Maryland Oncology Hematology is a guest on Great Day Washington

Dr. Surupa Sen Gupta and Dr. Colette Magnant represented Maryland Oncology Hematology on Great Day Washington to explain the importance of screenings, self-exams, and living a healthy lifestyle for breast cancer awareness month.



Breast Cancer: What you need to know

Cancer is a collective term referring to many different diseases. Simply put, cancer is uncontrolled cell growth, which can lead to tumor formation. A non-invasive tumor (in situ cancer) remains within the tissue where it originated. A malignant tumor (invasive cancer) has potential to spread to neighboring tissues and can form new tumors (metastases) elsewhere in the body. Tumors become dangerous when vital organ function is threatened by the overgrowth of cancer cells1.


Breast cancer is expected to affect 1 in 8 women, making it the most common cancer in women, after skin cancer2. This article discusses: diagnosis, treatment, taking proactive steps, and finding support.



In 2019, the US reported 3.8 million breast cancer patients and survivors.

Although breast cancer incidence is slightly higher in white women, breast cancer-related mortality is almost 50% higher in black women3. More than half of breast cancer patients are diagnosed at an early stage; however, men are slightly more likely to be diagnosed at a later stage compared to women.  As men make up just 1% percent of all breast cancer patients, there is still much to be learned about male breast cancer2,4.



Created for the National Cancer Institute,

Breast cancer can be diagnosed by imaging and histology (pathologic review). Imaging techniques help to visualize cancerous growths. Mammography, the most routine imaging technique used in breast cancer diagnostics, uses x-ray imaging5. There are some limitations, such as mild discomfort, very low radiation exposure, and a false positive rate. Ultrasound is often used to further define mammogram findings.  Additional imaging techniques (such as MRI breasts) are sometimes used; however, these techniques are expensive and still lack specificity (can have false positive findings).

Histology is the study of cells under the microscope6. Healthy cells usually look very uniform, but cancerous cells vary in shape and size. This is one way that they can be identified under the microscope; however, some non-cancerous diseases can cause cells to ‘look suspicious’. In such cases, cells can be stained for breast cancer-specific biomarkers to clarify the disease diagnosis7.

Cancer staging:

Once a diagnosis has been made, doctors must determine how far the cancer has progressed. The American Joint Committee on Cancer (AJCC) classifies tumors using the Tumor Node Metastasis (TNM) model. Specifically, this classification describes: the tumor size, the number of lymph nodes involved, and whether the tumor has metastasized. The details of the TNM model can be summarized using a 5-stage system, where stage 0 is in situ (non-invasive) cancer, and stages 1 through 4 are progressive extents of invasive cancer. Cancer staging helps doctors determine how much risk the cancer poses to a patient, and how it should be treated8–10.



When breast cancer is diagnosed at an early stage, surgery can be performed to remove the cancerous tissue. A lumpectomy is surgery that only removes the tumor, while a mastectomy removes the entire breast. The choice of surgery depends on the breast size, tumor size and location, and other factors. Lymph nodes are often also removed to determine the cancer stage, or if they are already known to contain cancer cells11.


Lumpectomy, accompanied by radiation treatment, has become standard practice, as it reduces the risk of local cancer recurrence in both in situ and invasive cancer12.

Radiotherapy uses high doses of radiation to destroy cancer cells by damaging their genetic material. Cancer cells are limited in their ability to repair damage. This makes them more susceptible to radiation than healthy cells, which are better at repairing damage. Nonetheless, healthy cells and tissues within and surrounding the breast can be damaged by radiation. Accordingly, radiation treatments are carefully planned to spare and protect healthy tissue13,14.


Chemotherapy can be used to shrink tumors prior to surgery (neoadjuvant), to prevent recurrence after surgery (adjuvant), or to treat advanced (metastatic) breast cancer15–17. Chemotherapy is a systemic medication that damages the genetic machinery needed for cell division, making it efficient in eliminating rapidly growing cells (such as cancer cells). Healthy cells with a high growth rate, such as those found in hair follicles and the digestive system, are also affected by chemotherapy, and this leads to the well-known side effects of hair loss and nausea18.


Targeted therapy, often used in combination with chemotherapy, focuses on specific molecules that stimulate growth or survival in cancer cells19. Hormone therapy is used in specific breast cancers where growth is stimulated by the hormones estrogen or progesterone. When cells are prevented from interacting with these hormones, hormone-induced growth is inhibited20. Some therapies are targeted at proteins that are associated with the growth of certain breast cancers. Tumors with high expression of HER2 can be treated with anti-HER2 therapies, which inhibit the function of this protein21. The choice of targeted therapy is dependent on the molecule that a particular type of breast cancer ‘responds to’. This is an important step towards personalized medicine: profiling a specific patient’s cancer and treating it accordingly to maximize treatment efficacy22.


Interestingly, when a tumor first forms, the immune system recognizes this as a strange event and tries to oppose tumor formation. Some cancer cells develop mechanisms that make them undetectable to immune cells. This is called immune tolerance. Immunotherapy aims to re-establish the immune system’s ability to detect cancer cells and combat immune tolerance23,24.


