Guest: Arthur Derse

More than 500,000 Americans die from cancer every year, and many of those people spend their final hours in the emergency department. More and more patients and their families turn to ED doctors to help make difficult decisions when it comes to end-of-life issues. Dr. Arthur Derse, director of medical and legal affairs and associate director of the Medical College of Wisconsin's Center for the Study of Bioethics and professor of bioethics and emergency medicine, joins host Dr. Shira Johnson to look at how doctors can help terminally ill patients and their loved ones when it comes to living wills, life support and pain management.

Guest: Elvira Lang

We've known anecdotally that simply waiting for the results of a tumor biopsy can be as stressful as coping with an unfavorable diagnosis itself. There is even some evidence to suggest that this stressful waiting period may subsequently impact the treatment of those patients who are found to have cancer. How do we explain this hypothesis? Further, how can we ease the anxiety of those patients awaiting cancer test results, and can we shorten the time patients must wait for their diagnosis? Host Dr. Jennifer Shu explores these key issues in the diagnostic process with Dr. Elvira Lang, associate professor of radiology at Harvard Medical School, and an interventional radiologist at Beth Israel Deaconess Medical Center in Boston.

Guest: Monica Morrow

As we expand the scope of breast-conserving surgery for patients with breast cancer, have we focused too much on the cosmetic results, to the potential detriment of the oncologic outcome? It's a question that concerns some in the field of breast surgery, who believe the evidence to establish clinical efficacy for certain procedures is not yet in. Dr. Monica Morrow, chief of the breast service in the department of surgery, and the Anne Burnett Windfohr Chair of Clinical Oncology at Memorial Sloan-Kettering Cancer Center in New York, joins host Dr. Mark Nolan Hill to explore how we can address the potential pitfalls of emphasizing cosmesis in breast-conserving surgery while maintaining the sound principles of oncologic surgery.

Guest: Benjamin Griffith

What is the connection between anxiety and pancreatic cancer? Certainly, patients can develop problems with anxiety after a cancer diagnosis. But pancreatic cancer seems to have the curious characteristic of anxiety as a presenting symptom. The age at which anxiety presents itself may be a clue as to whether you're looking at mental illness or a possible cancer diagnosis. Dr. Benjamin Griffith, assistant professor of medicine at the University of Virginia and the Edward Via Virginia College of Osteopathic Medicine, explains to host Dr. Leslie Lundt.

Guest: Arthur Derse

Matters of life and death occur constantly in emergency departments, but some ED doctors are not well trained for the death that's expected. There is a new push inside hospitals and medical schools to train ED personnel in palliative care. Dr. Arthur Derse, director of medical and legal affairs and associate director of the Medical College of Wisconsin's Center for the Study of Bioethics, joins host Dr. Shira Johnson to discuss the new techniques being taught to ED residents for dealing with end-of-life issues. They also look at a new sub-specialty in emergency room medicine that focuses on hospice and palliative care.

Guest: H. Richard Alexander

Whether cancer originates in the colon, breast, or elsewhere in the body, the liver is one of the most common places to which a malignancy will spread. When this occurs, if it's possible to control the metastasis in the liver, we may have a much better shot at holding the original tumor at bay. A technique called hepatic perfusion may help us do this. For more on hepatic perfusion and its potential role in the chemotherapeutic process, host Dr. Mark Nolan Hill talks with Dr. H. Richard Alexander, associate chairman for clinical research in the department of surgery at the University of Maryland School of Medicine. How might this technique, which affords us the opportunity to deliver high-dose therapy while circumventing most side effects, begin to change our perspective on the limitations of chemotherapeutics?

Guest: Per-Henrik Zahl

The widespread use of mammography to screen for breast cancer has resulted in an increase in breast tumor detection, as well as an increase in mortality rates associated with the disease. But the natural course of malignant diseases such as different types of cancer can vary considerably. Is it possible-even common-for some invasive breast tumors to regress without treatment? And if this is the case, how could this impact our strategies for screening, diagnosing and treating breast cancer? For more on these intriguing ideas, host Dr. Jennifer Shu welcomes Dr. Per-Henrik Zahl, epidemiologist and senior statistician at the Norwegian Institute of Public Health in Oslo, Norway, and lead author of a study published in the Archives of Internal Medicine that "raises the possibility that the natural course of some screen-detected invasive breast tumors is to spontaneously regress."

Guest: Charles Mullighan

How does understanding the genetics of rare disease help us understand other pressing pediatric problems? Dr. Charles Mullighan is assistant member of the faculty, pathology department, St. Jude Children's Research Hospital. He joins Dr. Bruce Bloom to discuss the genetics of acute lymphoblastic leukemia.

Guest: Constance Roche

It's estimated that one in eight women will be diagnosed with breast cancer in their lifetime. 75% of women who are diagnosed have no known risk factors. But the incidence and mortality rate of breast cancer has declined over the last couple of decades. The government released controversial amendments to screening recommendations last year based on mortality outcomes from breast cancer. What are the implications for our patients, and what screening guidelines should advanced practice clinicians recommend to patients? Nurse practitioner Constance Roche, a clinical coordinator at the Avon Comprehensive Evaluation Center in Boston, Massachusetts, joins host Mimi Secor to discuss how to identify high risk patients, the best screening techniques and how primary care providers can find the best specialist for their patients.

