7 Things to Know About Glioblastoma

News recently shocked the nation that Sen. John McCain was diagnosed with an aggressive form of brain cancer called glioblastoma. Dr. Mark Mishra, a radiation oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center and Maryland Proton Treatment Center who specializes in treating brain cancer, tells you 7 things to know about glioblastoma.

  1. How common is glioblastoma?

Glioblastoma is the most common type of primary brain tumor that is diagnosed in adults.  There are estimated to be nearly 13,000 patients who will be diagnosed with a glioblastoma annually within the United States.

  1. Why is it so aggressive?

Glioblastoma can be difficult to cure with radiation and chemotherapy.  In spite of surgery, radiation and chemotherapy, the tumor most commonly recurs within the same part of the brain where the tumor first started.

  1. What are the symptoms?

Symptoms can vary from patient to the patient, depending upon the size and location of the tumor.  Symptoms include persistent headaches and nausea, speech  and/or vision changes, confusion,  personality changes, or weakness in the arms or legs.

  1. How is it typically treated?

The optimal treatment for a glioblastoma is surgery, followed by 6 weeks of radiation delivered daily, Monday-Friday, with concurrent chemotherapy.  This is typically followed by additional chemotherapy, for at least 6 months.

  1. Has any progress been made in developing new treatments?

Prior to 2004, there was no effective chemotherapy to treat glioblastoma.  A large study conducted in Europe demonstrated improved cure rates when patients are treated with an oral chemotherapy drug (Temozolomide) during and after radiation therapy.  Most recently, a large study also demonstrated improved cure rates with the use of tumor-treating fields after completion of radiation therapy.

Due to the aggressive nature of glioblastoma, we are actively conducting clinical trials at the University of Maryland School of Medicine to better identify ways to improve cure rates and quality-of-life for patients with glioblastoma.

Current studies that are open at the University of Maryland School of Medicine include:

  • NRG-BN002: A study to evaluate the role of immunotherapy for patients with glioblastoma
  • NRG-BN001: A study to evaluate the benefit of high-dose radiation therapy with proton beam therapy compared to standard radiation for glioblastoma patients
  • 1224GCC: A study to evaluate the role of low-dose whole brain radiation for patients with a newly diagnosed glioblastoma
  • 1344GCC: A study to evaluate the role of tumor-treating fields, bevacizumab, and radiation for patients with a recurrent glioblastoma
  1. Is immunotherapy an option?

The benefit of immunotherapy for this diagnosis is still being evaluated in clinical trials.  We are currently conducting clinical trials to help better determine if this is an effective treatment for patients with a glioblastoma.

  1. What is the prognosis?

A patient’s prognosis can vary depending upon the patient’s age, ability to undergo and complete treatment, as well as molecular alterations within with the tumor.  The median survival time for patients with a glioblastoma who undergo treatment ranges from 15-20 months.  Ten percent of patients will survive five years after diagnosis.

Learn more about the University of Maryland Brain Tumor Treatment and Research Center.

Sofia’s Lemonade Stand

Sofia Joslin, a seven year Patterson Park native and daughter of child life manager Shannon Joslin, has raised an incredible amount of money to support the University of Maryland Children’s Hospital. Sofia decided that the day her neighborhood was having a large scale yard sale day (3 blocks long), she would use the opportunity to help give back to kids who may not be as fortunate as herself.

Sofia (left) and her friend pose with their lemonade stand they used for their donation to UMCH

From there, Sofia gathered up her friends and they began to play a part in the process as well. Sofia and her friends sold all of their lemonade and raised $250 which made all the effort she put in a positive experience.

After the fundraiser’s huge success, Sofia was determined to donate toys  of all different diversities to the Children’s Hospital.

She sought help from her parents who were quick to remind her there are all types of kids at the hospital: she needed to find toys that both girls and boys of different ages would like. The family headed to Target to maximize the most they could out of $250.

Staying true to her word Sofia went shopping and stuck to the basics. She set out to get dolls, craft kits amongst other items for girls, and Legos and cars for the boys.

