the major insurers are now covering this screening, says Dr. Lackner.

If a patient falls into this high-risk group, the pros and cons of lung cancer screening should be discussed between the patient and his or her primary care doctor. If a CAT is ordered and nodules are found, the patient should be referred to a lung specialist to determine whether they need to be biopsied or watched. About 50 percent of the population will have lung nodules from exposure to things like fungus or respiratory tract infections, but only 2 percent of these individuals will have cancerous nodules, says Dr. Lackner.

“Whether we biopsy the patient will depend on factors such as the size of the nodules and whether the nodules are increasing in size and multiplying,” says Dr. Lackner. “If the biopsy is negative, we will follow the patient for a minimum of three years.”

If no nodules are found, a CAT scan is recommended every year until age 74, says Dr. Lackner.

“The most challenging aspect of this screening is determining what should be done if nodules are found,” says Dr. Lackner. “This is where our expertise comes into play. We have a long track record of performing lung cancer screenings and treating lung cancer patients.”

Current data indicates that the chance for long-term survival improves when the medical team involved is dedicated to lung cancer treatment. The Nebraska Medical Center is unique in the region in that it has the only team of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, case managers and nurses dedicated to the treatment of lung cancer. Dr. Lackner works side-by-side with Apar Kishor Ganti, MD , a hematologist/oncologist specializing in lung, head and neck cancers, Karen Trujillo, MD , who with Dr. Lackner, are the only thoracic surgical oncologists in Nebraska with practices limited to cancers of the chest. The other members of his team dedicated to the care of lung cancer patients include oncologists Anne Kessinger, MD , and Alissa Marr, MD , radiation oncologist Weining (Ken) Zhen, MD , pathologist William West, MD , and radiologist Matthew DeVries, MD .

The Nebraska Medical Center is also a member of the NCCN and Dr. Lackner serves on the committee that developed the lung cancer screening guidelines.

Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable. It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined.



Neuroendocrine Tumor Clinic Specializes in Rare Carcinoid Tumors

Carcinoid tumors are rare and can be difficult to diagnose. Getting proper treatment for patients with these types of tumors can be even more challenging. The Nebraska Medical Center offers a Neuroendocrine Tumor Clinic to treat these difficult cases – one of a few in the country.

Luciano Vargas, MD , an abdominal transplant surgeon that specializes in the surgical management of neuroendocrine tumors at The Nebraska Medical Center, says the clinic sees patients from across the country for evaluation and treatment. “We have several types of surgical techniques that we use to remove the tumor: primary surgical resection, staged hepatectomy resection or liver transplantation.”

Dr. Vargas joined the staff at The Nebraska Medical Center in July 2012. He attended medical school at the University of Texas Health Sciences Center in San Antonio; completed two years of general surgery residency at the University of Nebraska Medical Center (UNMC) in Omaha; followed by two years of research in intestinal transplantation and a fellowship in liver transplantation. He is also an assistant professor of Surgery at UNMC.

The Neuroendocrine Tumor Clinic meets twice monthly and has a growing patient base. Dr. Vargas works in collaboration with a neuroendocrine oncologist, Jean Grem, MD  and a dedicated nurse, Lucie Case.

Patients with carcinoid tumors typically present in the fifth and sixth decade of life and have various presentations, notes Dr. Vargas. Some are asymptomatic while others experience vague symptoms such as abdominal pain and bloating. If individuals have excess hormone production, they can experience diarrhea, flushing spells, heart palpitations and wheezing.

A physical examination may show heart valve lesions and signs of niacin-deficiency. “To confirm the presence of a carcinoid cancer will ultimately require a tissue diagnosis,” says Dr. Vargas. “Additional studies that are used to follow individuals with carcinoid cancer include 5-HIAA levels in the urine, CT and MRI scans, chromogranin A and an octreotide radiolabeled scan.”

Surgery to remove the tumor is the first line of treatment. The staged hepatectomy procedure involves removing a portion of the tumor from the liver. A port-vein embolism to block the blood supply to the affected part of the liver is then performed to stimulate growth to the unaffected portion. If the carcinoid tumor is unresectable and localized to the liver, the patient may be a possible liver transplant candidate. Liver transplant patients can expect one-, three- and five-year survival rates of 81 percent, 65 percent and 49 percent respectively.

The liver transplant program at The Nebraska Medical Center was formed in 1985. With more than 2,500 liver transplants and more than 500 pediatric liver transplants under its belt, it is now one of the most active and advanced centers in the world.

