Surgeons and Oncologists

Robert J. Cerfolio M.D.

Dr. Robert Cerfolio is a thoracic surgeon at the University of Alabama at Birmingham Medical Center Department of Cardiothoracic Surgery. Dr. Cerfolio also serves as the Chief and Director of Thoracic Surgery at the Birmingham Veterans Administration Hospital. His expertise is wide-ranging but includes lung cancer, esophageal surgery, tracheal surgery, bronchopleural fistula, and video assisted thoroscopy. His most recent work has been focused on developing gene therapies for those diagnosed with esophageal cancer.

Dr. Cerfolio received his Bachelors degree from the University of Rochester in 1984. He then enrolled at the University of Rochester Medical Center in 1988. After an internship in general surgery at the Hartford Hospital St. Francis, he enrolled in a residency program in urology at Cornell-New York Hospital, an affiliate of the Memorial Sloan-Kettering Cancer Center, from 1991-1993. After completing his general surgery residency at the esteemed Mayo Clinic in Rochester, Minnesota, Dr. Cerfolio began a cardiothoracic fellowship, finishing in 1996.

Dr. Cerfolio has been consistently ranked as one of America’s best doctors, a distinction endowed by the voting of his peers. He has also developed a reputation as one of the busiest doctors in the country. In 1999, Dr. Cerfolio performed nearly 800 assorted operations of the lungs, esophagus, and trachea. He is not only widely considered exceptional within the US for his work, but also as one of the best thoracic surgeons in the world.

Dr. Cerfolio is more than just a surgeon however. He is also an avid researcher. Dr. Cerfolioa has presented to the American Society of Thoracic Surgeons on a number of occasions in addition to publishing dozens of papers on emerging therapies and techniques in thoracic surgery. As a leader in the field he is a member of several professional organizations. He is a statured member of both the American Association of Thoracic Surgery and the Southern Thoracic Surgical Association.

Surgeons and Oncologists

United Kingdom
David A. Waller, MD
Glenfield Hospital
Groby Road
Leicester
Leicestershire
LE3 9QP
United Kingdom
Specialty: Surgery for pleural mesothelioma


Tom Treasure, MD, MS, FRCS
Guy's Hospital
St. Thomas' Street
London
Greater London
SE1 9RT
United Kingdom
Specialty: Surgery for pleural mesothelioma


Andrew Ritchie, MD, PhD
Papworth Hospital
Papworth Everard
Cambridge
Cambridgeshire
CB3 8RE
United Kingdom
Specialty: Surgery for pleural mesothelioma

Dr. Ritchie is a Consultant Cardiothoracic and Transplant Surgeon at Papworth Hospital NHS Trust. He has a specific interest in pleural mesothelioma.


Loic Lang-Lazdunski, MD, PhD FRCS
Guy's Hospital
St. Thomas Street
London
SE1 9RT
United Kingdom
Specialty: Thoracic Surgery

Dr. Lang-Lazdunski has been leading the Mesothelioma Program at Guy’s Hospital since 2003, and has expertise in EPP, Pleurectomy/Decortication and VATS pleurodesis. He is one of two surgeons involved in the ongoing MARS trial.


Robin M. Rudd, MA, MD, FRCP
54 New Cavendish Street
London, W1G 8TQ
United Kingdom
Specialties: Respiratory oncology, pleural mesothelioma

Also at:

The London Chest Hospital
Bonner Road
London
Greater London
E2 9JX
United Kingdom

St. Bartholomew's Hospital
West Smithfield
London
Greater London
EC1A 7BE
United Kingdom

Dr. Rudd is Co-Director of Bart’s Mesothelioma Research, and is a Consultant in Medical Oncology at St. Bartholomew’s Hospital. He is world renowned as an expert on mesothelioma diagnosis and treatment, as well as lung cancer and other asbestos-related diseases.

