BY JAKE POINIER

Every decade or so, radiology

has had an inflection point

that revolutionizes how we

image and diagnose patients,” said

Dr. Don Schomer, Diagnostic Imaging

Section Chief at Banner MD Ander-

son Cancer Center. In the 1960s, it

was catheter-based angiography, and

in the 1970s, it was nuclear medicine.

The ‘80s, ‘90s and early 2000s saw the

advent of CT scanning, MR and func-

tional MR, and PET CT, respectively.

While each of these new tech-

niques put new tools in the hands

of radiologists and physicians, they

also had their shortcomings. Nuclear

imaging showed activity in three

dimensions, but without anatomic

precision. A CT gave an anatomic per-

spective, but didn’t add localization.

STATE OF IMAGING“In the mid 2000s, PET really took off

because of CT, because it heralded

the concept of a molecular-based di-

mension,” Schomer said. “Now, you’re

not just looking at anatomy, but how

it’s functioning on a molecular level.

There are a whole host of questions

that a molecular study can’t answer,

but an MRI and CT can. How densely

packed are the cells in a tumor? How

leaky are the vessels?”

Schomer believes that the next

inflection point in radiology is

biologic state imaging, a hybrid tech-

nique that combines functional and

molecular imaging to make decisions

about the biologic state of an organ

system or a tumor in question. Ban-

ner MD Anderson Cancer Center is

MARCH 2012A PUBLICATION FOR COMMUNITY PHYSICIANS

INSIDE3 New hope for endocrine cancer patients4 What’s happening at Banner MD Anderson5 Nurses are heartbeat of hospital

6 ‘Flavor profiling’ aids chemo patients7 Partial breast radiation treatment

speeds recovery

at the leading edge of developing the

techniques, along with The University

of Texas MD Anderson Cancer Center

in Houston and institutions such as

UCLA and Stanford. Schomer describes

the resulting images as absolutely

amazing, offering a 3D image with a

temporal component.

“At Banner MD Anderson, we’re

very passionate about cancer —

that’s the reason we exist,” Schomer

said. “For diagnostic imaging, our

Inflection pointBiologic state imaging is the next step in the evolution of diagnostic imaging — and providing clinicians with better tools for personalized cancer treatment

“

Dr. Don Schomer, Diagnostic Imaging Section Chief at Banner MD Anderson Cancer Center, with Dr. Susan Passalaqua, Director of Nuclear Medicine and Molecular Imaging.

2 MARCH 2012 ROUNDS

task is to give oncologists ways of

understanding the state of a pa-

tient’s tumor before, during and after

therapy. Ultimately, the vision is to

help clinicians manage these tumors

on a personalized basis.”

TECHNOLOGY CHANGESThe new technology has become

even more essential because of

broader changes in cancer therapies.

“The old paradigm of the way you

image cancer is that you measure

it, and then you give it some poison

and it shrinks,” Schomer said. “Your

success is gauged by how much vol-

ume loss there’s been in the tumor.

More-personalized cancer therapies,

however, are cytostatic rather than

cytotoxic—they halt the process, they

don’t make it shrink or die or go away.

Or oncologists may use combinations

of the two therapies.”

From an imaging point of view,

however, it’s very difficult to know that

a tumor treated with a cytostatic ther-

apy is quiescent. Since these agents

Suspicion of Cancer Program is game changer in early detection

Most patients who come to Banner MD Anderson Cancer Center already have a diagnosis of cancer. But sometimes a person may have radiological or lab abnormalities, or even symptoms that raise suspicion, and they’re not sure where to go.

Banner MD Anderson’s new Suspicion of Cancer Clinic is targeted at precisely this type of early detection. “Our goal is to ex-pedite the workup and get them to the right physician, because oncologists are very specialized,” says David Edwards, M.D., section chief of internal medicine at the Banner MD Anderson Cancer Center and a part-time clinician working in the program.

The staff includes two general internists and one pulmonologist. The process operates on a similar principle to triage in an emergency room, starting with a conversation between the patient and a nurse clinical navigator.

