UCSD Shares Findings on Cancer : Its Research Benefits Doctors, Patients in a Broad Area
Dr. Mark Green was explaining the importance of new research at the UC San Diego Cancer Center for stemming ovarian cancer when he glanced at his watch, remembered an errand and turned to his phone to make a quick call.
“Did she come in today for her blood counts?” Green, the center’s newly appointed director, asked his secretary about one of his patients. “Good. I’ll check on it soon,” he said, returning to his conversation about the worldwide reputation of the facility’s laboratories.
Green’s concern with the patient’s appointment illustrates the center’s emphasis both on scientific research into the mysteries of cancer and application of the results quickly to patients, a role unique in San Diego.
The center ties together some of the nation’s top cancer research with one of the nation’s most extensive clinical programs, where patients throughout the region often can benefit in short order from ongoing work in laboratories. The center ranks among the foremost facilities involved with advanced experimentation for the National Cancer Institute at the same time it disseminates the latest in treatment techniques directly to physicians as far north as Santa Barbara and east to Las Vegas.
“There’s a critical mass of people at work here,” said Green, who has directed the center’s clinical cancer programs since 1982. “We’ve got so many multiple programs, with research in molecular biology both here and on the UCSD (La Jolla) campus, with a tremendous number of clinical trials, with our cancer control outreach program (to private physicians). We are a hotbed of high quality research that puts its science to work on the clinical level: we are a tremendous academic and educational resource to the community.”
Green’s appointment to the director’s post was announced Friday.
The so-called war against cancer involves a multitude of efforts in a wide variety of areas, all stemming from the particular dread that the disease connotes to most Americans. While heart disease annually accounts for more deaths than any other disease, cancer retains a greater mystique, in part because of the pain and lingering death associated with it, Green said.
“There’s something particularly gripping about cancer that strikes a fear and great concern,” he said. “And that’s not necessarily inappropriate.”
Green’s fascination with the complexities of cancer go back to his third year at Harvard Medical School, where he assisted in a grueling, 12-hour operation--the minute details of which he can recall clearly today--to try and remove a large tumor from the liver of a spunky 21-year-old woman. Following surgery, the woman showed steady improvement for five or six days, when numerous complications suddenly developed and she soon died.
“That had a big impact on me,” Green said, adding that the path to his eventual specialty became clearer after post-doctoral work with well-known clinical oncologists in Boston and research at the National Cancer Institute.
Despite the seriousness of many cancers, Green stresses that most are curable if recognized early and that some can be prevented by following certain life styles.
Almost all lung cancers stem from tobacco smoking and Green cited American Cancer Society statistics that show the number of cases among men has begun declining as a result of sustained anti-smoking campaigns during the past decade. In contrast, active cases among women continue to climb as the consequences of heavier smoking among women.
Early detection, such as with cancers of the breast, the cervix and testes, gives doctors an excellent chance at defeating the disease before it spreads to other parts of the body, and defeating it with less physiological cost due to the pain and discomfort from radiation and chemicals used in treatments.
Whether early detection or late, the basic strategies for conquering a cancer remain: surgery, radiation and chemotherapy (powerful chemical drugs). And the center’s expertise lies in melding together research on those strategies with treatments for individual patients.
Green sketched that expertise in two areas: tracing of tumors and more effective drug treatment.
UCSD researchers are attempting in various ways to track the spread of tumors--the cancerous mass of cells that signals the illness--when they are too small to measure through touch, or X-rays, or find through usual means of detection. Doctors are often unsure, following surgery to remove a tumor, whether they have eliminated the mass entirely or whether some cells have escaped into the bloodstream to reappear eventually as tumors in other body organs or tissue.
For example, Green noted that the threshold size for detecting the presence of a tumor is at least a billion cells. “Below that, you just don’t know if you’ve eliminated it (during treatment) to zero or just to a level too small to measure,” Green said. Such is the unanswered question for President Reagan following surgery for his colon cancer last summer.
UCSD scientists are working with monoclonal antibodies, which are individually-engineered antibodies that can be targeted to recognize a characteristic of a tumor cell and attach to it. By tagging the antibody with a radioactive substance, it will show up attached to a tumor cell during an X-ray scan to indicate the presence of tumor.
Another promising path involves measuring a patient’s blood for a unique marker--a molecule--that some tumors are known to manufacture. If detected in the blood, it would indicate that the tumor is still present in some form.
In research to improve treatment, Green cited what he calls “bridging research” in the area of ovarian cancer. Existing knowledge of the drugs and methodology used for fighting ovarian cancer has been used by UCSD researchers to design a more potent treatment with fewer side effects. By means of an implant into a woman’s abdomen through which drugs are injected directly, the cancer can be bathed with chemicals far more powerful than those that could be used if injected first into the bloodstream.
“This took a lot of studying, revising--the science part,” Green said. “And then there was the direct application to patients (in a clinical trial), a rapid transfer of technology even though it is still experimental, and not the final answer.”
The cancer center has developed a regional network of private doctors who receive information on the latest research protocols. The doctors range from Santa Barbara to Las Vegas and have been approved for participation by the center. Through their work with the clinical research program, the doctors can use both state-of-the-art and experimental therapies with their own patients who are not part of the UCSD’s own clinic.
“We do our best to extend our clinical programs as much as possible,” Green said. A program begun this month with the support of the National Cancer Institute offers a second opinion from UCSD experts on diagnosis or treatment plans to any cancer patient or physician who requests it.
Green also emphasized the importance of not losing sight of cancer patients as individuals--”man’s humanity to man”--and understanding the times when the reality of dying, or the limits of therapy, must be acknowledged. “Treatment of cancer is the treatment of a person. And even when treatment is palliative, not curative, medical management continues with pain management, nutrition management, ways to maintain or improve the quality of life as well as longevity.
“If a cure is not available, that does not mean there is nothing to do.”