After Sofia and her family purchased the toys, they were collected in UMCH’s red wagon and transported to the hospital. Sofia got to see her work go full circle when her parents took her down to the hospital to deliver the toys in person.

Following such a positive turn out, Sofia’s neighborhood wants to ensure that this is not a one-time donation. Inspired by the children’s involvement and by UMCH’s great care, adults in the neighborhood would like to make this a tradition and make even bigger donations going forward.

Many thanks to Sofia, her family and neighbors! Your continued support of the Children’s Hospital ensures we have the resources available to make every patient’s stay comfortable and fun.

 

Learn more about the Child Life Program and meet the team.  http://www.umm.edu/childlife

Interested in giving to the Children’s Hospital? Here’s how you can help. http://www.umm.edu/programs/childrens/services/child-life/how-to-help

 

 

Where to go During an Emergency

Asthma attacks. Broken bones. Dehydration. Ear infections. Irregular heartbeat. Infectious diseases. Uncontrollable vomiting. This is a short list of the medical problems that are handled each year in the Pediatric Emergency Department at the University of Maryland Children’s Hospital.

Children and adults have different needs. This is why the University of Maryland Children’s Hospital has an exclusively pediatric emergency department staffed by highly experienced nurses and health care professionals trained to put children at ease. What makes this pediatric emergency department unique is the access to a large network of pediatric specialists who make up the Children’s Hospital. We are a resource for other physicians. When a case is very complicated, we are often called to help diagnose or treat complex problems. We pride ourselves on delivering care and compassion that can only come from an institution with a primary focus on providing the highest quality of care to children and their families.

Because we have access to specialists in more than 20 areas of pediatric medicine, we provide the most advanced care. The Pediatric Asthma Program is one example of how patients benefit from the close collaboration of physicians in the emergency department and other specialties. This asthma program, which is the first of its kind in the region to be awarded the Joint Commission’s Disease-Specific Certification, assures that children admitted to the emergency department not only leave breathing easier – they are also given the tools, knowledge and medication to improve their long-term asthma control.

During a medical emergency, there is little time to consider where to take your sick child. Remember the University of Maryland Children’s Hospital is here for you and your family.

Learn more about the University of Maryland Children’s Hospital by visiting www.umm.edu/pediatrics.

Men’s Health Month: Getting Back to the Basics

You know the type. The macho guy who’s rough, tough, go-it-alone, leader-of-the-pack, help-not-wanted. Macho man may put off seeing a doctor for a checkup – because he thinks he’s invincible, doesn’t get sick, it’s a waste of time, only for the weak.

Physicians at the University of Maryland Medical Center say some men only give in when they have symptoms, when major treatments are required, or when preventive steps are more demanding. Even so, it’s never too late to start on the road to health.

June, Men’s Health Month, is a great time to focus on preventable health problems and encourage early detection and treatment of disease among men of all ages.

So, you’re out of shape?

Heart disease kills 1 in every 4 men in the US. One clue to heart health is endurance. Can you walk up two flights of stairs or four city blocks without stopping (barring traffic lights, etc.), or has there been a change in your activity level over the past 6-12 months? A man may shrug off the changes and blame them on being “out of shape,” but these changes could signal changes in heart health, says Michael Miller, MD, professor of cardiovascular medicine, epidemiology and public health at the University of Maryland School of Medicine and director, Center for Preventive Cardiology at the University of Maryland Medical Center.

Dr. Miller: “If the answer to both questions is ‘no’ (presuming they have no other limitations such as joint disability, emphysema, etc.), then their heart is considered to be in reasonably good shape and no further workup is usually necessary.  If the answer to either question is ‘yes,’ then further questioning and/or workup is indicated.”

The paunch and the pound

Dr. Miller: “I ask men what their weight and waist size was when they considered themselves to be in good physical health (often in their early-to-mid-20s). If either their current weight or waist size exceeds 10 pounds or 2 inches, the risk of Type 2 diabetes and heart disease begins to increase.  After checking for the major cardiovascular risk factors (cigarette smoking, high blood pressure, high cholesterol, diabetes), we make recommendations aimed at improving their cardiovascular health.”