“If a patient already knows he has cancer, they’ll talk about how was it diagnosed, and what type of cancer it is,” said Edwards. “If someone has a spot on her lung, but hasn’t had a workup, the navigator will direct her to the appropriate physician. We even talk to ER physicians with a patient who they believe has can-cer, but don’t have an official diagnosis.”

Physicians can refer patients to the Suspicion of Cancer Clinic by calling (480) 256-3433. Patients can also self-refer by calling (480) 256-6444.

What we hope to do with

the biologic state techniques

is, when a patient goes onto a

therapy, to tell the oncologist

very quickly that the therapy

is working or not, so they can

maintain their current course

or try something else.

— Dr. Don Schomer, Diagnostic Imaging Section Chief, Banner MD Anderson Cancer Center

are so expensive, that’s a critical piece

of data—one that biologic state imag-

ing is perfectly suited to provide.

“The holy grail of biologic state

imaging is moving from PET CT to

PET MRI,” Schomer said. “What we

hope to do with the biologic state

techniques is, when a patient goes

onto a therapy, to tell the oncologist

very quickly that the therapy is work-

ing or not, so they can maintain their

current course or try something else.”

BannerMDAnderson.com 3

BY ANDREA MARKOWITZ

W ithin a few months of Banner

MD Anderson Cancer Center’s

(BMDACC) opening on Sep-

tember 26, 2011, Christine Landry, MD,

and her surgical team already successfully

treated a patient with a rare genetic con-

dition called von Hippel Lindau disease.

“This patient had a history of bi-

lateral cerebellar hemangioblastomas

and was later diagnosed with bilateral

pheochromocytomas,” said Dr. Landry,

a surgical oncologist/endocrinologist.

The surgical team performed a cortical-

sparing bilateral adrenalectomy, she

explained. By preserving the cortex and

removing the tumors, they were able to

wean the patient off all blood pressure

medications and avoid the need for

long-term steroids.

TREATING THYROID CANCERThe physicians at BMDACC treat thyroid

cancer patients just as aggressively.

According to Dr. Landry, patients are

evaluated with a thorough ultrasound of

the soft tissues of the head and neck. Any

suspicious thyroid nodules and lymph

nodes in the lateral neck are biopsied.

The results of the biopsy help dictate

the extent of operation. “After surgery,

patients with papillary or follicular

thyroid cancer are treated with thyroid

hormone suppression therapy, and

sometimes radioactive iodine. We then

Banner MD Anderson Cancer Center’s surgical team successfully treats both rare and routine cases

New center offers endocrine cancer patients new hope

Dr. Christine LandryDr. Landry is a board certified surgeon who specializes in surgical oncology and surgical endocrinology. She earned her medical degree from the Texas Tech University Health Sciences Center School of Medicine in Lubbock, completed a general surgery residency at the University of Louisville School of Medicine, and fellowships in both surgical oncology and surgical endocrinology at the University of Texas MD Anderson Cancer Center in Houston.

SPECIALTIES: Pancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers (including colorectal, small bowel, and stomach), liver tumors.

WORK EXPERIENCE: After completing a fellowship in surgical oncology and surgical endocrinology at MD Anderson in Houston in the summer of 2011, Dr. Landry joined the staff at Banner MD Anderson.

MEDICAL SCHOOL: Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas.

INTERNSHIP: General Surgery, University of Louisville School of Medicine, Louisville, Kentucky.

RESIDENCY: General Surgery, University of Louisville School of Medicine, Louisville, Kentucky.

POST-GRADUATE TRAINING: Surgical oncology, University of Texas MD Anderson

Cancer Center, Houston and Surgical endo-crinology, University of Texas MD Anderson Cancer Center, Houston.

BOARD CERTIFICATION: American Board of Surgery.

