IN 2018, MORE THAN 53,000 MEN, women and children in New Jersey will hear these words from their doctor: “You have cancer.” More than 16,000 people in the Garden State will lose their lives to this “killer” disease. In fact, more than a third of Americans, some 120 million people, will be diagnosed with cancer sometime during their lives. It is among the most feared of human diseases, but progress is being made in screening for and treating cancer using new technologies. Here are some frontline reports on how New Jersey’s top hospitals are fighting cancer and offering patients hope.
Englewood Hospital and Medical Center
By Steven Brower, M.D., Medical Director, the Lefcourt Family Cancer Treatment and Wellness Center and Chief of Surgical Oncology
When it comes to screening, detecting and treating cancer in its early stages, accuracy is key. Precision medicine is a new approach to disease prevention and treatment that bases medical decisions on a patient’s genes, environment and lifestyle; rather than using a one-size-fits-all approach, the individual patient and diagnosis become the central focus. At Englewood Hospital, we also offer cancer risk assessment and genetic counseling. Risk assessment is recommended for those with a personal diagnosis or multiple immediate family members with diagnosis of cancer younger than age 50; more than one cancer diagnosed in the same person; or three or more close family members with different types of cancer. Precision medicine and risk assessment allow us to better determine what kind of surgery, radiation or chemotherapy is best for that particular patient at that particular time. In prostate cancer, fusion biopsies combine ultrasound and MRI technology to pinpoint tumor vascularity, staging and aggressiveness, and better determine treatment options. For lung cancer patients, we use stereotactic body radiation therapy (SBRT) to precisely focus and deliver radiation, using a TrueBeam® radiotherapy system that switches on and off during the procedure as tumors move with the patient’s breathing, protecting surrounding tissue.
Holy Name Medical Center
By Adam Jarrett, M.D., M.S., Executive Vice President and Chief Medical Officer
At The Patricia Lynch Cancer Center at Holy Name, one of the most effective tests for early-stage cancer detection is colonoscopy to find and remove polyps before they have a chance to progress into colon cancer. Colon cancer is the third most common cancer in the United States and the third leading cause of cancer-related deaths. However, when found at an early stage, the cure rate is almost 100 percent. People with an average risk for colon cancer should have their first colonoscopy at age 50 and then every 10 years following. High risk patients with a history of inflammatory bowel disease, close relatives who had colorectal disease or polyps before age 60, family history of hereditary nonpolyposis colon cancer (Lynch syndrome), or the presence of multiple or large polyps at the first colonoscopy should be screened at age 45 and then every year to five years. Our gastrointestinal cancer team works collaboratively to determine the best treatment plan for patients with colon cancer. Early-stage treatment includes surgery, followed by close surveillance or the addition of intravenous and/or oral chemotherapy. Based on a chromosomal evaluation of cancer cells and family history, patients are offered genetic counseling for Lynch syndrome, which can predispose them to endometrial, ovarian, prostate, and hepatobiliary cancers.
Jersey Shore University Medical Center, Hackensack Meridian Health
By Thomas Bauer, M.D., Interim Medical Director, Hackensack Meridian Health Cancer Care in Monmouth, Middlesex and Ocean Counties; Medical Director, Thoracic Oncology, Hackensack Meridian Health Cancer Care; Chief, Thoracic Surgery, Jersey Shore University Medical Center
There are effective screenings for a variety of cancers, such as colonoscopy (colon), PAP (cervix), CT scan (lung), mammography (breast), and PSA (prostate). While each type of cancer has unique risk factors associated with it, smoking, obesity and family history are contributing factors for all types of cancers. Perhaps the most critical to catch early is lung cancer. More people will die from lung cancer than breast, colon, prostate and cervical cancers combined. Lung cancer is the #1 killer in both men and women. The high-risk population for developing lung cancer includes those who are age 55-80; smoke 30 pack years (1 pack a day for 30 years, or 1.5 packs a day for 15 years, etc.); and quit less than 15 years ago. Individuals at high risk can screen for lung cancer with a low dose CT scan. If lung cancer is detected, minimally invasive resection (including robotic surgery) is a common treatment. At Hackensack Meridian Health, 95 percent of all early stage lung cancers are treated with minimally invasive surgery. Additionally, the network is involved in clinical research for blood and saliva tests, which may someday identify new ways to diagnose lung cancer earlier and lead to even better outcomes for community members.