Recommendations: Eat a big breakfast or lunch with a light dinner, have a snack between meals, take a walk after dinner, and relax 30-60 minutes before bedtime to increase the odds of getting at least seven hours of uninterrupted sleep.

All or nothing

Diabetes in men jumped 177 percent in the US from 1980-2014, fueled in part by weight gain and obesity. Shedding the pounds is often a struggle, but If your ideal, normal body weight is 180 pounds, and you’re 300, it may be unrealistic to set a goal of getting back to 180, says diabetes expert Kashif M. Munir, MD, assistant professor of medicine at the University of Maryland School of Medicine and medical director of the University of Maryland Center for Diabetes and Endocrinology.

Dr. Munir: “Of course, getting back to 180 is worth striving for, but to make differences that affect your risk for diabetes and heart disease, we’ve shown in studies that if you lose just five or 10 percent of your body weight, you can reduce those risks in a big way and improve your overall health, often within weeks.”

Exercise snacks. Diet is the main mechanism for losing weight, but the other side of the equation is exercise and doing more.

Dr. Munir: “What I tell people is to take exercise snacks. Instead of snacking on peanuts or cookies or whatever, do a 5-10 minute moderate-to-high-intensity workout. And if you can do that several times per day, all the better. Most people can spare 5-10 minutes here and there, so I tell people in the morning before you go to work, do a quick 5-minute jog, or something like that. At work, if you have a lunch break, go out for a walk, or get in some activity, and in the evening try to do the same thing.”

Lung Cancer: Put out the fire before it starts

Lung cancer is the leading cause of cancer death in Maryland men, yet men tend to wait longer to seek medical treatment for the condition than women, says Gavin L. Henry, MD, assistant professor of surgery at the University of Maryland School of Medicine and thoracic surgeon at the University of Maryland Medical Center.

Dr. Henry: “Many men who are referred to us have symptoms, but the referral is often a good sign because it likely means the cancer is in an early stage when there’s time to take action. As surgeons, we always say ‘the chance to cut is the chance to cure.’”

Annual lung cancer screening. Low-dose screening CT scans have become the standard for detecting early lung cancer.

Dr. Henry: “We recommend that men get a primary care physician, get regular checkups and screening, especially for men ages 55-70 with a significant history of smoking, (greater than 30 packs of cigarettes a year), and those with a family history of lung cancer.

Quit smoking. 80-90 percent of patients with lung cancer have a history of smoking.

Henry: “If a man is a smoker, the best thing he can do for himself is to quit. Many of my patients know smoking is bad for them. But it’s tough, it’s a habit. We recognize it’s a struggle, and we try to help with a variety of smoking cessation tools and techniques.

A man’s a man, and all that

Prostate cancer, the second leading cause of cancer death in Maryland men after lung cancer, is one of three major issues in urology for men, including sexual dysfunction and prostate enlargement, also known as BPH. “These three areas can disrupt men’s lives significantly; the incidence really starts to go up when men are in their 50s-60s-70s,” says Michael J. Naslund, MD, professor of surgery and chief of the Division of Urology at the University of Maryland School of Medicine and director of the Maryland Prostate Center.

Prostate cancer:  Cancerous cells develop in the prostate, one of the male sex glands. There’s not good data on preventing prostate cancer, and since there are no specific signs or symptoms, screening is the best way to detect it early. If it’s found, there are many treatment options, depending on health, age, expected life span, personal preferences, state and grade of cancer and the anticipated effects of treatment.

Dr. Naslund:  “When a man gets to age 50, he should be getting prostate cancer screening that includes a rectal exam and PSA blood test once a year, along with a blood and urine check. If there’s anything abnormal, then he’ll need further testing.”

Sexual dysfunction: It usually takes the form of erectile dysfunction, the inability to sustain or maintain an erection.