PUBLICATIONS OF INTEREST:Landry C., Grubbs E., Busaidy N., Staerkel G., Perrier N., Edeiken-Monroe B. Cystic Lymph Nodes in the Lateral Neck are an Indicator of Metastatic Papillary Thyroid Cancer. Endocrine Practice, Mar-Apr 2011; 17(2):240-4.Landry C., Grubbs E., Hernandez M., Hu M., Hansen M., Lee J., Perrier N. Predictable Criteria for Selective, Rather than Routine, Calcium Supplementation Following Thyroidectomy, Archives of Surgery, December 2011 (E pub ahead of print).Landry C., Waguespack S., Perrier N., Surgical Management of Nonmultiple Endocrine Neoplasia Endocrinopathies: State-of-the-Art Review. Surg Clin North Am, October 2009; 89(5):1069-89.Landry C., Ruppe M., Grubbs E., Vitamin D Receptors and Parathyroid Glands. In Press. Endocrine Practice, Mar-Apr 2011; 17 Suppl 1:63-8.Landry C., Grubbs E., Edeiken-Monroe B., Vu T., Kim E., Perrier, N. Parathyroid Imaging. In press for Surgical Endocrinology Handbook. Landry C., Rich T., Jimenez C., Grubbs E., Lee J., Perrier N. Multiple Endocrine Neoplasia. In: Yao JC, Hoff PM, Hoff, AO, eds. Neuroendocrine Tumors. New York, NY: Springer; 2011:29–49. Current Clinical Oncology Series.Landry C., and Lee J., Pancreatic Endocrine Tumors and Multiple Endocrine Neoplasia. In press, The M. D. Anderson Surgical Oncology Handbook, 5th Edition.

follow the patients closely with regular

ultrasounds,” Dr. Landry said.

Patients with medullary thyroid can-

cer are screened for genetic conditions

such as multiple endocrine neoplasia

type 2 (MEN 2). Genetic testing is ben-

eficial in high-risk patients because the

specific RET mutation in MEN 2 can be

used to predict the MEN 2 subtype as

well as the aggressiveness of medullary

thyroid cancer. Likewise, family mem-

bers can also be screened for the muta-

tion and treated appropriately.

BUILDING A FULL-SERVICE CENTERDr. Landry and her team are building a

full-service endocrine center that will

include a surgical team, endocrinolo-

gists, radiologists, pathologists and

genetic counselors, to provide com-

prehensive care. “With time, we hope

to develop a thyroid nodule clinic to

expedite diagnosis and treatment, and

offer clinical trials for patients with

metastatic thyroid cancer.”

4 MARCH 2012 ROUNDS

Banner MD An-

derson Cancer

Center has been

open just about six

months. In that time,

we’ve treated more

outpatients than origi-

nally projected and

opened a variety of new programs and

services. Here’s a glimpse into what’s

happening at Banner MD Anderson.

RESEARCH:We have built our research structure

for the cancer center and are ready

to open our first protocols. Once stud-

ies open, they will be listed on our

website at www.bannermdanderson.

com for both physicians and patients

to view. I anticipate we will be adding

new clinical trials monthly now that

our structure is in place. You can con-

tact our Clinical Trials office directly

at 480-256-3425.

PHYSICIANS:I am proud of the high caliber of phy-

sicians now working at Banner MD

Anderson. These physicians are highly

skilled and most focus on specific dis-

ease sites. For this reason, our patient

intake process matches patients with

the best physician for their diagnosis.

When you make a referral, or when

a patient calls directly, our first step

is to review the patient’s medical

records. This ensures the patient is

placed with the most appropriate

physician for their care.

Please see the list of physicians

(on page 8) for more information

on their subspecialties.

What’s happening at Banner MD Anderson Cancer Center

BY DR. EDGARDO RIVERA, MEDICAL DIRECTOR

CLINICAL CANCER GENETICS:Our clinical cancer genetics program

will begin soon. Patients can access a

genetic counselor for high risk cancer

surveillance and management, and

genetic testing. To make a referral to

our genetic counselor, physicians can

call (480) 256-3433.

DIAGNOSTIC IMAGING: Our diagnostic imaging service offers

new and innovative modalities. From

4D imaging and a unique scan for

parathyroid disease to interventional

radiology procedures such as cryo-

ablation and 3D Tomosynthesis for

breast screening, we offer the latest

screening technologies backed by

highly skilled and experienced radi-

ologists and technologists.

To schedule a patient for an imag-

ing procedure at Banner MD Anderson

Cancer Center, call Banner Health

Central Scheduling at 480-684-7500.