If the entire tumor is resected, the patient will continue to be monitored for the rest of his or her life. “These types of tumors tend to recur so we like to see them twice a year with repeat imaging to confirm tumor remission,” says Dr. Vargas.

He says his clinic works closely with the primary care doctor to follow up with these patients. “We believe that a good communicative relationship is vital to patient outcomes,” says Dr. Vargas. “Often our patients are not local or our interaction with them comes down to once or twice a year. So we rely on the primary care physician to be the first responders to any changes in the condition of our neuroendocrine patients. To foster this relationship, we make ourselves easily available by email and phone.”


Hope After Stroke

by Nicole Lindquist

The lime-green one is for Bailey, a 16-year-old girl. The light-purple one is for Diane, a go-getter from Seattle. And the orange one is for her, Lenice Hogan, a 47-year-old from Omaha. It simply reads “Hope After Stroke.”

The bracelets that take up most of Hogan’s left forearm each carry a special meaning, and represent someone, or something, from the stroke community.

Hogan has suffered three strokes. Coincidentally, that’s also the number of marathons she’s run SINCE her third and biggest stroke robbed her of full function in her left foot.

The mother of three boys and inspirational speaker was on campus recently as part of www.triexercise.org, a free monthly program sponsored by the Olson Center for Women’s Health to help individuals accomplish their exercise goals.

As a runner, I went for the inspiration. And to hear Hogan’s story. For a stroke survivor to run one marathon, let alone three, boggled my mind. I tried to train for a marathon once. This was before kids. When I was 100 percent healthy. And 23 years old.

Hogan was 26 when she had her first stroke and seven months pregnant when she had her second at 38. She compares the feeling to a light bulb that isn’t quite screwed into the socket.

After numerous doctor visits (at another hospital system) it was finally determined she had a hole in her heart. Surgery closed it up, and she thought her health issues were behind her. Two months later, her third stroke caused her to collapse and lose the use of her left leg.

It was Dr. Pierre Fayad, who Hogan calls her “angel in life,” at The Nebraska Medical Center’s Stroke Center who finally diagnosed her with a venous angioma that bled. There is no known cause and no known cure.

While Hogan walked out of the hospital of her own accord shortly after her third stroke, she spent the next two years in denial. Thirty-nine-year-olds shouldn’t have strokes. It wasn’t until she met a fellow stroke survivor that her life took a turn for the open road.

He, too, seemed too young to have suffered a stroke. He, too, was just trying to enjoy the sun on a Florida vacation. But the similarities ended there. Just as Lenice was relearning to run, he was struggling to walk. Her left foot was finally feeling good. His left side wouldn’t move and hadn’t in seven years.

She struck up a conversation with him. Hogan remembers eight words of it verbatim.

“You have no idea how lucky you are,” he said.

And that was it. After a few slow jogs on the beach in Florida, Hogan coincidentally received an e-mail from the National Stroke Association seeking runners for its first-ever New York City Marathon team. It seemed serendipitous. But everywhere Hogan turned, she hoped to find a roadblock. Sure, she’d run a mile on the beach, but 26.2 of them was unfathomable. After a green light from her physician and just as importantly, her mother, she called NSA, half-hoping the team was already full. No luck. She signed up.

She only had a few months to train, and was worried it wasn’t enough. But when Hogan stepped off the plane in New York, an overwhelming sense of peace came over her. She knew she could do it. And she did. She ran the whole thing and finished in just over five hours.

“Crossing the finish line was an amazing sense of accomplishment,” she said. “I wanted to sign up for the next one right then.”

She ran her second NYC marathon on behalf of NSA the next year and her third the year after that, bettering her time each year. She planned to run her fourth last fall, but Hurricane Sandy had other plans. So Hogan is signed up to run her fourth marathon in five years this Nov. 4.


New Pancreas Disease Clinic Gives Patients New Hope The only clinic of its kind in the region.

New Pancreas Disease Clinic Gives Patients New Hope The only clinic of its kind in the region.
Katie Eastman was afraid her pain was just part of living. For five years, the young mother suffered with crippling pain in her midsection. “Horrible pain, debilitating pain, severe nausea,” she says. “It was constant all day long. Eating made it worse, so that became a problem.”