Dr. Naslund: “There are many things a man can do to prevent sexual dysfunction: maintaining good physical shape, not gaining a lot of weight will lower the risk of getting sexual dysfunction later in life. Not smoking is key: that helps prevents all kinds of vascular disease including erectile dysfunction. Eating smart, exercise, don’t smoke are the things men can do. Those three benefit men in a lot of other ways as well. As for treatment, pills are the first option and probably solve the problem three times out of four.”

Prostate enlargement (BPH): Partially block the bladder, resulting in a weak stream of urine and frequent urination

Dr. Naslund:  “Virtually all men get prostate enlargement, when compared to young men in their 20s. I would estimate that half of men don’t have any effects from it. They urinate normally and it never becomes an issue. Men often ignore symptoms and may not realize that treatment, if required, is less invasive with fewer side effects than it used to be.”

 

Giving Back to The Hospital That Gave A Family So Much

Guest Blog By: Deb Montgomery, University of Maryland Children’s Hospital Parent

My daughter, Neriah, has had many varied health issues over the course of her childhood, including severe asthma, allergies, gastrointenstinal issues, and more. We have been blessed to have her under the care of several of the doctors in the Pediatric Specialty Clinic at the University of Maryland Childnre’s Hospital (UMCH). During the past several years, we’ve been through a multitude of appointments, testing, and hospitalizations.

As you can imagine, this has been really hard, and especially heartbreaking to see all that our little girl had to endure. Good care from doctors and nurses helped, but it was hard to keep positive and distract our sweet girl from all of the pain and discomfort. In some of the toughest medical tests and hospitalizations, we were introduced to the Child Life program.

Through that, she was given some toys and crafts to keep her busy, and distract her a bit from what was going on. It was such a help to have someone else “on our side”, trying to make the whole hospital ordeal a more positive experience for our little girl! When she got home from different times in the hospital, she would show her sisters some crafts that she made, or little presents she got to keep. She never told stories about the hard stuff, but she focused on those fun, positive memories! We really appreciate the positive memories that she has of the hospital, through the Child Life program.

It’s because of that, that we would like to help more children in the hospital to go home with some positive memories! We know how much it means to get some help at some of the hardest times. Our little girl loves to read, and we are having a book drive to raise money to buy Usborne books and more for the Child Life program to give to kids at UMCH. Usborne books are really engaging and interactive, and would really help to bring some joy to a child in the hospital. Usborne will match your donation at 50%, so we’ll be able to get even more books to the children! Click through the link below to donate to the fundraiser, to take part in giving some wonderful books to children in the hospital at UMCH!
Click here to support Provide books to children in the hospital at UMCH

What Parents Need to Know About Dry Drowning

Dr. Christian Wright is an Assistant Professor of Pediatrics at the University of Maryland School of Medicine and specializes in pediatric emergency medicine at the University of Maryland Children’s Hospital. Below he answers everything parents need to know about “dry drowning.”

What is dry drowning?

“Dry drowning” is actually an outdated term. These days, research and health organizations prefer to simply define drowning as a process where being submerged or immersed in liquid leads to respiratory impairment—that is, difficulty breathing. Drowning can be fatal or nonfatal. Sometimes a person can develop difficulty breathing after they have left the water, sometimes even hours later, and sadly there have been cases when children have died of drowning hours after being exposed to water.

In the media, a distinction is often made between “dry drowning” and “secondary drowning.” Again, these are outdated terms, but they do attempt to explain two physiological processes that occur in drowning.

When water is inhaled, it causes a spasm of the airways which causes them to close, which makes it difficult to breathe. This usually happens right after the water has been inhaled, so the person could still be in the water or they could have just left it. In the past, it was thought that in this way a person could drown without water entering the lungs, so this was called “dry drowning.” In reality, though, water enters the lungs in almost every drowning death.

When water gets into the lungs, it interferes with our lungs’ ability to exchange oxygen and carbon dioxide, so oxygen levels in the body drop. Water also washes out surfactant, which is a substance in our lungs that prevents the small air sacs (alveoli) from collapsing when we exhale. This leads to pulmonary edema, or a buildup of fluid in the lungs, and difficulty breathing. A child could develop these symptoms up to 24 hours after exposure to water, and in rare cases this results in death. This has been referred to as “secondary drowning,” though it is really just the culmination of the drowning that started when the child was in the water.