Our ultimate goal is to provide pa-

tients with excellent cancer treatment in

a healing and welcoming environment.

Please let me know if I can answer any

questions about our services or assist

you or your patients.

BannerMDAnderson.com 5

BY ALISON STANTON

Patients who arrive at Banner

MD Anderson Cancer Center for

the first time typically have many

things in common.

Most are scared and nervous. Many

have questions about their treatments.

All of them need calm reassurance.

The patients also share something

in common that will make all the dif-

ference in the time they spend at the

center: they will all be treated with the

utmost of care and respect by the highly

trained and skilled staff of oncology

nurses who understand how frightening

a cancer diagnosis can be.

SPECIALIZED CARE“The nursing staff has over 1,099 years of

combined nursing oncology experience

and 60 percent are oncology certified

through Oncology Nursing Certification

Corporation,” said Cathy Townsend,

R.N., Chief Nursing Officer at Banner

MD Anderson Cancer Center and Ban-

ner Gateway Medical Center.

“Their goal, out of all of the chaos

that surrounds a cancer diagnosis and

treatment, is to try to keep things as

normal for the patients as possible, by

helping to keep their routines going as

much as possible, so it really does not

interfere with their schedules that much

and they can try to lead as normal a life

as they can,” she said.

Townsend said that the nurses

provide specialized care in three of the

center’s departments.

“In our radiation oncology department,

nurses actively help to educate and put

together information for the patients on

the complexity of their treatment,” she said.

“For example, a patient may get

30 treatments over 30 days, and so the

nurse will meet with them and discuss

what those treatments will be like as

well as go over any necessary pre-

scriptions they might need. They will

also handle all of the related teaching

about the equipment they will use,

how it will affect the patients, what

side effects they might have and how

it will affect their lives.”

PATIENT COMMUNICATIONOver in the clinical department,

Townsend said nurses are present

when the patient is first diagnosed

with cancer. At this point, she said,

many patients are overwhelmed, so

the nurses perform the valuable ser-

vice of assisting with communication

with the oncologist.

“Patients don’t know what they

should do or what to expect — it’s like

if someone has never flown in an air-

plane before and will not know what

will happen. It’s a similar situation

with being diagnosed with cancer;

how can they cope if they have not

experienced it?”

From making sure cancer patients

are asking the right questions or, in some

cases, asking the questions for them

to advocating for them throughout the

entire treatment process, the nurses

offer both guidance and reassurance to

patients with cancer.

MANAGING CAREIn the infusion department, Townsend

said nurses are constantly assessing pa-

tients who are undergoing chemothera-

py to help them manage any symptoms

they may be experiencing.

“Nurses know how to monitor things

about patients and their routines, and

they know what tests and procedures

the patients will be having, and when to

get a physician if a patient needs extra

medication or help.”

Regardless of what department the

oncology nurses work in at Banner MD

Anderson Cancer Center, they provide

each and every patient with a welcome

and predictable presence that goes a

long way in helping patients feel better,

both physically and emotionally.

“At our center, patients keep coming

back to utilize the facility for their treat-

ments, so the nurses build up a rapport

and a bond with them. The nurses get

to know their families, and they share

stories with them,” she says.

“It takes a whole team to work

with each patient and everyone is a

valued member.”

Nurses: The heartbeat of Banner MD AndersonA highly trained nursing staff educate patients, ease fears

6 MARCH 2012 ROUNDS

BY GREMLYN BRADLEY-WADDELL

Chemotherapy is a wonderful

tool in the war against cancer,

but as most folks know, it has

some less than wonderful side effects

like hair loss, fatigue and nausea.

And an overwhelming majority of

patients also suffer from “taste acuity,”

says Heather Metell, executive chef at

Banner MD Anderson Cancer Center

and Banner Gateway Medical Center

in Gilbert.

“Food doesn’t taste like it’s sup-

posed to,” she says, explaining that

taste buds – like cancer cells – are a

type of cell that grows quickly. Just the

type that an anti-cancer treatment

such as chemo is created to destroy.