Altogether, breast cancer treatment is a multidisciplinary approach that benefits from the combination of different therapies. Besides increasing treatment efficacy, combination therapy can allow for the use of lower doses, which reduces adverse effects and delays drug resistance25.


What you should do:

Women are encouraged to take a proactive approach to their health, especially as it relates to breast cancer. Primary breast cancer prevention is the avoidance of known risk factors. Secondary prevention is early detection26. The American Cancer Society recommends that women can choose mammogram screening starting at age 40, but that all women should start annual mammogram screening by age 45.  Also, adult women should consider performing monthly self-exams. Forty percent of breast cancers are detected by the patients themselves27,28.

When breast cancer is familial, or has an early age of onset, genetic testing is often advised. If genetic testing suggests a high possibility for breast cancer development, preventative treatments, such as medications or risk-reducing mastectomy, are available.  Also, enhanced screening for cancer is considered for some genetic testing results.  In all cases, the psychological effects of genetic testing should be taken into account. The cancer risk should be well examined in order to avoid unnecessary interventions29.

Finding support:

Breast cancer treatment extends well beyond the confines of the doctor’s office. Support groups, hosted by mental/medical healthcare professionals or cancer survivors, can offer shared experiences/education and can provide a sense of community and comradery30. Psychoeducational support groups provide patients and their families with the knowledge and psychological tools they need to move forward in a holistic manner31.

Cancer, of any kind, is a difficult road to travel; access to the right people and the right information can provide fuel for the journey.



About the Author

Carol Tweed, MD joined Maryland Oncology Hematology in our Annapolis division October 2020. Dr. Carol Tweed attended Duke University, where she was inducted into Phi Beta Kappa. She graduated summa cum laude with a degree in Biology, and a concentration in molecular biology. She received her medical degree from Washington University in St. Louis, where she was elected to Alpha Omega Alpha. She then completed her Internal Medicine Residency and Hematology/Oncology Fellowship at the University of Pennsylvania.

From 2006-2012, Dr. Tweed was an Assistant Professor on faculty at the University of Pennsylvania’s Abramson Cancer Center. During this time, she practiced as a breast oncology specialist and enthusiastically educated medical students, residents, and fellows.

In 2012, she moved to Annapolis, MD, and joined AAMC Oncology & Hematology, before joining Maryland Oncology Hematology in October 2020. Dr. Tweed passionately cares for patients with a broad range of hematologic and oncologic disorders. Her work as a breast medical oncology expert continues.  She is a regional speaker on the topics of breast cancer and cancer genomics. She is co-founder and co-director of the Maryland Breast Cancer Consortium.

Dr. Tweed is an active clinical researcher; she has served as principal investigator on numerous national and international clinical trials. She also is an Instructor of Medicine/preceptor for Johns Hopkins School of Medicine, educating medical students.

Dr. Tweed is board certified in Hematology and Medical Oncology.



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COVID-19 Vaccine and Cancer: What you need to know

The Coronavirus: Did we need a vaccine?

Every aspect of the Coronavirus disease 19 (COVID-19) pandemic has occurred at record speeds, from disease transmission to vaccine development. COVID-19, caused by a novel coronavirus known as SARS-CoV-2, targets the respiratory system. Most people experience flu-like symptoms; however, in the elderly and those with comorbidities, mild respiratory issues can quickly progress to Acute Respiratory Distress Syndrome, resulting in multiple organ failure and death.

The highly contagious nature of this virus, which is spread through droplets and aerosols released when an infected person sneezes or coughs, is evident by the fact that over 106 million COVID-19 cases have been reported worldwide. Over 2.35 million people have already succumb to the virus1–3.

The limitations of hospital capacity, ventilators, and healthcare personnel have been constant concerns throughout this pandemic. Worldwide regulations promoting social distancing and hygiene have prevented transmission, but they have also crippled the economy and stifled social freedoms1,2.

The overwhelming nature of this pandemic has led to the development of COVID-19 vaccines within an unprecedented timeframe. Despite the relief that this brings to some, many are concerned about the effects of the vaccine. A poll conducted by The Associated Press-NORC Center for Public Affairs research reported that of the 20% of Americans that did not want the COVID-19 vaccine, 70% were concerned about side effects4. Furthermore, the speed with which the COVID-19 vaccines were developed have left many questioning whether proper precautions and protocols are still being implemented. The Food and Drug Association (FDA) has stated that vaccine production will be in accordance with legal and regulatory guidelines5.

A cancer patient, who’s immune system is likely compromised by the effects of chemotherapy, would be understandably concerned about the virus and possible risks associated with the vaccine. This article aims to provide insight into the COVID-19 vaccine, concerns for cancer patients, and recommendations of healthcare professionals.

The COVID-19 vaccine: development, efficacy, and side effects

A vaccine is considered effective when it reduces the infection rate,  disease severity, or disease transmission. One of the main goals of a vaccination strategy is to create herd immunity, which is a large population of people that are immune to a specific disease6. With the aid of new vaccine development technologies, human clinical trials for the first potential COVID-19 vaccine began on March 16th 2020, just 4 months following the outbreak7. On February 10th 2021, the New York Times Coronavirus Vaccine Tracker reported that 69 COVID-19 vaccines were in the human clinical trial phase8.