John Theurer Cancer Center, Hackensack Meridian Health
By Andre H. Goy, M.D., M.S., Chairman and Director, Chief of Lymphoma; Director of Clinical and Translational Cancer Research, Chief Science Officer and Director of Research and Innovation, Regional Cancer Care Associates; and Professor of Medicine, Georgetown University School of Medicine
One of the most promising ways to reduce the burden of cancer at scale may be through very early diagnosis— before any symptoms or detection by current screening methods. There is now established evidence that cancer cells shed cfDNA and exosomes in the bloodstream, which carry the same mutations as the original tumor. This has led to the emergence of the growing new field of liquid biopsies, which are already used to monitor disease response, evaluate MRD and track the emergence of drug resistance. A recent study (Science, January 2018) showed that by using a test based on a combination of cancerrelated DNA and proteins in the blood, 70 percent of the most common eight cancers subtypes tested could be found at a very early stage. Less than 1 percent of false positives were found in a group of more than 800 individuals. This needs to be validated in a real world setting but raises the possibility of one day having a routine cancer screening test. Given the complexity of genetics counseling, with the number of genes associated with potential increased risk factors, this screening test might offer a non-invasive way to closely monitor individuals at risk.
Morristown Medical Center and Carol G. Simon Cancer Center, Atlantic Health System
By Missak Haigentz, M.D., Chief, Hematology and Oncology
In my fields of focus, lung and head & neck cancer, the needs for early detection are great. Carcinogen exposure from cigarettes remains the greatest risk factor, and a growing number of former smokers remain at high risk. The National Lung Screening Trial has demonstrated that low-dose CT scans in high-risk populations improved both lung cancer-specific and all cause survival, the gold standard for cancer screening. Despite this major advance against the most common cause of cancer death, only 1 percent of the current seven million eligible persons have been screened. Atlantic Health System has a focus on access to this life-saving technology, as well as expert cancer care and clinical trials. Additionally, human papillomavirus (HPV) is the cause of the fastest growing subset of head & neck cancers, often occurring in never smokers.
Although highly curable, early detection can substantially limit treatment morbidity. The Atlantic HPV Center has the most experienced, multidisciplinary team of head & neck cancer specialists in New Jersey dedicated to prevention, diagnosis, treatment, research and survivorship. During April, Head and Neck Cancer Awareness Month, Morristown Medical Center offers free oral and head and neck cancer screenings and sponsors a symposium on the latest advances in therapy.
Rutgers Cancer Institute of New Jersey
By Andrew M. Evens, D.O., MSc, FACP, Associate Director for Clinical Service; Medical Director of the Oncology Service Line at RWJBarnabas Health
The most effective screening tests for detecting cancer in early stages remain colonoscopy screening for colon cancer; Pap smear testing for cervical cancer (and pre-malignant conditions); and mammography for breast cancer. An example of this is Screen NJ, a collaborate project of organizations across New Jersey established by Rutgers Cancer Institute of New Jersey committed to reducing cancer incidence through effective screening, education, and awareness programs. One clinical risk factor that calls for an aggressive screening regimen is persons with history of heavy smoking and who smoke now or have quit within the past 15 years and are between 55 and 80 years old; these persons should be considered for yearly lung cancer screening with low-dose computed tomography. In addition, family history of particular cancer subtypes may impact type and interval of cancer screening as well as persons with known family or personal history of certain genetic mutations. For solid tumors such as breast cancer, colon cancer, lung cancer and cervical cancer that are diagnosed at an early stage, surgical resection is usually a critical component of therapy. It is also an important consideration to have surgery done at centers and systems with significant experience in cancer surgery. Post-surgical (adjuvant) therapy may also include radiation, chemotherapy and/or use of novel targeted cancer treatments.