Guest: William Foulkes

What has genetic research taught us about the inheritance of common cancers? And how can we use this knowledge to help patients? Dr. William Foulkes, director of the cancer genetics program at McGill University in Canada, talks with host Dr. Bruce Bloom about the questions raised and the answers revealed when we look at cancer risk from a genetic perspective.

Guest: Gary D. Steinberg

Early diagnosis of bladder cancer is a significant step toward survival. Over the years, findings have suggested that women and African-Americans are particularly vulnerable to the disease, and often times, we are delayed in our diagnosis and subsequent treatment of these more highly susceptible populations. What are the most effective steps we can take to improve our recognition of bladder cancer earlier in its progression? Host Dr. Mark Nolan Hill welcomes Dr. Gary Steinberg, professor and vice chairman of urology, and director of urologic oncology at the University of Chicago Pritzker School of Medicine, to discuss the key issues relative to gender and race, as well as awareness among patients and primary care physicians toward prevention of a delayed diagnosis of bladder cancer.

Guest: Désirée Ratner

In the next year, nearly 120,000 new cases of melanoma will be diagnosed in the United States, more than half of which will be invasive disease. Unfortunately, trends indicate the overall incidence will continue to rise in the coming years. Who are the key at-risk populations, and how do we identify early warning signs of cancer? Dr. Désirée Ratner, director of dermatologic surgery at Columbia University Medical Center, shares her expertise with host Dr. Mary Leuchars on strategies to recognize early development and initiate treatment of melanoma and nonmelanoma skin cancers.

Guest: Laurie Zoloth

The preservation of female cancer patients' fertility after treatment is a new area of concern for researchers, clinicians, and patients. Dr. Laurie Zoloth, professor of medical humanities, bioethics, Jewish studies and religion and also director of the Northwestern University Center for Bioethics, Science and Society, talks with host Dr. Maurice Pickard about broad issues of reproduction, as well as breakthroughs in the lab and how clinicians can handle treatment discussions when they're compounded by the topic of fertility.

Guest: Greg Brown

For breast cancer patients, there is often an untold story after mastectomy and treatment. Greg Brown, chief executive officer of ImpediMed, tells host Bruce Japsen about how women can suffer a debilitating complication known as lymphedema and how test makers are moving to help diagnose the problem early.

Guest: Lajos Pusztai

What does microarray-based gene expression profiling tell us in terms of diagnosing and treating breast cancer? How is this technology changing our perceptions of breast cancer? Dr. Lajos Pusztai, associate professor of medicine at the University of Texas M.D. Anderson Cancer Center, discusses some clinical applications of a multigene assay. Dr. Lee Freedman hosts.

Guest: Leif Ellisen

A new program at Massachusetts General Hospital in Boston includes extracting the DNA from its cancer patients’ tumors to determine which abnormalities occur in the tumor cells, specific to the type of tumor. From these results, physicians hope to create better, targeted cancer therapies. Host Dr. Lee Freedman asks Dr. Leif Ellisen, associate professor of medicine at Harvard Medical School, about the details of this program. Will genetic tumor profiling be conducted at many more cancer centers in the near future?

Guest: Seth Corey

Physician scientists keep one foot in clinical care and the other in the lab, hoping to bridge that gap to help patients. Are breakthroughs on the horizon? Dr. Seth Corey, the Sharon Murphy and Steven Rosen Professor of Cancer Biology and Chemotherapy at Northwestern University Feinberg School of Medicine and director of oncology research at Children's Memorial Hospital and the Robert H. Lurie Comprehensive Cancer Center, joins host Dr. Bruce Bloom to discuss his research on repurposing safe pharmaceutical and botanical medicines for relapsed pediatric cancers.

Guest: F. Anthony Greco

Cancer is so often an agonizing diagnosis, one that can be that much more difficult for a patient to accept when the origin of the cancer cannot be traced. Novel genetic tests are just one of a few new options that may help us in situations where imaging, therapy, and other genetic markers have not been effective. Dr. F. Anthony Greco, director of the Sarah Cannon Cancer Center in Nashville, tells us that we appear to be making progress toward new ways to diagnose cancers of unknown primary origin. Dr. Larry Kaskel hosts.

Guest: David Abramson

Survival rates for retinoblastoma now approach 100 percent, but in years past, enucleation was the only sure way to cure this rare pediatric malignancy. We're now seeing advances in chemotherapy that not only spare the child's eye, but can preserve vision as well. What makes this chemotherapy regimen so effective, and how can we build on its effectiveness to enhance the vision and the livelihood of children affected by retinoblastoma? Dr. David Abramson, chief of the ophthalmic oncology service at Memorial Sloan-Kettering Cancer Center in New York, joins host Dr. Jennifer Shu to talk about the breadth of retinoblastoma research that has helped us take important strides toward remediation of this disease.