Vaccine development was previously a 10-15 year process, and had the COVID-19 vaccines been made in this manner, scientists would still be the exploratory phase of the development process9. Soon after the COVID-19 outbreak in China, scientists unraveled the genetic code for SARS-CoV-2, which serves as the blueprint for the virus’s structure10.Then, by studying the virus’s structure, a protein called the spike protein was found on the outer surface of SARS-CoV-2. Researchers found that SARS-CoV-2 uses the spike protein to bind to and enter human cells, where it can replicate and cause sickness11. The spike protein is now the main target for COVID-19 vaccines12.

Traditionally, vaccines contained a weak or inactivated form of a virus that would allow the body to train against a weakened opponent so it would be better prepared to fight the same virus during an actual infection13. The COVID-19 vaccine was developed using RNA technology, an idea that was introduced in the 90’s by French researchers14. An RNA vaccine contains an mRNA sequence, which is simply a refined version of the blueprint used to build a particular protein. Once in the body, cells can process this code to produce the protein. If this is a viral protein, the body recognizes it as foreign, and the immune system is trained to eliminate it. Some COVID-19 vaccines introduce the code for the spike protein so that the body will be trained to fight it when presented with the actual virus13. Two of the leading COVID-19 vaccines, BNT162b2 Pfizer-BioNTech and mRNA-1273 Moderna, which have been approved for emergency use in the U.S. and E.U., are mRNA vaccines that target this spike protein8,15. COVID-19 vaccines may require periodic updates, similar to the Influenza vaccine, in order to accommodate mutations16.

The Centers for disease control and prevention (CDC) reports a 94.1% efficacy with the Moderna vaccine based on 1 large Phase III clinical trial with 30,000 participants aged 18-95 that had not previously tested positive for COVID-19. Systemic adverse effects, described as mild to moderate, were more common after the 2nd dose. These effects were more severe in patients under 6517. Pain, swelling, and redness were reported as localized reactogenicity symptoms, while chills, fatigue, and headaches were listed as systemic adverse effects18. The World Health Organization (WHO) reported that the Moderna vaccine is safe in patients with comorbidities, such as hypertension or diabetes, and chronic infections, provided that their condition is stable and controlled. Due to the possibility of severe allergic reactions, vaccinees must be monitored for 15 minutes after administration. They also report that the effect on immunocompromised people has not been properly investigated. Persons who have previously tested positive for COVID-19 are not deterred from getting vaccinated, but are advised to wait 6 months19.


Both the Moderna and Pfizer vaccine require 2 doses for maximal efficacy. The New England Journal of Medicine reported 95% efficacy in persons that received both doses of the Pfizer vaccine and 52% efficacy is expected after the 1st dose20. A recent report from Israel described a 33% reduction in COVID-19 cases after the first dose. It is important to consider that the Israeli report is based on persons over 60 years, whereas the original Pfizer study included young people as well21. The Pfizer Emmergency Use Authorization Fact Sheet reports similar side effects to that of Moderna, and immunocompromised patients are asked to report their conditions beforehand22.

Female doctor showing two coronavirus vaccine options


The COVID-19 vaccine: considerations for cancer patients

Due to the heterogeneity in cancer patients, there has been some debate as to whether they should be considered a high-risk group. Morbidity and mortality rates between 5 and 61% have been reported in cancer patients that contract COVID-1923. The immunosuppressive effect of many cancer treatments make cancer patients more susceptible to infection. One literature review reported that 10/11 studies in COVID-19 patients reported higher fatalities in patients that also had cancer, especially hematological cancers. Such data argues that cancer patients should be also receive priority vaccination23,24.


Data concerning the effect of the COVID-19 vaccine in cancer patients is very scarce. Of the nearly 44,000 participants in the Pfizer clinical trial only 3.7% were cancer patients23. The immunosuppression in cancer patients caused by chemotherapy, radiation, and/or targeted therapy is also expected to reduce the efficacy of the vaccine. The goal of a vaccination is to elicit an immune response that will train the immune system to fight against a particular disease. A weakened immune system is less likely to respond to this challenge and may therefore be incapable of being trained25. Some have tried to compare the COVID-19 vaccine to the Influenza vaccine; however, studies reporting the vaccine efficacy in cancer patients who received the flu vaccine show that the outcome depends on the cancer type and treatment26–28.

Dr. Nora Disis, a medical oncologist and the director of the Institute of Translational Health and the Cancer Vaccine Institute at the University of Washington, suggests that vaccine dosage and the timing are points of concern, especially in patients in active treatment. She also suggested that cancer patients avoid vaccinations containing an active form of the virus as this could lead to infection in immunocompromised patients29.