How common is it?

“Secondary drowning” is rare, so there aren’t good statistics about how frequently it happens.

What are the symptoms?

Any time water enters our airway, our body has reflexes that kick in to clear the water. So a child could have coughing, gagging or difficulty breathing. Usually, this is sufficient to clear the airway. However, if water got into the lungs, the child could develop symptoms hours later. These include coughing, difficulty breathing, chest pain, vomiting, irritability or fatigue.

How does someone become a victim of dry drowning?

Any time water is inhaled, it could cause delayed symptoms. This could be after swimming or bathing or even after a short exposure to water like being dunked or the face being submerged in a puddle.

How’s it treated?

Drownings are treated by monitoring lung function and treating as necessary. A patient without symptoms may only need to be monitored. Patients with symptoms will need to have their lung functions monitored and supported. They might need supplemental oxygen, noninvasive forms of ventilation like CPAP, or a breathing tube may need to be placed. These patients will need to be monitored until their symptoms go away and their lungs are working normally again.

What’s the best way to prevent dry drowning?

The best way to prevent “dry drowning” is to exercise good water safety principles, including the following:

  • All children should be closely watched whenever they are are in or near water. Never leave children unattended near water.
  • Swim where there is a lifeguard, but don’t rely on the lifeguard alone to watch your child—continue to closely monitor your child.
  • Make sure pools are properly fenced and guarded. Fences should completely surround the pool area, be at least 4 feet tall, and gates should be self-closing and self-latching.
  • Teach teenagers the dangers of drinking alcohol while engaging in water activities.
  • Teach children to not roughhouse in the water
  • Enroll children in swimming lessons as early as possible
  • Have young or inexperienced swimmers wear U.S. Coast Guard-approved life jackets
  • Learn CPR

To learn more about Pediatric Emergency Medicine at the Universtiy of Maryland Children’s Hospital, please click here.

Summer Safety: How to Treat Your Child’s Cuts and Scrapes

More outdoor playtime usually brings more cuts and scrapes for kids. Here are some tips from the experts at the University of Maryland Children’s Hospital on the best way to treat your child.

What’s the best way to treat a small cut or scrape?

If the wound is bleeding, keep the area elevated and apply pressure to the site with a clean cloth or gauze. Most minor wounds will stop bleeding in about 5 to 10 minutes. Continue to hold pressure until the bleeding stops.

After the bleeding stops, wash the wound with lots of water. Soaking the wound in water can be helpful if there is dirt or other debris in the wound. You can use mild soap to clean the wound but don’t use rubbing alcohol or hydrogen peroxide —they irritate the tissue in the wound, which causes pain.

After cleaning the wound, apply antibacterial ointment and cover it with a clean dressing.

How do I know if my child needs stitches?

Here are some examples of wounds that probably require stitches:

  • Cuts that go all the way through the skin
  • Cuts with visible fat (yellow) or muscle (dark red)
  • Cuts that are gaping open
  • Cuts longer than half an inch. Note that smaller cuts can often benefit from butterfly closures or skin glue

Your doctor can examine the wound and help decide the best way to close it.

What is the process for getting stitches?

Getting stitches can be scary for children, but there are many ways to make the experience easier. These include numbing the area, distracting and coaching the child, and giving medications to decrease the child’s anxiety or even help them sleep through the procedure.

There are two options for stitches: absorbable and non-absorbable sutures. Absorbable sutures don’t need to be removed. Non-absorbable sutures need to be removed; how long they stay in depends on where the wound is, so your doctor will tell you when to come back to have them taken out.

What other options will a doctor use to close a cut?

