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University of Nebraska Medical Center

987430 Nebraska Medical Center
Kiewit Tower, 3rd Floor
Omaha, Nebraska 68198-7430

1-402-559-3656 or 1-402-559-3090

Cancer Care

You or some one you know has been diagnosed with Cancer. You are searching for answers to the many questions running through your head. For many it is a very frightening time. There are no insignificant questions. The International Healthcare Services department at the University of Nebraska Medical Center is here to assist you in any way we can. We hope this website will be helpful to you as you search for more answers. Please contact us at your convenience if you need additional assistance.

Cancer Overview – Let’s start with the basics…

What is cancer?
Cancer is an abnormal growth of cells. Cancer cells rapidly reproduce despite restriction of space, nutrients shared by other cells, or signals sent from the body to stop reproduction. Cancer cells are often shaped differently from healthy cells, they do not function properly, and they can spread to many areas of the body. Tumors, abnormal growth of tissue, are clusters of cells that are capable of growing and dividing uncontrollably; their growth is not regulated.
Oncology is the branch of medicine concerned with the diagnosis and treatment of cancer.

What do the terms benign and malignant mean?
Tumors can be benign (non-cancerous) or malignant (cancerous). Benign tumors tend to grow slowly and do not spread. Malignant tumors can grow rapidly, invade and destroy nearby normal tissues, and spread throughout the body.

What do the terms "locally invasive" and "metastatic" mean?
Cancer is malignant because it can be "locally invasive" and "metastatic":

* locally invasive - the tumor can invade the tissues surrounding it by sending out "fingers" of cancerous cells into the normal tissue.

* metastatic - the tumor can send cells into other tissues in the body, which may be distant from the original tumor.

What are primary tumors?
The original tumor is called the "primary tumor." Its cells, which travel through the body, can begin the formation of new tumors in other organs. These new tumors are referred to as "secondary tumors." The cancerous cells travel through the blood (circulatory system) or lymphatic system to form secondary tumors. The lymphatic system is a series of small vessels that collect waste from cells, carrying it into larger vessels, and finally into lymph nodes. Lymph fluid eventually drains into the bloodstream.

How is each cancer type named?
Cancer is named after the part of the body where it originated. When cancer spreads, it keeps this same name. For example, if kidney cancer spreads to the lungs, it is still kidney cancer, not lung cancer. (The lung cancer would be an example of a secondary tumor.) Staging is the process of determining whether cancer has spread and, if so, how far. There is more than one system used for staging cancer, and the definition of each stage will depend on the type of cancer.

What are the different types of cancer?
Cancer is not just one disease but rather a group of diseases, all of which cause cells in the body to change and grow out of control. Cancers are classified either according to the kind of fluid or tissue from which they originate, or according to the location in the body where they first developed. In addition, some cancers are of mixed types. The following five broad categories indicate the tissue and blood classifications of cancer:

* carcinoma
A carcinoma is a cancer found in body tissue known as epithelial tissue that covers or lines surfaces of organs, glands, or body structures. For example, a cancer of the lining of the stomach is called a carcinoma. Many carcinomas affect organs or glands that are involved with secretion, such as breasts that produce milk. Carcinomas account for 80 percent to 90 percent of all cancer cases.

* sarcoma
A sarcoma is a malignant tumor growing from connective tissues, such as cartilage, fat, muscle, tendons, and bones. The most common sarcoma, a tumor on the bone, usually occurs in young adults. Examples of sarcoma include osteosarcoma (bone) and chondrosarcoma (cartilage).

* lymphoma
Lymphoma refers to a cancer that originates in the nodes or glands of the lymphatic system, whose job it is to produce white blood cells and clean body fluids, or in organs such as the brain and breast. Lymphomas are classified into two categories: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

* leukemia
Leukemia, also known as blood cancer, is a cancer of the bone marrow that keeps the marrow from producing normal red and white blood cells and platelets. White blood cells are needed to resist infection. Red blood cells are needed to prevent anemia. Platelets keep the body from easily bruising and bleeding. Examples of leukemia include acute myelogenous leukemia, chronic myelogenous leukemia, acute Lymphocytic leukemia, and chronic lymphocytic leukemia. The terms myelogenous and Lymphocytic indicate the type of cells that are involved.