Recommendations and reminders for cancer patients

Currently, no COVID-19 vaccines containing live virus have been approved for administration, therefore there should be no risk of becoming infected by the vaccine itself29. As studies of the vaccine in cancer patients are lacking, it is uncertain if cancer patients are susceptible to side effects other than those reported in the general population. The overall recommendation for cancer patients is to receive the vaccine as the risk of contracting the virus is far greater than the possibility of the vaccine being less effective30. We recommend that patients actively on treatment discuss with their oncologist the timing of vaccine administration.


Dr. Jeffrey Farma, a surgical oncologist at the Fox Chase Cancer Center in Pennsylvania, recommends that cancer patients with upcoming surgeries schedule enough time between surgery and the vaccination. Furthermore, patients that have undergone a bone marrow transplant should consult with their hematologist to determine when their immune system will be able to respond to the vaccine. All cancer patients or survivors should consult with their physicians before getting vaccinated31.


Time will tell if current COVID-19 vaccines provide long-term protection and whether they are effective against new variants. Therefore, the advice given to all vaccination recipients is to continue adhering to social distancing and hygiene regulations. Cancer patients, especially, should continue to protect themselves from unnecessary exposure to COVID-19 and any other diseases32,33.



Dr Juneja joins Maryland Oncology Hematology’s White Oak Cancer Center after 13 years of practice in Northern Virginia and Bethesda.  He has subspecialized in breast, gastrointestinal, lymphoma, and myeloma in his prior practices. He is very interested in clinical research and cutting edge as well as precision medicine. Previously, he has designed clinical trials with Bristol Myers Squibb, been a medical officer at the FDA, and has been an investigator in several clinical trials.

Having survived cancer himself, he completely understands what it is like to be a patient. He lives with his wife, 2 children, dog, and enjoys playing piano, tennis, running, bicycling, and sailing.




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  20. Polack, F. P. et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N. Engl. J. Med. 383, 2603–2615 (2020).
  21. Mahase, E. Covid-19: Reports from Israel suggest one dose of Pfizer vaccine could be less effective than expected. BMJ 372, n217 (2021).
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Eating Healthy Really Can Prevent Cancer

Did you know that eating a healthy, balanced diet is an important way to protect yourself from cancer? Putting the right kinds of food into your body can provide you with the vitamins, minerals, and nutrients to keep you healthy and strong. To help build your defense against cancer, focus on eating some of these cancer-fighting foods that may already be in your kitchen.

Foods That Help Fight Cancer

The National Cancer Institute does not recommend any dietary supplement for the prevention or treatment of cancer. However these foods have shown potential for reducing the risk of developing cancer due to their cancer-fighting properties.

Leafy Green Vegetables

Leafy green vegetables are loaded with vitamins, minerals, and enzymes, while remaining very low in calories, sodium, and fat. Greens such as spinach, kale, collard greens, swiss chard, leaf lettuce, and romaine lettuce, are known to combat a variety of cancers including skin cancer, breast cancer, stomach cancer, and breast cancer. Because they are also rich in carotenoids, the plant pigments that act as antioxidants in the body, leafy greens are also thought to be good at battling cancers of the mouth, pharynx, and larynx.

Cruciferous Vegetables

Cruciferous vegetables such as broccoli, cauliflower, cabbage, brussels sprouts, radishes, and even wasabi, contain fiber, folate and vitamins C, E, and K. They also get their strong smell and bitter flavor from substances known as glucosinolates, which are sulfur-containing chemicals. Adding vegetables like these to your diet can help boost your body’s protective enzymes and flush out cancer-causing chemicals.

Cruciferous veggies are considered to be most useful in reducing the risk of developing bladder cancer, stomach cancer, liver cancer, lung cancer, prostate, skin cancer, and breast cancer.


Garlic is a staple ingredient that has been used for both culinary and medicinal purposes around the world. Protective effects from garlic may arise from its antibacterial properties or from its ability to block the formation of cancer-causing substances, enhance DNA repair, reduce cell proliferation, or induce cell death. Garlic is most useful in fighting against breast cancer, pancreatic cancer, esophageal cancer, and stomach cancer.

Most people take garlic in the form of a supplement rather than eating bulbs of garlic. The World Health Organization’s (WHO) guidelines for general health promotion for adults is one of the following:

  • a daily dose of 2 to 5 g of fresh garlic (approximately one clove)
  • 0.4 to 1.2 g of dried garlic powder
  • 2 to 5 mg of garlic oil
  • 300 to 1,000 mg of garlic extract
  • or other formulations that are equal to 2 to 5 mg of allicin


While tomatoes are an excellent source of vitamins C and A, it’s the lycopene, the pigment that gives red tomatoes their color, that has been studied for its cancer-fighting effects. Antioxidants, such as lycopene, destroy damaging free radicals, which can attach your your cells and hurt your immune system. Although the evidence suggests that foods containing lycopene, including tomatoes, likely offer cancer protection, the American Institute for Cancer Research stresses the importance of eating a variety of plant foods. No single food can effectively lower cancer risk, so it is important to eat a variety of healthy foods so you can gain the most benefit in fighting cancer.

Lycopene in tomatoes is believe to be most helpful in fighting endometrial cancer, lung cancer, prostate cancer and breast cancer.