  • Skin glue is helpful for minor cuts. It is applied to the cut while the cut is held closed and allowed to dry. Skin glue is not as strong as stitches, so it is not good for cuts that are under tension from a nearby muscle. But when the cut can be appropriately closed with skin glue, the cosmetic result can be just as good as with stitches.
  • Butterfly closures are narrow adhesive strips that are placed across a cut to keep it closed. They are helpful for small cuts or areas over joints. They aren’t as strong as stitches and can fall off early. Stitches provide a strong closure for wounds and almost always stay in place until they are removed.
  • Staples are a fast way to close certain wounds. In children, they are used most often to close cuts on the scalp.

How soon does my child need to see their doctor for stitches?

While it’s ideal to close the wound as soon as possible after an injury, wounds up to 8 hours old can still be closed. Some wounds can be closed up to 24 hours after the injury.

How can I make my child’s scar less visible?

While your child’s skin won’t look exactly the same as it did before the injury, there are some steps you can take to make the scar less visible. Sunlight can make the scar turn dark, so protect the scar from the sun by covering it with a hat, clothing or sunscreen. You can also massage the scar or apply silicone scar sheets.

For more information, visit umm.edu/childrens.

To make an appointment at one of our locations, call 410-328-6749.

Summer Safety: How to Treat Your Child’s Sunburn

Pool time and outdoor play may increase your child’s chance for developing sunburn. Here are some tips from the experts at the University of Maryland Children’s Hospital on the best way to treat your child.

What causes sunburn?

Sunburn appears within 6 to 12 hours after the skin is exposed to ultraviolet (UV) rays from the sun. Artificial light sources like sun lamps and tanning beds can also cause sunburns. The skin becomes red and painful, and swelling of the skin, tenderness and blisters can develop. Severe sunburn can also cause nausea, chills and malaise (“feeling sick”). The burned area remains red and painful for a few days. Later, peeling may occur as the skin heals.

What are the risks of sunburn?

Exposure to the sun can harm children even when they don’t get sunburn. Over the years, the effects of sun exposure build up and can lead to wrinkles, freckles, tough skin and even skin cancer later in life. Some medications and medical conditions can also make people more sensitive to sunlight. Since people get most of their sun exposure as children, it’s important to teach children sun safety early on so they can be protected from these problems in the future.

Sunlight contains both UVA and UVB rays. UVB rays cause sunburn. However, UVA rays also cause damage in the long run, including skin cancer. Since tanning beds use UVA light, they aren’t healthy and should be avoided.

How is sunburn treated?

If your child has sunburn, he or she should stay out of the sun until the burn has healed completely. Once it’s healed, be sure your child is wearing sun protection, including sunscreen, before going out in the sun again.

You can control pain from sunburn by applying cool washcloths to the area. Over-the-counter sunburn sprays that contain numbing medications like benzocaine or lidocaine can help, although they may also cause irritation to the skin. You can give anti-inflammatory medications like ibuprofen by mouth to help with the pain. As the burn heals, apply a moisturizing lotion. Products that contain aloe vera can be helpful in soothing the skin.

How is sunburn prevented?

The sun doesn’t need to be shining brightly to be dangerous. Children can be exposed to UV rays even on foggy or hazy days, and exposure is greater at higher altitudes or when UV rays are reflected off of water, snow, sand, or other surfaces. UV rays are strongest when the sun is the most intense, so try to keep your child out of the sun between 10 am and 4 pm. Infants and young children can quickly develop serious sunburns.

Dermatologists recommend using a sunscreen with a sun protection factor (SPF) of at least 30. Check the label to make sure the sunscreen blocks both UVA and UVB rays. Apply sunscreen 15-30 minutes before going outside. Reapply sunscreen every 2 hours. Since no sunscreen is waterproof, you may need to reapply sunscreen more frequently if your child is spending lots of time in the water.

Appropriate clothing is also important for sun protection, such as wide-brimmed hats and lightweight cotton clothes with long sleeves and pants.

Keep babies under six months of age out of the sun and in the shade as much as possible. Avoid sunscreen in babies less than six months old.

For more information, visit umm.edu/childrens.

To make an appointment at one of our locations, call 410-328-6749.