As a result, Metell says, patients often

find their food tastes odd: metallic-like,

too salty, too sweet or just plain taste-

less. And taste can vary from day to day;

one day, foods taste sweet; the next, they

don’t. But because maintaining one’s

weight and strength is vital to be able to

continue and finish chemo treatments,

it’s that much more important to make

sure one is getting enough sustenance,

adds registered dietitian Monika Baxter,

who also works at the cancer center.

All of this got Metell to thinking.

And one of her first thoughts was in-

stead of sending food up to a patient’s

room and finding out later that the

food tasted wrong, why don’t we go up

to their room first and ask what they

can taste? Then, a meal can be tailored

to their specific needs. So, that’s what

Metell’s staff began doing. Armed with

samples of vanilla pudding, peanut

butter and lemon yogurt – foods that

typically register to most folks as

sweet, savory and sour – they meet

one-on-one with patients, often before

chemotherapy treatments have begun,

to determine what they can taste and

how it tastes. Then, if a patient can

detect sourness, for example, Metell

might whip up a lemon crème sauce

to put atop halibut. If another patient

can taste sweetness, a protein-packed

Chocolate Diablo smoothie may be

added to the menu.

Metell calls the process “flavor pro-

filing,” and believes she and her staff

may be the only ones in the country

doing this kind of thing in a hospital

setting. They began this “very motherly

approach,” as she calls it, after the

cancer center opened in September

2011 and have worked with about 25

people thus far. Metell is also collecting

data and trying to improve upon the

method every day.

“So far, it’s been working out pretty

well,” Metell says. “It’s challenging but

pretty rewarding when you get some-

one nourished.”

‘Flavor profiling’ helps in chemo treatmentExecutive chef tailors’ meals to patients’ taste,nutritional needs

Profile: Executive Chef Heather Metell

Heather Metell has always felt at home in the kitchen, whether it was the one in her childhood home or a more com-mercial variety.

“I was washing dishes at a little inn at 12 years old,” says the executive chef, who now oversees a staff of about 50, including dietitians, cooks and dishwashers, at Banner MD Anderson Cancer Center and Banner Gateway Medical Center in Gilbert.

Originally from Massachusetts, Metell made her living for years in the kitchens of some of the finest East Coast resorts. And while she ditched the country-club atmosphere and its stressful demands when she moved to Arizona – she yearned for a more relaxed lifestyle, one in which she didn’t have to put in “90 hours a week” – the elegant and refined approach to food she had mastered during her years on the resort scene is evident in the menu offerings she now serves up for patients.

“It’s been a bit of a challenge to make the food taste good without salt or fat,” says Metell, whose culinary passion is making sauces. “But we’re probably one of the only hospitals that makes its own veal demi-glacé.”

Metell calls the process ‘flavor profiling’ and believes she and her staff are the only ones in the country doing this kind of thing in a hospital setting.

BannerMDAnderson.com 7

BY ALISON STANTON

Thanks to a procedure called

partial breast radiation treat-

ment, some breast cancer

patients at Banner MD Anderson

Cancer Center are able to have

just one week of radiation after a

lumpectomy, instead of the tradi-

tional six weeks.

“The radiation is focused on the

breast tissue just around the area of

the lumpectomy site, and we do the

procedure soon after surgery for an

accelerated period,” said Dr. Matthew

Callister, radiation oncology section

chief at Banner MD Anderson, adding

that the treatment has been offered

at the center for some time.

“The advantages of this treatment

are that in addition to a significant

reduction of the amount of time a

patient has to receive radiation, the

whole breast is not exposed to the

radiation but rather just the treatment

bed or tissue around it.”

Over the last few years there have

been significant improvements in the

partial breast radiation treatment,

Callister said, including in the devices

that are placed in the breast to deliver

treatment in a conformal way.

“We are able to customize the

doses better with this treatment,”

Callister said.

Although a recent abstract that

was presented by colleagues at The

University of Texas MD Anderson

Cancer Center in Houston and

which looked at the earlier years

of the technique raised concerns

about its effectiveness and risks,

Callister said he feels any negative

side effects of the treatment can

be avoided with a combination

of preparation and prudence.