Raspberries, blackberries, strawberries, blueberries, and berries of every color are good sources of vitamin C and fiber. They are also rich in antioxidants and ellagic acid, which help block free radicals and deactivate specific carcinogens (cancer causing agents) that can lead to cancer growth. Berries have been found to be useful in fighting colorectal cancer, esophageal cancer, skin cancer, and oral cancer.

These are just a handful of foods that will help you maintain an overall healthy diet which is recommended to fight cancer. To learn more about what foods make for healthy choices, you can visit the American Cancer Society’s Basic Ingredients for a Healthy Kitchen. Consume all things in moderation, even healthy foods, and include a wide variety of healthy foods in your daily intake, not just those listed here.

Foods That Can Cause Cancer

Animal Fats

Not all meats and dairy products are bad for you, however, the ones that contain saturated fats can be. Consider choosing low-fat versions of meats and cheeses, and steer clear of processed meats whenever you can which tend to be higher in fat, nitrates and other preservatives.


The less alcohol you drink, the lower the risk of cancer. It doesn’t matter whether it’s beer, wine, or spirits–too much alcohol can impair your body’s ability to fight disease. The National Cancer Institute recommends that women have no more than one drink per day and men have no more than two drinks per day. Excessive alcohol consumption can put you at an increased risk of mouth cancer, esophagus cancer, breast cancer, and liver cancer.

Charred Meats

When high-temperature methods, such as grilling, are used to cook meats like beef, pork, fish, and poultry, certain DNA-damaging chemicals, called HCAs and PAHs can form. Although it is still unclear whether such exposure causes cancer in humans, the cancer that it has been found to cause in animals indicates that it may be best to avoid foods that are highly charred (black from heat exposure).

There are many other foods that researchers are still studying to determine whether they may contribute to the development of cancer or help reduce your risk of cancer. If you have questions regarding how to prevent cancer, it’s best to consult your doctor. The team at Maryland Oncology Hematology is always ready to help patients find healthy food options they can enjoy both now and after cancer treatment. For more information, contact us, or visit us at one of our 12 locations including Annapolis,  Bethesda, Brandywine, Clinton, Columbia, Frederick, Lanham, Laurel, Mt. Airy, Rockville at Aquilino Cancer Center and Silver Spring at White Oak Cancer Center.

For more information on cancer prevention you can visit the following blogs:



What are Complementary Therapies, and What Can They Do for Cancer Patients?

Complementary therapies are products and/or practices that differ from standard medical care provided by your oncologists. These non-traditional methods are in no way meant to replace cancer treatment. They’re called complementary because they are meant to work alongside your cancer treatment in hopes of relieving symptoms and side effects, relieving pain, and improving quality of life.

Complementary therapies typically concentrate on relaxation and reducing stress. Many of these types of therapies may help calm emotions, relieve anxiety, reduce nausea, minimize pain, provide extra energy, and increase overall health and well being.

Many cancer patients feel as though complementary therapies leave them with a little more control over their health as they go through cancer treatment. They also tend to appreciate that complementary therapies do not require additional medicines. When the symptoms and side effects of your cancer treatment are difficult to cope with, these alternative approaches can be supportive in bringing relief. Before adding any complementary therapy to your current treatment, however, it is important to talk with your cancer specialist.

There are many different types of complementary therapy. Be sure to tell your therapist or instructor that you are a cancer patient before you start any complementary therapy. This is important information that could impact what they recommend for you.

Complementary therapies include, but are not limited to:

  • Aromatherapy and Essential Oils: The use of essential oils either by inhalation or topical application. Oils can aid in reducing anxiety, nausea, depression, and pain. Be sure you receive instruction before applying any oils to your skin.
  • Acupuncture: The practice of applying needles, heat, pressure, and other treatments to one or more places on the skin known as acupuncture points. It can be effective for cancer treatment side effects such as nausea and vomiting, pain, and fatigue.
  • Chiropractic: A chiropractor can provide hands-on manipulation of the spine (adjustment) that can help with stresses cancer treatment has put on the musculoskeletal system, which can increase mobility, flexibility, strength, and function. It may also help relieve nausea, fatigue, headaches, and other body pains in the back and neck area.
  • Herbal supplements: May help strengthen the immune system and ease the side effects of cancer treatment. These can interact with medicines being used for cancer treatment and should always be discussed with your cancer care team before using.
  • Massage therapy: A hands-on method of manipulating the soft tissues of the body that can promote relaxation and help with pain, fatigue, immune function.
  • Guided Imagery (Visualization): A technique that focuses and directs the imagination toward a specific goal. Practicing this may be able to reduce feelings of depression and increase feelings of well-being. The University of Michigan provides a free guided imagery audio library.
  • Art or music therapy: Creative arts that promote a better quality of life by aiding in the reduction of depression, anxiety, and pain. It can also be a positive outlet for emotional expression.
  • Yoga: Yoga connects the mind and body through movement and meditation. Yoga can help improve quality of life by relieving both physical and emotional stress.
  • Support groups: Group meetings can help cancer patients cope. Having emotional support can help improve both quality of life and survival.