* myeloma
Myeloma grows in the plasma cells of bone marrow. In some cases, the myeloma cells collect in one bone and form a single tumor, called a plasmacytoma. However, in other cases, the myeloma cells collect in many bones, forming many bone tumors. This is called multiple myeloma.


What causes cancer?
There is no one single cause for cancer. Scientists believe that it is the interaction of many factors together that produces cancer. The factors involved may be genetic, environmental, or constitutional characteristics of the individual.
Diagnosis, treatment, and prognosis for childhood cancers are different than for adult cancers. The main differences are the survival rate and the cause of the cancer. The survival rate for childhood cancer is about 75 percent, while in adult cancers the survival rate is 60 percent. This difference is thought to be because childhood cancer is more responsive to therapy, and a child can tolerate more aggressive therapy.


Childhood cancers often occur or begin in the stem cells, which are simple cells capable of producing other types of specialized cells that the body needs. A sporadic (occurs by chance) cell change or mutation is usually what causes childhood cancer. In adults, the type of cell that becomes cancerous is usually an "epithelial" cell, which is one of the cells that line the body cavity, including the surfaces of organs, glands, or body structures, and cover the body surface. Cancer in adults usually occurs from environmental exposures to these cells over time. Adult cancers are sometimes referred to as "acquired" for this reason.


What are the risk factors for cancer?
As mentioned, some cancers, particularly in adults, have been associated with certain risk factors. A risk factor is anything that may increase a person's chance of developing a disease. A risk factor does not necessarily cause the disease, but it may make the body less resistant to it. Persons who have an increased risk of developing cancer can help to protect themselves by scheduling regular screenings and check-ups with their physician and avoiding certain risk factors. Cancer treatment has been proven to be more effective when the cancer is detected early. The following risk factors and mechanisms have been proposed as contributing to the development of cancer:



* lifestyle factors
Lifestyle and environmental factors such as smoking, high-fat diet, exposure to ultraviolet (UV radiation from the sun), or exposure to chemicals (cancer-causing substances) in the work place over long periods of time may be risk factors for some adult cancers. Most children with cancer, however, are too young to have been exposed to these lifestyle factors for any extended time.

* genetic factors
Family history, inheritance, and genetics may play an important role in some adult and childhood cancers. It is possible for cancer of varying forms to be present more than once in a family. Some gene alterations are inherited. However, this does not necessary mean that the person will develop cancer. It indicates that the chance of developing cancer increases. It is unknown in these circumstances if the disease is caused by a genetic mutation, other factors, or simply coincidence.

* virus exposure
Exposures to certain viruses, such as the human papillomavirus (HPV) and human immunodeficiency virus (HIV; the virus that causes acquired immune deficiency, or AIDS), and the herpes virus have been linked to an increased risk of developing certain types of cancers. Possibly, the virus alters a cell in some way. That cell then reproduces an altered cell and, eventually, these alterations become a cancer cell that reproduces more cancer cells. Cancer is not contagious and a person cannot contract cancer from another person who has the disease.

* environmental exposures
Environmental exposures such as pesticides, fertilizers, and power lines have been researched for a direct link to childhood cancers. There has been evidence of cancer occurring among non-related children in certain neighborhoods and/or cities. Whether prenatal or infant exposure to these agents causes cancer, or whether it is a coincidence, is unknown.


How do genes affect cancer growth?
The discovery of certain types of genes that contribute to cancer has been an extremely important development for cancer research. Over 90 percent of cancers are observed to have some type of genetic alteration. A small percentage (5 percent to 10 percent) of these alterations are inherited, while the rest are sporadic, which means they occur by chance or occur from environmental exposures (usually over many years). There are three main types of genes that can affect cell growth, and are altered (mutated) in certain types of cancers, including the following:



* oncogenes
These genes regulate the normal growth of cells. Scientists commonly describe oncogenes as similar to a cancer "switch" that most people have in their bodies. What "flips the switch" to make these oncogenes suddenly become unable to control the normal growth of cells and allowing abnormal cancer cells to begin to grow, is unknown.

* tumor suppressor genes
These genes are able to recognize abnormal growth and reproduction of damaged cells, or cancer cells, and can interrupt their reproduction until the defect is corrected. If the tumor suppressor genes are mutated, however, and they do not function properly, tumor growth may occur.