“I think the study provides us with

important cautions to oncologists to

consider before doing a partial breast

radiation treatment; for example, to

properly select appropriate patients

for this procedure, so we are giving

it to the right ones and attending to

how the treatment is given.”

Despite the findings, Callister

said Banner MD Anderson Cancer

Center still offers the partial breast

radiation treatment to many breast

cancer patients, as do his colleagues

in Houston.

The advantages of this treatment are that in addition to a significant reduction of the amount of time a patient has to receive radiation, the whole breast is not exposed to the radiation but rather just the treatment bed or tissue around it.

– Dr. Matthew Callister

Partial breast radiation treatment speeds recoveryRecent improvements ease concerns, risks

Dr. Matthew Callister Section Chief, Radiation OncologySPECIALTY: The treatment of cancer with radiotherapy

RECENT WORK EXPERIENCE:Assistant professor of radiation oncology and a consultant in the department of radiation oncology at Mayo Clinic Scottsdale.

MEDICAL SCHOOL: Duke University School of Medicine, Durham, N.C.

INTERNSHIP: Mayo School of Graduate Medical Education, Scottsdale

RESIDENCY: University of Texas MD Anderson Cancer Center, Houston

BOARD CERTIFICATION:American Board of Medical Specialties

AFFILIATIONS:American Society for Therapeutic Radiology and Oncology; American Society of Clinical Oncology; Children’s Oncology Group

PRESORT STD

U.S. POSTAGE

PAID

LONG BEACH, CA

PERMIT NO.1677

HEMATOLOGY & MEDICAL ONCOLOGY Tomislav Dragovich, MD, PhD, Section ChiefDigestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary

Shakeela Bahadur, MDLung, colorectal, breast cancers

Mary Cianfrocca, DOBreast cancerBreast Cancer Program Director

Jade Homsi, MDMelanoma, sarcoma, immunotherapy

H. Uwe Klueppelberg, MD, PhDMultiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers

Edgardo Rivera, MD, Medical DirectorBreast cancer

Bryan Wong, MDGenitourinary cancers

ONCOLOGY SURGERYJudith K. Wolf, MD, Section ChiefGynecologic Oncology

Mark Gimbel, MDMelanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers

Christine Landry, MDPancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers, breast cancer, liver tumors

Diljeet Singh, MDProgram Director, Gynecologic Oncology

Benny Tan, MDPlastic and reconstruction surgeonBreast cancer reconstruction and most forms of cancer reconstruction

RADIATION ONCOLOGYMatthew Callister, MD, Section ChiefGastrointestinal, Skin, Sarcomas, and Head and neck cancers

Emily Grade, MDBreast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers

Terence Roberts, MD, JDBrain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy

DIAGNOSTIC IMAGINGDonald Schomer, MD, Section Chief, CAQ NeuroradiologyOncologic diseases of the brain, spine, head and neck

John Chang, MD, PhDAdvanced magnetic resonance and computerized tomography imaging of gastrointestinal and genitourinary systems; imaging guided biopsies

Vilert Loving, MDBreast imaging and intervention

Harvinder Maan, MD, CAQ NeuroradiologyDirector of Neuroradiology Neuroradiology and interventional spine procedures

Rizvan Mirza, MDAbdominal and pelvic magnetic resonance imaging

Susan Passalaqua, MDDirector of Nuclear Medicine and Molecular Imaging Board Certified in Nuclear Medicine and RadiologyOncologic Imaging, PET/CT

Andrew Price, MD, CAQ Interventional RadiologyInterventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization

David Russell, MD, FACPBreast imaging and intervention

CRITICAL CAREShiva Birdi, MD, Section ChiefJohn Jijo, MDDeven S. Kothari, MDDean Prater, MDAnthony Sado, MD

INTERNAL MEDICINEDavid Edwards, MDSuspicion of Cancer Clinic

Ronald Servi, DOPulmonary Medicine

Banner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff. Physicians continue to join Banner MD Anderson,

so this list will continue to evolve.To make a referral to a physician on our staff, call 480-256-3433.

To contact a member of the medical staff, call 480-256-6444 and ask for the physician to be paged.

Introducing Banner MD Anderson Physicians