Jeremy P.C. Steele, MD, MRCP
54 New Cavendish Street
London, W1G 8TQ
United Kingdom
Specialty: Respiratory oncology, pleural mesothelioma

Dr. Steele is Co-Director of Bart’s Mesothelioma Research, and is a Consultant in Medical Oncology at St. Bartholomew’s Hospital, the Royal London Hospital and the London Chest Hospital. He is also a member of the Board of Directors of the International Mesothelioma Interest Group (IMIG) and is chairman of Mesothelioma UK.


Ireland

Kenneth J. O’Byrne, MD
St. James' Hospital
James Street
Dublin 8
Ireland
Specialty: Oncology


Germany

Dr. med. Erich Hecker
Klinikum Bremen-Ost gGmbH
Lehrkrankenhaus der Universität Göttingen
Züricher Str. 40
28325 Bremen
Germany
Telephone: 0421 408 – 0
Specialty: Surgery for pleural mesothelioma

Dr. med. Ludger Hillejan
Klinik für Thoraxchirurgie
Klinikum St. Georg
Krankenhaus St. Raphael
Bremer Strasse 31
49179 Ostercappeln
Germany
Specialty: Surgery for pleural mesothelioma

Dr. med. Herwart Müller
Onkologische Chirurgie
Ofenthaler Weg 20
D-97762 Hammelburg
Germany
Speciality: Surgery for peritoneal mesothelioma


Italy

Dr. Marcello Deraco
U. O. Melanoma e Sarcoma
Istituto Nazionale Tumori Milano
Via Venezian, 1
20133 Milano
Italy
Specialty: Surgery for peritoneal mesothelioma


Spain

Alberto Gómez Portilla, MD, PhD
Policlinica San José
Beato Tomas de Zumarraga, 10
01008 - Vitoria
Spain
Specialty: Surgery for peritoneal mesothelioma

Australia

Thyroid Cancer

Thyroid Cancer : Definition of thyroid cancer: Cancer that forms in the thyroid gland (an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight). Four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic thyroid cancer. The four types are based on how the cancer cells look under a microscope.Estimated new cases and deaths from thyroid cancer in the United States in 2009:
New cases: 37,200
Deaths: 1,630See the online booklet What You Need To Know About™ Thyroid Cancer to learn about thyroid cancer symptoms, diagnosis, treatment, and questions to ask the doctor.
TreatmentInformation about treatment, including surgery, chemotherapy, radiation therapy, immunotherapy, and vaccine therapy
Thyroid Cancer Treatment[patient] [health professional]Clinical Trials to Treat Thyroid CancerRadiation Therapy for Cancer: Q & ALasers in Cancer Treatment: Q & AMetastatic Cancer: Q&A
Prevention, Genetics, CausesInformation related to prevention, genetics, risk factors
Genetics of Medullary Thyroid Cancer[health professional]Understanding Gene TestingSearch: Cancer Genetics Services DirectoryCancer Genetics Overview[health professional]Radioactive I-131 from Fallout
Screening and TestingInformation about methods of cancer detection including new imaging technologies, tumor markers, and biopsy procedures
Interpreting Laboratory Test Results

Clinical TrialsInformation and current news about clinical trials and trial-related data
Thyroid Cancer Trial ResultsClinical Trials for Thyroid CancerHow to Find a Cancer Treatment Trial
Cancer LiteratureResources available from the PubMed database
Cancer Topic Searches: Endocrine CancersCancer Literature in PubMed
Research and Related InformationIncludes NCI-supported research, funding opportunities, and special reports
NCI Funded Research Portfolio
StatisticsInformation related to cancer incidence, mortality, and survival
Cancer Stat Fact Sheet: Cancer of the ThyroidFinding Cancer StatisticsUnderstanding Cancer Statistics