Guest: William Foulkes

The need to manage the health of patients with cancer, and at risk for developing cancer, has given rise to the field of cancer genomics. What is this field? What are the roles within the specialty? And how do they work with patients?Host Dr. Bruce Bloom talks with Dr. William Foulkes, director of the cancer genetics program at McGill University in Montreal, Canada.

Guest: Scott Waldman

How is the biomarker guanylyl cyclase 2C helping to predict colorectal cancer recurrence rates? Host Dr. Lee Freedman welcomes Dr. Scott Waldman, professor in the departments of medicine and biochemistry at Thomas Jefferson University, to discuss how this biomarker found in regional lymph nodes can predict the recurrence rate for colorectal cancer patients. How does the presence of metastatic tumor cells predict clinical outcomes?

Guest: Keith Black

Despite our best efforts at surgery and chemotherapy for patients with glioblastoma, survival time is often far too limited. One novel weapon in our arsenal could be a vaccine that bolsters the immune system in the body's fight against these tumors. As we move forward with research toward a vaccine, what are the keys to boosting its efficacy? How much additional time could a vaccine buy for our glioblastoma patients? Host Dr. Mark Nolan Hill probes these questions and more with Dr. Keith Black, professor of neurosurgery and chair of the department of neurosurgery, and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles. Dr. Black also describes the fascinating process by which the research team collects tissue from each patient, which is subsequently applied toward the formation of a vaccine customized for the individual's condition.

Guest: John Docherty

Cancer cells can be made to become more vulnerable to treatments like chemotherapy, and there are therapeutics under development which are designed to impact this so-called microenvironment of tumor cells. John Docherty, president of Toronto-based Helix BioPharma, tells host Bruce Japsen about a new wave of treatments and therapies in the biotechnology industry that could better target cancer cells and in turn help patients deal with the side effects of chemotherapy.

Guest: Marc Hedrick

Many view the promise of stem cells as something far off in the distance, but these regenerative cells are nearing commercialization in the area of cosmetic and plastic surgery, particularly for women who are in need of reconstructive breast surgery. Dr. Marc Hedrick, president of San Diego based Cytori Therapeutics, tells the Chicago Tribune's Bruce Japsen about a commercialized device in Europe that uses adult stem cells derived from fat as a way to reconstruct breasts following surgery. Clinical trials may begin in the US in the next year.

Guest: Jeffrey Settleman

Cancer cells almost always defeat drug therapies. Can combination therapies prevent or overcome drug resistance? Join host Dr. Bruce Bloom as he discusses the research and clinical issues of cancer treatment with Dr. Jeffrey Settleman, professor of medicine at Harvard Medical School and scientific director of the Massachusetts General Hospital Cancer Center.

Guest: Anil Vachani

Dr. Anil Vachani, assistant professor of medicine, and director of clinical research in interventional pulmonary services, at the University of Pennsylvania Health System, joins host Dr. Lee Freedman. They talk about Dr. Vachani's exciting work on the development of a blood test that may be useful in distinguishing benign from malignant in patients with lung nodules. Along with researchers at the Wistar Institute in Philadelphia, Dr. Vachani has developed a test utilizing the profiling of gene expression of peripheral blood lymphocyte involved in tumor immunity. Still in the early stages of development, this work has led to a 24 gene 'signature' that has a sensitivity of 85 percent and specificity of 87 percent. Find out how soon this test might be available for clinical use, and other potential applications of this technology in clinical medicine.

Guest: Stephen B. Baylin

The Cancer Genome Atlas (TCGA) has recently reported results from its first comprehensive study focusing on glioblastoma multiforme. How might this new research help us develop new therapies? Dr. Stephen Baylin, professor of oncology and medicine at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, joins host Dr. Leslie Lundt to explain how the TCGA may guide future cancer treatment.

Guest: Greg Brown

Lymphedema is a condition faced by many breast cancer survivors, and it can be debilitating for one in five of these women. But lymphadema can be detected early. Greg Brown, chief executive officer of Australia-based ImpediMed tells host Bruce Japsen about the benefits of early detection and the coming technology platforms to assist doctors in this regard.

Guest: Laurie Zoloth

Dr. Laurie Zoloth, director of the Northwestern University Center for Bioethics, Science and Society, talks about ovarian cryopreservation, maturation of oocytes in vitro, and politicized laboratory breakthroughs that were intended to meet the needs of female cancer survivors. She argues that we need to be prepared to deal with patients who will use the tools offered by oncofertility to delay childbearing, and meet the need for tissue in stem cell research. Hosted by Dr. Maurice Pickard.

Guest: John Docherty

While vaccines have emerged to treat a cancer caused by human papilloma virus, there is still a need for therapies to treat cancerous tissue caused by HPV. John Docherty, president of Toronto-based Helix BioPharma, tells host Bruce Japsen about his company's research and that of the biotech industry in the study and treatment of HPV, a key virus in the development of cervical cancer.