* mismatch-repair genes
These genes help recognize errors when DNA is copied to make a new cell. If the DNA does not "match" perfectly, these genes repair the mismatch and correct the error. If these genes are not working properly, however, errors in DNA can be transmitted to new cells, causing them to be damaged.

Usually the number of cells in any of our body tissues is tightly controlled so that new cells are made for normal growth and development, as well as to replace dying cells. Ultimately, cancer is a loss of this balance due to genetic alterations that "tip the balance" in favor of excessive cell growth.



The Nebraska Medical Center is home to one of the most reputable and well-known stem cell and solid organ transplant programs in the country. Through our dedicated efforts in education, research and clinical medicine, we have helped shape the field of cancer care and transplantation.



* Our state-of-the-art transplant programs provide comprehensive treatment for diseases of the liver, small intestine, kidney, pancreas, heart and lungs. The world-class reputation of our programs and physicians attracts patients from across the country and around the world.

* We’re proud to offer one of the most respected cancer care departments in the country. People from across the United States and around the world come to The Nebraska Medical Center in Omaha, to receive innovative treatment from some of the top cancer specialists in the world.

* With the search for new and innovative treatments, our primary focus is people. Our healthcare providers and all of our employees put our patients and their families first.

* Each year, patients are learning that cancer is not the death sentence it once was. With recent advances in cancer research, treatment innovations and early detection, we are getting closer to beating this disease. Success in the fight against cancer depends on a complete understanding of this complex disease. UNMC is committed to developing innovative treatments for patients in a caring and compassionate manner.

* UNMC is a leader in the fight against cancer. For more than 40 years UNMC has been on the cutting-edge of clinical and basic research by offering the latest in state-of-the-art patient care and educating the cancer healthcare professionals and researches of tomorrow.

* Over the years, the UNMC’s Bone Marrow Transplantation Program has been ranked as one of the busiest adult and pediatric bone marrow transplantation programs in USA. The program, which was established in 1983, by Dr. Anne Kessinger has been recognized internationally for pioneering autologous transplantation for lymphoma, using peripheral stem cells as an alternative rescue product and conducting groundbreaking studies on various growth factors while performing transplants in alternate settings other than traditional isolation inpatient hospital units.

* UNMC is nationally and internationally recognized for its excellence in patient care. At UNMC, the goal is not to simply treat the disease, but to provide the latest advancements in a caring a compassionate environment.

* With the search for new and innovative treatments UNMC’s primary focus is patients. Our healthcare providers and all of our employees put our patients and their families first — treating them with warmth and compassion — just like we’d want our own family members treated.

* UNMC’s 164 Cancer Center members, including 61 practicing physicians, are involved in basic, clinical and population-based research and are awarded millions of dollars in peer-reviewed research grants annually.

* UNMC is the only Center in the United States with two physicians on the National Comprehensive Cancer Network’s (NCCN) board of directors and the only National Cancer Center (NCI) designated cancer center in this region of the country. UNMC has made the list of America’s Best Hospitals. The ratings are issued by the national magazine, U.S. News & World Report, in its annual ranking of hospitals around the country. Hospitals are rated by such factors as reputation, mortality and nurse-to-bed ratios.

* Patients receiving care at UNMC get the best of both worlds – the clinical expertise of our academic and private practice physicians and access to cutting edge procedures and technology through the work of researchers at the University of Nebraska Medical Center.

* Novalis® Shaped Beam Surgery. The Nebraska Medical Center, known in the region for its medical breakthroughs, has brought new technology to physicians in our region for more precise Stereotactic radiosurgery and radiotherapy. Novalis® is a state-of-the-art treatment device where the radiation beams are shaped to match the exact contour of the tumor or lesion so that even irregularly shaped tumors or lesions can receive doses of radiation while avoiding damage to critical, adjacent structure.

* Innovative treatments: We were the first hospital in Nebraska and one of only a few in the Midwest to offer patients Intensity Modulated Therapy (IMRT) to improve radiation targeting of tumors without damaging nearby healthy tissues and organs.

* We are also one of only a few hospitals in the United States offering ultrasound-based radiation for the treatment of prostate cancer. B-Mode Acquisition and Targeting (BAT) allows higher doses of radiation to be used on prostate tumors, thereby increasing the cure rate by up to 30 percent.