In most cases, cancer doctors are very supportive of their patients using complementary therapies. This is typically because they have seen people cope better with the cancer and its treatment.

Again, it isn’t recommended that complementary therapies replace cancer treatment. They are simply meant to be used in conjunction with the current cancer treatment. Talking with your cancer specialist can help find the right balance between the complementary therapies and traditional treatments you are receiving for your cancer. Our oncologist at Maryland Oncology Hematology are able to talk you through these complementary cancer therapies, as well as additional methods of therapy that may be best for your cancer care. If you are in Maryland or the Washington D.C. area, you can schedule a consultation by picking the Maryland Oncology Hematology location that’s most convenient to you and calling to make an appointment.



The Importance of Genetic Testing in Cancer Research

It’s common for cancer patients and their families to feel helpless, as if their futures and those of their loved ones are entirely dependent on physicians and medications. Genetic testing is one way for cancer patients and their relatives to regain a sense of control over the horrible disease, and make a valuable contribution toward improving cancer detection, new cancer treatments and understanding cancer prevention methods.

One of the most effective ways for cancer researchers to learn why a type of cancer occurs (an important step in discovering new cancer treatments) is to study the genes of cancer patients and those who share their DNA profile.

How is Genetic Testing used to Advance Cancer Research?

When researchers study the genes from a large sampling of individuals who have or are susceptible to certain cancers, they’re able to detect patterns, or genetic markers. This information can be used to predict the likelihood that someone will develop a disease, as well as to develop cancer screening tests, prevention protocols and various cancers treatments.

Because of cancer genetic testing, researchers from the National Cancer Institute’s Division of Cancer Epidemiology & Genetics (DCEG) have made important discoveries that have advanced cancer research and cancer treatment. For example:

  • Researchers studying the genes of a patient with nevoid basal-cell carcinoma syndrome identified the gene responsible for the skin cancer. That finding culminated in the first U.S. Food & Drug Administration-approved biological agent therapy for advanced and metastatic basal cell skin cancer.
  • Researchers studying breast cancer patients’ genes discovered that a gene mutation on the BRCA1 or BRCA2 gene increases the likelihood of developing the disease. Today, people who discover they have this gene have the option of choosing elective mastectomies to reduce their risks of breast cancer.
  • Researchers studying the genes of dyskeratosis congenita patients discovered that 60 percent have the same genetic mutation. That finding led to a new diagnostic test for the disease and new criteria for evaluating potential bone-marrow donors.
  • Researchers studying monoclonal B-cell lymphomatosis patients discovered that the disease is a precursor for chronic lymphocytic leukemia (CLL). That finding paved the way for screening tests now used to diagnosis CLL in its early stages, which allows patients to begin treatment before the disease advances.

The research continues. DCEG researchers are currently conducting several studies, including:

  • Studies of melanoma-prone families to search for “melanoma susceptibility” genes.
  • Studies of patients with a group of rare genetic blood disorders known as inherited bone marrow failure syndromes to learn how these cancers develop.
  • Studies of children with a rare lung tumor, pleuropulmonary blastoma, to determine if changes in a particular gene contribute to this lung cancer.

Genetic testing isn’t foolproof, but it is a powerful tool for cancer patients who want to contribute to science, and individuals who want to assess their risks.

How Is Genetic Testing Conducted?

Most physicians require a patient to undergo genetic counseling before undergoing genetic testing for cancer because the results of your cancer genetic test may yield unwelcome news, and patients should be prepared.

In most cases, the process of undergoing genetic testing is surprisingly simple and painless. Typically, the person being tested provides either:

  • A blood sample (usually several tubes taken from a vein in your arm)
  • A sample of DNA obtained from saliva, skin cells or cheek cells (obtained by swabbing the inside of the cheek)
  • Genetic testing for a fetus may require the mother to have an amniocentesis, although non-invasive prenatal tests are also available

The sample is sent to a genetic testing laboratory for analysis, where they will determine your sample to be positive, negative or inconclusive. Within two – three weeks, the detailed results will be sent to the physician of genetic counselor who ordered the testing.

Can anyone be Candidate for Cancer Research Genetic Testing?

Genetic testing leads to genetic screening tests. Individuals with family histories of certain types of cancer (such as breast cancer, ovarian cancer, colon cancer, and others) who are interested in learning if they possess a certain hereditary gene mutation — and who are mentally prepared for the possibility of a positive result — are candidates for genetic testing.

Features suggestive of hereditary cancers include:

  • Any individual diagnosed with cancer prior to age 50
  • Any individual who has developed more than one cancer
  • Any individual with a rare type of cancer (ovarian, male breast cancer, pancreatic)
  • An individual with two or more family members diagnosed with the same cancer
  • A family member with an identifiable gene mutation known to increase the risk of cancer
  • Ashkenazi Jewish ancestry with a personal or family history of  cancer

Individuals who already have cancer and want to contribute to research that could lead to advances in detection and treatments are also candidates.

If you or someone in your family thinks they need to have cancer genetic testing performed, it is important to review our Genetic Risk Assessment section with your doctor or genetic counselor, or if you are located in the Maryland or Washington DC area, schedule an appointment with the Maryland Oncology Hematology team for a more in depth discussion.