By Steven K. Libutti, M.D., FACS, SVP of Oncology Services; Director, Rutgers Cancer Institute of New Jersey
We can make a greater impact on saving lives if we focus more on identifying cancer at an earlier stage or preventing it altogether with an emphasis on screening, early detection and education. Spiral CT scans for lung cancer, Pap smears for cervical cancer, mammograms for breast cancer, PSA blood tests and digital rectal exams for prostate cancer, colonoscopy for colon and rectal cancers, and regular dental exams to detect oral cancer are all preventative screening tests that one should discuss with their doctor. Risk factors such as age, lifestyle, overall health history, family history of cancer, and use of tobacco products should be taken into consideration when discussing a screening regimen, as certain factors may indicate a need for increased frequency. To help reduce colorectal and lung cancer incidence and mortality, Rutgers Cancer Institute of New Jersey in partnership with the state established the ScreenNJ initiative. This cancer screening, education and awareness program is a collaborative project of organizations across New Jersey, including the RWJBarnabas Health facilities. If cancer is detected, a physician through one of these programs can recommend treatment based on staging and other factors, such as the molecular make-up of the cancer.
Valley-Mount Sinai Comprehensive Cancer Care
By Ephraim Casper, M.D., Chief Medical Officer
Mammography is the most effective way to identify early stage breast cancer. The Valley Hospital Breast Center, part of Valley-Mount Sinai Comprehensive Cancer Care, provides advanced breast imaging. We offer 3-D mammography, and add ultrasound, MRI and fine needle biopsy as needed to establish a precise diagnosis. Trained navigators support our patients through the diagnostic evaluation. Screening with annual mammograms should begin at age 40. Women with a previous personal or family history of breast cancer, a genetic mutation that increases the risk of breast cancer or a precancerous breast condition, may need more aggressive, personalized screening. Not all early-stage breast cancers are the same. With optimal therapy, most women with early breast cancer are cured. We individualize treatment after extensive testing of each tumor and believe in sharing the decision-making with our patients. For some women with early breast cancer, we offer a breakthrough treatment that delivers an entire course of radiation therapy in the operating room at the time of breast surgery, eliminating the need for what is typically weeks of post-surgery radiation. From routine screening to advanced cancer care, Valley’s personalized approach reflects our fundamental commitment to putting patients at the center of all care.
Treating Cancer with Robotic Surgery
CentraState Medical Center
By Troy Sukkarieh, M.D., Board-Certified Urologist
Robotic surgery offers many benefits in the treatment of a variety of cancers and the positive outcome for my patients. We use robotic surgery to treat colorectal, prostate, bladder and kidney cancer. Traditional surgery requires a large incision, but with robotic surgery, surgeons work through the arms of a robot to perform delicate and complex surgery through tiny incisions. This minimally invasive approach offers exceptional control, range of motion and visibility. When compared with traditional, open surgery, patients undergoing robotic surgery may have reduced blood loss; less pain and scarring; decreased risk of infection; fewer complications; and faster recovery times.
Gene Therapy for Radiation-Induced Chronic Dry Mouth
For most patients who survive head and neck cancers, the relief of successful treatment can be tempered by a troubling side effect of radiation: chronic dry mouth. Because radiation kills both tumor cells and healthy saliva-producing cells, saliva production can dwindle or even shut down completely. Patients with dry mouth may find it hard to speak as well as chew, taste, and swallow food. They may have pain from slow-to-heal ulcers and be at increased risk for tooth decay or other infections. Treatments can help, like saliva substitutes, salivary stimulants, ice chips that moisten the mouth. But there’s no cure for radiation-induced dry mouth. Inspired by a colleague’s success in transferring and expressing genes in rat lungs in 1991, National Institute of Dental and Craniofacial Research (NIDCR) emeritus scientist Bruce Baum thought that gene transfer might also work in the salivary gland, which is biologically similar to the lungs. He hit on the idea of using a modified virus to deliver a corrective gene directly into the damaged gland to restore the flow of saliva. But the journey from concept to clinical trial would take many years and multiple studies to complete. Baum’s work is among many parallel efforts in the field of gene therapy, where safety and logistical concerns have delayed the clinical debut of several promising approaches. Only in the last year have a handful of these therapies—two for blood cancers and one for an inherited form of blindness— received U.S. Food and Drug Administration approval. The therapy for blindness is the only one in which a corrective gene is directly administered to the patient. This so-called in vivo delivery method is the approach Baum and colleagues have been developing over 25 years to treat radiation-induced dry mouth. Their experimental therapy was the first ever salivary gland gene therapy tried in humans. Its initial success surprised even the investigators and encouraged them to explore additional applications for its use. A second NIDCR clinical trial is now under way to assess the safety and effectiveness of a similar approach that uses a different gene-delivery vehicle.