Eastman saw doctors at another hospital. When removing her gallbladder didn’t solve the problem, they sent her to The Nebraska Medical Center where she was seen by the team in the newly-created Comprehensive Pancreatobiliary Disorders and Autologous Islet Cell Transplant Clinic. “The impetus behind starting this clinic was making sure we could offer specialized care for these individuals,” explains surgeon Luciano Vargas, MD.  “These patients have complex problems and often they get left behind.”

Doctors at the clinic diagnosed Eastman’s debilitating pain as chronic pancreatitis. They recommended a transplant, but not a kind Eastman was familiar with. She needed an auto-islet cell transplant, where surgeons remove the pancreas and relocate the islet cells, which release insulin. “We are able to infuse those islet cells into the liver where they retain their function,” Dr. Vargas explains. “It is just housing the islet cells. The islet cells have just changed zip codes if you will. They were in the pancreas, now they’re sitting in the liver.”

For Eastman, hearing the word “transplant” was daunting at first. “Anytime you hear transplant, you freak out a little, obviously,” she says. “But as soon as I walked in and met my surgeon it all subsided. I felt very comfortable, I was ready to get it done. I was tired of suffering. I was like, ‘how fast can we do it?’”
Since her transplant, Eastman has lived a pain-free life she had almost forgotten during her five-year struggle with pancreatitis. “My husband has his wife back, my kids have their mom back and I have my life back, so I couldn’t ask for anything more.”

While the clinic is new, the physicians behind it bring with them years of experience in a number of medical specialties. “Not only do you have a surgeon involved, you have a pancreatic specialist from a GI standpoint involved, you have an endocrinologist involved,” Dr. Vargas says. “So that’s the biggest thing we’ve done. Consolidated these individuals into one place.”

In addition to the specialist physicians in the clinic, there is also a nurse case manager who works directly with each patient. “Prior to coming to this clinic, many patients feel like they’re not being heard,” says Christina Sailors, clinical nurse coordinator at the clinic. “They can’t go to school, they’re missing work and sometimes they’re on disability. They’re really at the end of their rope when they contact us. So to give them hope is really exciting.”

Eastman says she has found that hope and happiness. “When I walked in here, they got to know me as a person, not just me as a patient. I’d recommend this place to anyone. I wouldn’t go anywhere else.”


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New Lung Cancer Screening Guidelines Expected to Improve Survival Rates

Rudy P. Lackner, MD,
thoracic surgical oncologist

Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable.  It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined. Rudy P. Lackner, MD, thoracic surgical oncologist, is hopeful that a new screening will help turn those statistics around.

Until recently, about 75 percent of lung cancer cases were found at advanced stages of the disease. Lung cancer found at these stages have a cure rate of 5 percent or lower. “Lung cancers are difficult to diagnose early because most people who develop lung cancer initially lack symptoms that warrant medical attention. It’s not until the disease has progressed, do symptoms such as persistent cough, chest pain, shortness of breath or recurring infections begin to appear,” says Dr. Lackner. The most common diagnostic test had been X-rays, which are inadequate at picking up lung cancer at an early stage.

But new guidelines from the National Comprehensive Cancer Network® (NCCN®) recommend certain high-risk groups can benefit from lung cancer screening with low-dose Computed Tomography (CT) scan.  “A CT scan can detect lung cancer nodules in stage 1A when the cure rate can be as high as 90 percent or more,” says Dr. Lackner. “This is very good news because the five-year survival rate for lung cancer is highest when the disease is still localized, but few lung cancers are diagnosed at this early stage.”

With these new NCCN guidelines, current or former smokers aged 50 years or older with a 20 pack-history could benefit from a CT scan lung cancer screening.  A 20 pack-year history is defined as smoking one pack each day for 20 years or two packs each day for 10 years. This applies even to individuals who smoked in their earlier years and have not smoked for many years. “For those people who fall into this high-risk group, they should discuss the pros and cons of being screened with their primary care doctor,” notes Dr. Lackner.

The Nebraska Medical Center now offers CT scans for lung cancer screening at the Village Pointe Cancer Center. The $250 scan is available for those who meet the above criteria. All screenings are self-pay. Appointments can be made by calling 9-4389 from 8 a.m. to 4:30 p.m.

The chance for long-term survival improves when the medical team involved has a dedicated interest in treating patients with lung cancer. “Determining what should be done if nodules are found is one of the most challenging aspects of this screening,” says Dr. Lackner. “The new type of screening for lung cancer and our team of specialists are accessible to our employees. I am hopeful that both current and former smokers take advantage of the opportunity, which could be lifesaving.”