5 New Year’s Resolutions for Cancer Patients

Making and implementing New Year’s resolutions that can improve your lifestyle while undergoing cancer treatment can seem too difficult to tackle. But it can be done! Working towards maximizing your emotional and physical strength during this time is an excellent goal with long-term benefits.

There are several ways you can improve your lifestyle, helping you to better cope with the challenges involved in battling cancer. Here are five ideas and how you can incorporate them into your routine this new year.

1. Regular Exercise

For many cancer patients, the idea of following an exercise program while you’re going through cancer treatment is overwhelming. But even small amounts of exercise – such as walking around the block or 15 minutes of yoga – will provide long-term benefits.

According to the American Cancer Society, research shows that exercise is safe for most cancer patients. Planning exercise into your daily routine can help with how you feel physically and emotionally. Patients reported:

  • Better physical functioning
  • Less fatigue
  • Less anxiety

If you are undergoing chemotherapy or radiation therapy for cancer treatment, you should begin an exercise program at a lower intensity and build it gradually. The National Cancer Comprehensive Network urges patients to engage in a moderate workout program such as a daily walk combined with strength training using light weights. Moderate exercise is proven to boost immunity, which is essential for patients battling cancer.

If you regularly exercised before cancer treatment, try not to compare your current pace and workout intensity to what you used to do. Listen to your body and be as consistent as you can.

2. Engage in Meditation

Meditation is recommended for cancer patients because it helps manage anxiety, sleep problems, pain, high blood pressure, and fatigue. You can choose from several methods of meditation – a few examples are: mindfulness meditation, focused meditation, or prayerful meditation. Although side effects of these techniques are rare, experts say patients should inform their oncologist of any complementary therapies, such as meditation, before starting. There are resources for helping you learn how to meditate if this is something new to you. The Mindfulness Center and Hope Connections for Cancer Support, both in the Bethesda area, offer programs that can help you with understanding how to use meditation to produce benefits during and after cancer treatment.

3. Follow a Nutritious Diet

Food may not always sound good, or side effects of treatment can make it hard to eat. But taking in the right amount of calories is still really important for keeping up your strength and maintaining a healthy weight. What you eat while going through cancer treatment may be a little different from your typical diet, but try to keep it as nutritious as possible.

When possible, select healthy sources of fat including avocado, olive oil, nuts and fish such as salmon. Stay away from trans fats and foods high in cholesterol, such as processed snacks, fast food, and shortening. Here are a few suggestions that can help you with following a healthy diet during cancer treatment and beyond:

  • Eat protein every day. It will help you feel full, maintain your strength and rebuild tissue during your cancer treatments. This might include nuts, yogurt, cheese, or eggs.
  • The American Cancer Society suggests eating at least 2.5 cups of fruits and vegetables a day, including citrus fruits and dark-green and deep-yellow vegetables. Colorful vegetables and fruits and plant-based foods contain many natural health-promoting substances. During cancer treatment try to cook vegetables before eating them.
  • Use liquid meal replacements if it’s hard to get the right amount of nutrients every day. This is especially helpful if you have dry mouth.
  • Try eating smaller meals more often so that you can keep up your strength without feeling overly full. Keeping food in your stomach can also counter nausea.

If you find that some of your favorite foods don’t taste quite right during cancer treatment, that’s OK. Eat healthy foods that taste good and make sure to keep them stocked up in the house.

4. Cultivate an “Attitude of Gratitude”

Because of the mind-body connection, a grateful, positive attitude can make a decided difference in how you feel. Thankfulness helps people deal with adversity and is consistently linked to greater happiness. Cure Today magazine encourages cancer patients to find three things each day for which they are grateful. Write them down so you can revisit them when times are hard. This habit will grow stronger the more you engage in it.

5. Let Others Help You

You don’t often hear of resolutions that include “allowing others to help me.” But as a cancer survivor, this is something that you can commit to trying. It’s not only good for you but gives your family members and friends a way to feel like they are helping you. It can also help you avoid feelings of loneliness and isolation.

Allow loved ones to bring you a meal or stop by, even if your house isn’t in perfect order. Joining a cancer support group may also be helpful. These organizations offer the opportunity to share feelings with people who can understand and relate to your situation, and you can do the same for them. Studies show belonging to such groups makes cancer patients feel more hopeful and less anxious. They are available in person and online.

Maryland has an array of cancer support organizations, such as those offered by the Baltimore Cancer Support Group, Hope Connections for Cancer Support, The Mindfulness Center in Bethesda, and the Cancer Support Community. Your oncology team can put you in touch with those who can provide an additional list of cancer support groups available in the Maryland and Washington D.C. communities, even groups that might be for your specific type of cancer.


Managing the Holidays with Cancer

Even people in perfect health often feel exhausted and overwhelmed during the holiday season; that feeling is often magnified when you’re battling cancer. You may not have the stamina to battle Black Friday crowds, deck the halls and entertain as lavishly as you have in years past, and that’s OK. If you’re a cancer patient try not to overexert yourself, but don’t isolate yourself either. Here are some ways cancer patients can manage and even enjoy the holidays while undergoing or recovering from cancer treatment.