 

A Gift of Thanks – 3 Years (and 43 Surgeries) Later

Grant (second from right) with part of the STC team and his parents

Three years ago, Grant Harrison was in a horrific motorcycle crash.  It was a bright sunny day on the Eastern Shore when a large deer struck the motorcycle Grant was riding.  He was airlifted to UMMC’s R Adams Cowley Shock Trauma Center with multiple life threating injuries.

The fact that he is alive today is nothing short of astonishing. Grant had a fractured skull, severe traumatic brain injury, bleeding of the brain and severe injuries to his limbs.

Grant spent 58 days on the Neurotrauma Critical Care Unit, and has had 43 surgeries on his road to recovery.

Grant is a now a walking, talking (and hilarious) miracle.

Exactly three years after the accident, June 6, 2017, Grant, along with his mother and father, wanted to give thanks to the nurses and doctors at Shock Trauma who showed them extraordinary compassion and care throughout this life-altering experience.

They brought the Shock Trauma team a framed thank you letter, along with photos documenting Grant’s journey to recovery.  The gift is now hung along the walls of the Neurotrauma Critical Care Unit, right outside the Patient Family Waiting Area.

The Harrison Family hopes that families pacing those halls (like they did many times 3 years ago), will read the testimony and find hope and encouragement.

Read a portion of the family’s letter below:

“The doctors and nurses here not only care for the patient, but for you, the family as well. They will always hold a special place in our hearts for their kindness and compassion. We encourage you to listen well to them, as they will educate and guide you through this unexpected journey. The Trauma Survivor’s Network, a resource offered through the hospital, was also most helpful to us.”

Grant with TRU Nurse Christopher Wentker

 

An Interview with Orthopaedic Oncologist Dr. Vincent Ng

Dr. Vincent Ng is an orthopaedic oncologist with the University of Maryland Greenebaum Comprehensive Cancer Center and an Assistant Professor or Orthopaedics with the University of Maryland School of Medicine.  Dr. Ng specializes in treating bone cancer and soft tissue sarcoma.  Below he answers common questions about orthopaedic oncology.

What is an orthopaedic oncologist? How do they differ from surgical oncologists?

“An orthopaedic oncologist specializes in bone and soft tissue tumors.  I treat any adult or pediatric patient with any bone or soft tissue tumor/lesion/mass, whether benign or malignant, whether it is originating from the bone or soft tissue itself or spread from another part of the body, regardless of how large or small, in the upper or lower extremities, pelvis or shoulder region.  I am often the first provider patients see when they find a concerning lump.  I can help direct their care in terms of imaging, biopsy, and referral to other providers like medical oncology and radiation oncology.

Surgical oncologists are general surgeons who tend to specialize in tumors of the organs within your abdominal cavity (pancreas, liver, colon, etc).”

What are cartilage tumors? Are they treatable?

“There is a definite spectrum of cartilage tumors and they can present in a variety of fashions.  We are seeing many patients with a variety of cartilage tumors.  Many are very small and benign, while some can be large and life-threatening.  Cartilage tumors can be challenging in diagnosis and treatment.

While tissue sample analysis can identify a lesion as a cartilage tumor and can separate the most aggressive tumors from the least aggressive ones, it is difficult to necessarily predict the future behavior based on this alone.  A comparison of the relationship between the tumor and normal bone on imaging can often be more helpful.  Whether the patient has pain is often helpful information as well.

Making careful treatment decisions for cartilage tumors (chondrosarcoma) can require a very subtle approach and it is important to have a team of radiologists, pathologists and surgeons that deal with a lot of cartilage tumors.  Sometimes cartilage tumors may be simply observed over time to make sure they remain stable while some may require very large and complex surgery to safely remove them.”

How can surgery help treat tumors in the pelvis?

“Surgical management of tumors affecting the pelvic bones is one of the most challenging areas of orthopaedic oncology.  Because of the complex anatomy associated with this region of the body, successfully removing malignant tumors from the pelvis requires a surgeon with extensive knowledge of the critical structures and how they work together.

