Dreams Episode 1

A grandmother with a breast cancer diagnosis and a teenager facing osteosarcoma share their hopes and dreams for a brighter future while undergoing cancer treatment.

Michele

Michele Schindler
Breast Cancer with Brain Metastases

"I’ve discovered that I am more of a fighter than I ever thought was possible. And I want to be here as long as I can."

Danni

Danni M. Pierini
Osteosarcoma

"I got to keep all of my muscle. Everything is the same—it feels the same, it feels like bone, except it’s metal."

Ask the Experts

Roswell Park Cancer Institute’s medical experts featured in the Cancer Can’t Win documentary “Dreams” answer questions about the types of cancer and treatments that Danni and Michelle experienced.

What does it mean to have a multidisciplinary team approach to treatment?

 
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A multidisciplinary team approach to treatment means that a team of physicians meets about the care a patient will receive here at Roswell Park. We meet with pathologists, surgeons, radiation oncologists and medical oncologists to determine the best possible course for each patient that is treated.

Tracey O’Connor, MD

To which body areas does breast cancer usually metastasize?

 
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Breast cancer can metastasize to many areas of the body, but most commonly it will spread to areas like bone, liver, lung, brain, as well as skin and soft tissues. By far, the most common place we see metastatic disease is involving the bone.

Tracey O’Connor, MD

What treatments are available for metastatic breast cancer?

 
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Many patients with metastatic breast cancer do receive chemotherapy. However, a lot of women are great candidates for anti-estrogen therapy, which is less toxic. In addition, as we've gotten smarter and better at treating women with metastatic breast cancer, there have been developments of certain therapies like antibody therapy such as Herceptin, the new agent Pertuzumab, as well as very targeted agents that we're now using in everyday care of our patients.

Tracey O’Connor, MD

If breast cancer spreads to the brain, do I need to see the brain cancer team?

 
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I certainly think so. If a breast cancer spreads to the brain, I immediately consult with my colleagues in neurosurgery and radiation oncology. We, together, discuss the patient and the best course of action for her.

Tracey O’Connor, MD

For patients with metastatic disease to the brain, we have a variety of treatment options. Those include external beam radiation, Gamma Knife radiosurgery, open craniotomy, and laser interstitial thermal therapy. And for each individual patient, I would discuss that case with Dr. O'Connor or the patient's medical oncologist or radiation oncologist, and determine what treatment recommendations to bring forward to the patient.

Andrew J. Fabiano, MD

I heard some people remain awake during brain surgery. Is this true?

 
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In rare instances, we will perform what is called an awake craniotomy. In those cases, at some point during the procedure, the patient will be awoken and different areas of their brain are tested in order to map out function. This way, we can identify certain areas of the brain, such as those responsible for speech function or motor function so they can be preserved during surgery. With advances in non-invasive imaging, such as functional MRIs, often times this type of cortical localization can be performed before surgery, making an awake craniotomy unnecessary. But it still is a procedure in our armamentarium that can be used to treat tumors to the brain.

Andrew Fabiano, MD

Is there really surgery without a scalpel?

 
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There are certain types of surgical procedures that don't actually involve cutting. One of those, Gamma Knife radiosurgery, involves a focused dose of radiation given to a lesion in the brain. In that type of procedure, there is no scalpel or incision.

Andrew Fabiano, MD

What causes radiation necrosis and how can it be treated?

 
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Radiation necrosis can occur as a side effect of a radiation treatment to the brain. In some instances, it does not need to be treated and it will resolve on its own. In other instances, if it's causing symptoms for a patient, it can be treated with medications. If those medications fail, it can then be treated with a surgical procedure. Laser interstitial thermal therapy, which is a minimally invasive surgical procedure, or an open surgical procedure such as a craniotomy, can both be used to treat radiation necrosis in those cases.

Andrew Fabiano, MD

What is the Visualase procedure Michele underwent?

 
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Visualase is a brand name for a type of probe that's used for treatment in the brain. The type of treatment is laser interstitial thermal therapy. It's a minimally invasive procedure, with an incision about 2-3 mm in size, and a very small probe is inserted into a lesion in the brain. Once the probe is inserted into the brain, the patient is monitored while the probe is heated. This heat causes light deposition into the tissue and destruction of the lesion. In this way, the tumor or other lesion is treated. This has become a great option for patients who want to have a minimally invasive treatment rather than an open craniotomy for tumors in the brain.

Andrew Fabiano, MD

Is the radioactive tracer used for a bone scan dangerous to a patient or a patient's family?

 
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The answer is no. The dosing that is used of radioactive tracer in bone scanning is very low. It is sufficient to show areas of abnormality within the bone, but should cause no harm to the patient or to the patient's family.

Martin Brecher, MD

After treatment ends, do pediatric patients come back to Roswell Park for check-ups?

 
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Yes, they do. We see our patients on a regular basis after they've completed therapy. We usually see them fairly frequently when therapy is first completed to make sure that the patient is remaining well. Even long-term after therapy, we see our patients periodically to check their health status overall, in terms of the illness for which they were treated, and also to watch for any potential long-term side effects of either the illness itself or the treatments that we've administered.

Martin Brecher, MD

Do pediatric cancer survivors have side effects from treatment when they become young adults? Will there be issues with fertility or a risk for other cancers?

 
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Some of the survivors may indeed have side effects from prior treatment. Fortunately, we are doing much better in our ability to cure children with cancer. And, in fact, the great majority of our patients now do survive their disease. But treatments can be difficult and can take a toll. Surgery, radiation and chemotherapy all have the potential for long-term side effects. We have a clinic at Roswell Park that is devoted strictly to the survivors of childhood cancer for this very purpose -- to evaluate them for possible long-term side effects, to learn what these might be and also so we can better alter our therapies in the future to try to prevent these side effects. There are some treatments that may cause fertility problems in the future and we actively seek fertility preservation options, particularly for adolescent patients who may be undergoing cancer therapy. There are some treatments that themselves can increase the risk for cancer later in the life and, this too, is a reason why patients should be observed periodically for any late effects of treatment and why we continue to do research to refine our therapies, to less the long-term side effects of those treatments.

Martin Brecher, MD

Do pediatric cancer patients have different doctors at Roswell Park and Women and Children’s Hospital?

 
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They do not. It is the same group of pediatric cancer specialists who take care of children both at Roswell Park and at the Women and Children's Hospital of Buffalo. Some of the doctors within our team specialize, in particular, in pediatric cancers. We have a doctor who primarily sees those children who have tumors of the nervous system or brain tumors. We have pediatric transplant specialists. All of us are specialists in general pediatric oncology and see the patients at each of the centers. Roswell Park Cancer Institute and the Children's Hospital of Buffalo have had a collaborative relationship in treating pediatric cancer patients for a number of years. Each center brings essential expertise to this program, cancer expertise here at the cancer center at Roswell Park, as well as all the pediatric expertise that the freestanding Children's Hospital has to offer. The same doctors treating these children work at both centers. We treat the younger children primarily at the Children's Hospital. Those patients from school-age on up get most of their therapy at Roswell Park. With the new Children's Hospital being planned for right across the street on the Medical Campus, we anticipate a tighter collaboration still in the years to come.

Martin Brecher, MD