Thursday, April 3, 2014

Diagnosing Lymphoma: Yale Cancer Center Answers

I've been meaning to post this for a while (it's been a crazy couple of months):

Yale's Smilow Cancer Hospital sponsors a weekly show on our local public radio station called "Yale Cancer Center Answers." Each week, the hosts (a pair of oncologists at Yale) bring on a guest from the oncology community (usually affiliated with Yale) to discuss some topic related to cancer. Topics range from advances in research on a specific cancer, to information about nutrition and exercise for cancer patients, to advice for supporting caregivers. It's a nice show. I think I didn't really, fully understand stem cell transplants until I heard them discussed on YCCA.

At one time, I had reason to be in the car regularly on Sunday nights, when the show airs. Lately, not so much, so I forget to listen, or to check their web site, where all of the shows are archived (by date and topic, as a sound file or as a text transcript of what was said).

The most recent one to get me curious was the show on "Research in Hematopathology," with Dr. Samual Katz, who teaches Pathology at the Yale Medical School. It was on the radio on February 9.

Hematopathology is the pathology of blood diseases. That is, looking at blood cells and trying to figure out which disease, cancerous or otherwise, is affecting the patient. It sounds like a pretty fascinating field. According to Dr. Katz, a lot of hematopathology is kind of Old School -- looking at cells under a microscope. This is the way it used be done, up until fairly recently. Follicular Lymphoma is called what it is called because of its appearance under a microscope, just as various "Large" and "small" celled cancers got their names.

So while a quick look under a microscope can start to narrow things down, Dr. Katz says a couple of other tools work better to get at some of the more crucial information that is necessary to guide treatment options: flow cytometry can look into individual cells, and cytogenetics can look at the chromosomes (so he can tell if, for example, there was a 14;18 switch that resulted in Follicular Lymphoma). You can see how the pathologist plays a crucial role in guiding treatment decisions, especially as treatments are becoming more geared toward information at the chromosome level.

And Dr. Katz does address some of those decisions, too. He mentions the "small molecule" treatments that have been in the news lately -- those treatments that can identify and target "touch points" on proteins that disrupt the processes that cancer cells are going through. He discusses BCL-2 in particular, a protein that prevents cells from dying naturally. Treatments are being designed to turn off BCL-2, allowing cancer cells to die off like normal cells. Dr. Katz calls BCL-2 a "guardian," and mentions that there are 4 others: "There are at least five total guardians, there is BCL-2, BCL-XL, BCL-W, those three are targeted by the first of these compounds that have been designed. There is also BFL1 and MCL1 two other guardians which are not touched at all by that." In other words, we're figuring out how to identify these guardians, and then work on getting past them.

Dr. Katz isn't really saying anything new, but he does explain things in a different way than I've heard before. And that's the value of a show like Yale Cancer Center Answers.

The February 9 show is definitely worth 30 minutes of your time (or a little more or less, if you'd prefer to read the transcript). You might want to check out a couple of others, too, from December: "Discussion of Hematological Malignancies Part II," from December 29, and "Clinical Trials for Hematological Malignancies" from December 22. Both feature Dr. Steven Gore, Director of Hematologic Malignancies at Smilow Cancer Hospital.


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