It requires a large team to do these operations, from anesthesia and interventional radiology to the ICU and physical therapists, dozens of dedicated healthcare providers are essential to the success of the patient.

Personally, I enjoy these surgeries and have been blessed to have trained at two cancer centers with a high volume of pelvic operations and excellent surgeon mentors.  By the nature of University of Maryland being a tertiary referral center, we see many patients with pelvic tumors, some of which can be managed with radiation for which we have the new Maryland Proton Treatment Center, and some of which benefit from surgery.  The road to recovery for these patients can be long, but with rehab and a positive attitude, they often do well.  As a surgeon, seeing them succeed is one of the most rewarding parts of this profession.”

What are some misconceptions about soft tissue sarcoma?

“Soft tissue sarcoma is a life-threatening condition and I believe strongly that it needs to be addressed swiftly and aggressively.  Part of our job is educating non-oncologic physicians that any soft tissue mass could potentially be a soft tissue sarcoma and should be evaluated to avoid missing, and therefore delaying treatment for, a soft tissue sarcoma.

When the soft tissue sarcoma is localized (only in one location, the original location) and has not spread to other parts of the body, it is curable in many instances.  Treating it with radiation and surgery before it has a chance to send microscopic cells to other parts of the body is important.  It is hard to predict when a tumor will release these cells elsewhere and they sometimes do not appear until many months or even years later.  We currently do not have an effective treatment for these cells once they have spread and established themselves elsewhere in the body.  This is one of the areas that we are examining in a clinical immunotherapy trial, NEXIS, which I have designed.  If it is successful, it has the potential to help many soft tissue sarcoma patients.”

Explain the challenges of treating Ewing sarcoma.

“Ewing sarcoma often presents in a delayed fashion and can be missed by non-oncologic practitioners.  It affects children and teenagers and is truly a life-threatening condition.  Luckily, we have strong chemotherapy regimens that can usually cure the disease, particularly in younger patients.  Successfully treating Ewing sarcoma is a very long process with many weeks of chemotherapy.  Because it can occur in any part of the body, but oftentimes in the pelvis or major bones of the limbs, surgery to remove the tumor can be quite extensive and the recovery from skeletal reconstruction can be prolonged.  Nevertheless, the most important thing is removing the cancer.  I am a strong believer in wide surgical margins and radiation when possible to eliminate the primary tumor and make sure it does not return.  The success rate of treating recurrent disease is suboptimal. You really only get one good chance to cure Ewing sarcoma.”

What’s new in the world of metastatic bone cancer?

“Patients are living longer and more productive lives even when diagnosed with metastatic and incurable disease.  When cancer spreads from one part of the body to the bone, our job as orthopaedic oncologists is to minimize its impact on patients’ lives.  While we cannot cure them of their original cancer, we can stabilize the bones with surgery to significantly reduce pain and prevent fractures where the cancer has eroded through the structural integrity of the bone.  Some types of metastases such as those from thyroid or kidney cancer may be better treated with a complete resection of the cancer rather than a palliative procedure.”

How is research playing a part in improving treatment options for bone and soft tissue cancer?

“Moving the needle forward, particularly in cancer research, requires a team approach.  Each person brings their own set of experiences, perspectives, and ideas to the table.  An effective leader must have a creative vision, an untiring spirit, and the ability to think outside the box in order to solve a variety of challenges.  Here at University of Maryland, we hope to parlay the success of immunotherapy in other areas of oncology to soft tissue sarcoma in the NEXIS trial.  It is the first neoadjuvant checkpoint inhibitor immunotherapy trial that adds the potential benefit of combination immunotherapy to the existing standard of care for soft tissue sarcoma.  On a preclinical level, we are looking for potential treatments in the future with retinoic acid and chondrosarcoma, and new targeted therapy combinations for osteosarcoma.  The opportunity for me to collaborate as a clinician with these scientists is one of the advantages of working at a large University with many PhD’s and award-winning researchers.”

To learn more about UMGCCC’s Bone Cancer and Soft Tissue Sarcoma Service, please click here, or call 410-448-6400.