Leukemia


Leukemias are malignancies of the bone marrow. There are several different types of leukemia. Optimal treatment for leukemia depends on the exact type of leukemia as well as other factors such as patient age, the presence of DNA (cytogenetic) abnormalities within the leukemia cells, and previous treatment. Making treatment recommendations for patients with leukemia can be quite complex and is best done by physicians with special expertise in this area, such as the physicians of the Leukemia Team at the University of Nebraska Medical Center (UNMC).



The Leukemia Team physicians dedicate their practice to the treatment of leukemia only. Through the UNMC Leukemia Team, patients have access to the latest research findings and innovative clinical trials. Diseases that are commonly treated by the Leukemia Team at UNMC include Acute Myelogenous Leukemia (AML), Acute Lymphoblastic Leukemia (ALL), Chronic Myelogenous Leukemia (CML), and Myelodysplastic Syndrome (MDS). In addition, the UNMC Leukemia Team commonly treats patients with bone marrow failure problems, such as Aplastic Anemia, Large Granular Lymphocyte Leukemia and Pure Red Cell Aplasia.


The UNMC Leukemia Team provides consultations and second opinions as well as state-of-the-art treatment. Treatment may be a standard treatment or participation in a clinical research trial. Furthermore, the UNMC Leukemia Team offers a full spectrum of bone marrow and stem cell transplantation options, including mini transplants, unrelated donor transplants and cord blood transplants. The UNMC Leukemia Team works together closely with your referring oncologist or primary care provider to customize your treatment according to your needs and preferences.


Clinical Research

The UNMC Leukemia Team participates in two large research groups, comprised of some of the major leukemia and transplant centers in the United States . The Cancer and Leukemia Group B (CALGB) offers clinical trials for patients with leukemia and MDS. The Bone Marrow Transplant Clinical Trials Network (BMT CTN) offers clinical trials for patients who will undergo a bone marrow or stem cell transplantation. In addition, the Leukemia Team offers participation in a number of trials that are performed in cooperation with a pharmaceutical company as well as trials that are initiated by UNMC investigators.

Following is a list of available trials. If you have a question about any of these trials please contact us at (402) 559-3090

IRB# 026-06

Phase 2 Open-Label Study of Amonafide L-Malate in Combination with Cytarabine in Subjects with Secondary Acute Myeloid Leukemia (Clinical Protocol 0001A3-200-GL)

IRB#128-05

Treatment Plan for Farnesyltransferase Inhibitor Zarnestra® (tipifarnib, R115777) in Elderly Patients with Previously Untreated Poor-Risk Acute Myeloid Leukemia (AML)

IRB# 185-05

Treatment Plan For Farnesyl Transferase Inhibitor Zarnestra® (Tipifarnib, R115777) In Patients With (High Risk) Myelodysplastic Syndrome

IRB# 265-04

An Open Label Extended Use Study of Oral CEP 701 in Patients With Hematologic and Non Hematologic Malignancies Who Have Completed a Clinical Study of CEP 701

IRB# 289-04

A Phase II, Multi-Center, Open-Label, Repeat-Dose Study of Forodesine Hydrochloride Infusion in Patients with Advanced T-Cell Leukemia with an Option of Long Term Forodesine Hydrochloride Use (Protocol ID BCX-1777-T-04-201)

IRB# 330-04

A Phase II Study Of An Oral VEGF Receptor Tyrosine Kinase Inhibitor (PTK787/ZK 222584) (IND #66370, NSC #719335) in Myelodysplastic Syndrome (MDS) (CALGB 10105-03)

IRB# 355-03

A Multi-Center Phase III Double-Blinded Clinical Trial to Evaluate the Efficacy of Mycophenolate Mofetil for the Treatment of Newly Diagnosed Chronic Graft-versus-host Disease

IRB# 376-03

A Randomized, Open Label Study of Oral CEP-701 Administered in Sequence with Standard Chemotherapy to Patients with Relapsed Acute Myeloid Leukemia (AML) Expressing FLT-3 Activating Mutations

IRB# 389-00

Allogeneic Peripheral Blood Stem Cell Transplantation with a Minimally Myelosuppressive Regimen of Pentostatin and Low-Dose Total-Body Irradiation

IRB# 440-05

An open label, safety and tolerability study of deferasirox for treatment of transfusional iron overload in low-risk and INT-1, myelodysplastic patients using serum ferritin monitoring

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