Bladder Cancer

Bladder Cancer

Definition of bladder cancer: Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.Estimated new cases and deaths from bladder cancer in the United States in 2009:
New cases: 70,980
Deaths: 14,330See the online booklet What You Need To Know About™ Bladder Cancer to learn about bladder cancer symptoms, diagnosis, treatment, and questions to ask the doctor.
TreatmentInformation about treatment, including surgery, chemotherapy, radiation therapy, immunotherapy, and vaccine therapy
Bladder Cancer Treatment[patient] [health professional]Clinical Trials to Treat Bladder CancerBiological Therapies for Cancer: Q & ALasers in Cancer Treatment: Q & AMetastatic Cancer: Q&ABiological Therapy
Prevention, Genetics, CausesInformation related to prevention, genetics, risk factors
Smoking Home PageArtificial Sweeteners and CancerMore...
Screening and TestingInformation about methods of cancer detection including new imaging technologies, tumor markers, and biopsy procedures
Bladder and Other Urothelial Cancers Screening[patient] [health professional]Validation Study of Test to Detect Bladder CancerInterpreting Laboratory Test ResultsTumor Markers: Q&A

Clinical TrialsInformation and current news about clinical trials and trial-related data
Bladder Cancer Trial ResultsClinical Trials for Bladder CancerHow to Find a Cancer Treatment Trial
Cancer LiteratureResources available from the PubMed database
Cancer Topic Searches: Urinary Tract CancersCancer Literature in PubMed
Research and Related InformationIncludes NCI-supported research, funding opportunities, and special reports
NCI Funded Research PortfolioGenitourinary (GU) SPOREs
StatisticsInformation related to cancer incidence, mortality, and survival
Cancer Stat Fact Sheet: Cancer of the Urinary BladderSnapshot of Bladder CancerFinding Cancer StatisticsUnderstanding Cancer Statistics

Laryngeal Cancer

Steve Wiemeyer tells his story of surviving laryngeal cancer with the help of the caregivers of Methodist Estabrook Cancer Center.





Laryngeal cancer may also be called cancer of the larynx or laryngeal carcinoma. Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium. Cancer can develop in any part of the larynx, but the cure rate is affected by the location of the tumor. For the purposes of tumour staging, the larynx is divided into three anatomical regions: the glottis (true vocal cords, anterior and posterior commissures); the supraglottis (epiglottis, arytenoids and aryepiglottic folds, and false cords); and the subglottis.

Most laryngeal cancers originate in the glottis. Supraglottic cancers are less common, and subglottic tumours are least frequent.

Laryngeal cancer may spread by direct extension to adjacent structures, by metastasis to regional cervical lymph nodes, or more distantly, through the blood stream. Distant metastates to the lung are most common.
Incidence
Two in 20,000 (12,500 new cases per year) in USA.[3] The American Cancer Society estimates that 9,510 men and women (7,700 men and 1,810 women) will be diagnosed with and 3,740 men and women will die of laryngeal cancer in 2006.
Laryngeal cancer is listed as a "rare disease" by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that laryngeal cancer affects fewer than 200,000 people in the U.S.[4]
Each year, about 2,200 people in the U.K. are diagnosed with laryngeal cancer.
Treatment
Specific treatment depends on the location, type, and stage of the tumour. Treatment may involve surgery, radiotherapy, or chemotherapy, alone or in combination. This is a specialised area which requires the coordinated expertise of ear, nose and throat (ENT) surgeons (otolaryngologists) and oncologists.

Lung Cancer

More than 85 percent of lung cancer cases are smoking-related.



Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3 million deaths worldwide annually, as of 2004.[1] The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss.[2]
The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important, because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.[3] The most common cause of lung cancer is long-term exposure to tobacco smoke.[4] The occurrence of lung cancer in nonsmokers, who account for as many as 15% of cases,[5] is often attributed to a combination of genetic factors,[6][7] radon gas,[8] asbestos,[9] and air pollution,[10][11][12] including secondhand smoke.[13][14]
Lung cancer may be seen on chest radiograph and computed tomography (CT scan). The diagnosis is confirmed with a biopsy. This is usually performed by bronchoscopy or CT-guided biopsy. Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient's performance status. Possible treatments include surgery, chemotherapy, and radiotherapy. Depending on the stage and treatment, the five-year survival
Signs and symptoms .
Symptoms that suggest lung cancer include:dyspnea (shortness of breath)
hemoptysis (coughing up blood)
chronic coughing or change in regular coughing pattern
wheezing
chest pain or pain in the abdomen
cachexia (weight loss), fatigue, and loss of appetite
dysphonia (hoarse voice)
clubbing of the fingernails (uncommon)
dysphagia (difficulty swallowing).
If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia. Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.
Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease. In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia, or syndrome of inappropriate antidiuretic hormone (SIADH). Tumors in the top (apex) of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome) as well as muscle weakness in the hands due to invasion of the brachial plexus.
Many of the symptoms of lung cancer (bone pain, fever, and weight loss) are nonspecific; in the elderly, these may be attributed to comorbid illness. In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the brain, bone, adrenal glands, contralateral (opposite) lung, liver, pericardium, and kidneys. About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest radiograph.

Treatment

Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread, and the patient's performance status. Common treatments include surgery, chemotherapy, and radiation therapy.

Breast Cancer

Breast cancer refers to cancers originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas. There are many different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup; survival varies greatly depending on those factors.[1] Computerized models are available to predict survival.[2] With best treatment and dependent on staging, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation.
Worldwide, breast cancer comprises 10.4% of all cancer incidence among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death.[3] In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).[4] Breast cancer is about 100 times more common in women than in men, but survival rates are equal in both sexes.[5][6][7]
Some breast cancers require the hormones estrogen and progesterone to grow, and have receptors for those hormones. After surgery those cancers are treated with drugs that interfere with those hormones, usually tamoxifen, and with drugs that shut off the production of estrogen in the ovaries or elsewhere; this may damage the ovaries and end fertility. After surgery, low-risk, hormone-sensitive breast cancers may be treated with hormone therapy and radiation alone. Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are higher-risk, and are treated more aggressively. One standard regimen, popular in the U.S., is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. An equivalent treatment, popular in Europe, is cyclophosphamide, methotrexate, and fluorouracil (CMF).[8] Monoclonal antibodies, such as trastuzumab (Herceptin), are used for cancer cells that have the HER2 mutation. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years.
Signs and symptoms.

The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump.[17] By the time a breast lump is noticeable, it has probably been growing for years. The earliest breast cancers are detected by a mammogram.[18] Lumps found in lymph nodes located in the armpits[17] can also indicate breast cancer.
Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.[17][18][19]
When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.[17]
Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.[20]
Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.[21] Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.[22]
Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.
Treatment

Breast cancer is treated first with surgery, and then with drugs, radiation, or both. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence.Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy with or without radiation.[55] Although the aggressive HER2+ cancers should also be treated with the trastuzumab (Herceptin) regime.[56]Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), radiation (sometimes) and chemotherapy (plus trastuzumab for HER2+ cancers).Stage 4, metastatic cancer, (ie spread to distant sites) is not curable and is managed by various combinations of all treatments from surgery, radiation, chemotherapy and targeted therapies. These treatments increase the median survival time of stage 4 breast cancer by about 6 months.

Mesothelioma

Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is usually caused by exposure to asbestos.[1]
Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,[2] the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.[3] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers.[4] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Signs and symptoms

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
Chest wall pain
Pleural effusion, or fluid surrounding the lung
Shortness of breath
Fatigue or anemia
Wheezing, hoarseness, or cough
Blood in the sputum (fluid) coughed up (hemoptysis)
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
Abdominal pain
Ascites, or an abnormal buildup of fluid in the abdomen
A mass in the abdomen
Problems with bowel function
Weight loss
In severe cases of the disease, the following signs and symptoms may be present:
Blood clots in the veins, which may cause thrombophlebitis
Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
Jaundice, or yellowing of the eyes and skin
Low blood sugar level
Pleural effusion
Pulmonary emboli, or blood clots in the arteries of the lungs
Severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

Treatment

The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.