Accept Help

When you were diagnosed with cancer and going through cancer treatment, you were probably inundated with offers of help and support. Now is the time to accept those offers. Whether you need help hanging Christmas lights or wrapping gifts, don’t hesitate to ask friends, neighbors and family members for help. Most people will feel honored that you asked, and you’ll probably enjoy both their help and their company.

Tweak Traditions

It’s easy to become caught up in the hustle and bustle of the holidays and become overwhelmed. This year, try to focus on the underlying reason for your traditions: Celebrating relationships and enjoying spending time with loved ones. If your tradition involves gathering the family for Christmas dinner, you can achieve that without spending hours in the kitchen. Ask each guest to bring a dish and have a pot-luck, have the meal catered, meet at one of the many wonderful restaurants in Maryland, or move the dinner to someone else’s house.

Let Your Fingers Do the Shopping

One of the most daunting aspects of the holidays is battling traffic and crowds to buy gifts. You certainly don’t have to buy gifts. However, if you want to consider shopping online. You’ll save time and energy, and you’ll probably also save money. Visit sites such as, and for online coupon codes. Another benefit of online shopping is that many sites offer a gift wrapping option. You can buy your gift and arrange to have it wrapped and shipped directly to your loved one.

Carve Out Time for Yourself

It’s easy to become overwhelmed during the holidays, so take care of yourself by taking breaks to recharge your batteries. Take a walk, take a bath, or take a nap. This is a good idea for cancer patients, even when it’s not the holidays. But it’s almost critical during the holiday season.

If it becomes clear the festivities will carry on into the wee hours, it’s OK to excuse yourself and make an early exit. If you’ve accepted an invitation but aren’t feeling well, feel free to send your regrets at the last minute. The holiday season is a marathon, not a sprint. Make your health top priority, and those around you will understand.

You Don’t Have to be Cheerful All the Time

When you have cancer, that fact is always on your mind. For most people, the holiday season is a time for reflection. As a cancer patient, it’s only natural that you’ll mourn your life before cancer and feel anxiety about the future. Anger, sadness and frustration are common, understandable emotions that don’t go away during the holidays. Express your feelings, as your honesty gives your loved ones permission to express their feelings, too. Cancer is a terrible disease, and it’s cathartic to acknowledge that. It’s OK to laugh and to cry.

Celebrate Life, Love and Happiness

You may have cancer, but cancer does not define you. Celebrate and enjoy your life. Whether you spend time with friends and loved ones, volunteer to help others or meditate in preparation for a brand new year, take time during the holiday season to celebrate all the wonderful things about your life, and know that our cancer specialist at Maryland Oncology Hematology are here to help you.




Facts You Need to Know About Colorectal Cancer

Colorectal cancer actually refers to two parts of the body: the colon and the rectum. Treatment options are often very similar so they’re typically bundled together when explaining prevention, detection and treatment options for either colon cancer or rectal cancer.

Thankfully because of new technologies and greater awareness of screening, the death rate from colorectal cancer has been dropping for decades. Here are some things you should know about how to reduce your personal risk of developing colorectal cancer.

Colorectal Cancer Can be Genetic

About one in five people who develop rectal or colon cancer have a close relative (parent, sibling or child) who has had colorectal cancer or a certain kind of colon polyp called adenomatous. If someone in your family has been diagnosed with this type of polyp you should talk to your doctor about starting colorectal cancer screening sooner than the typical age of 50.

There can also be a genetic cause of colorectal cancer for about 5-10% of colorectal cancer patients. If someone in your immediate family has been diagnosed, especially if they were diagnosed before the age of 45, you may want to talk to one of our cancer experts about a Genetic Risk Assessment. Knowing whether there are genetic changes present can help your doctor with recommending preventive measures and screening in the future.

Other Risk Factors For Developing Colorectal Cancer

There are quite a few other factors that can play into whether you’re at an increased risk of developing colorectal cancer. Some you can control while others you cannot.

Risk factors you can control to help prevent colorectal cancer include:

  • Obesity
  • Smoking
  • Heavy alcohol use

Risk factors for colorectal cancer you cannot control in addition to your family history include:

  • Age – Your risk increases after the age of 50.
  • Race – African Americans have the highest death rate from colorectal cancer compared to all other races.
  • Type 2 Diabetes – Those with Type 2 Diabetes are at an increased risk of developing colorectal cancer.

Regular Colorectal Cancer Screenings Save Lives

Even if you don’t have a family history, colorectal cancer specialists recommend that adults get screened between the ages of 50 and 75. The older you are, the higher your risk for developing the disease. While a colonoscopy is the most commonly used colorectal screening process, there are several other options such as:

  • Sigmoidoscopy every five years. The doctor uses a flexible, lighted tube to check for polyps, remove them and have them tested. Unlike a colonoscopy, this test doesn’t require you to have anesthesia.
  • Virtual colonoscopy every five years. This test does not require anesthesia either. A doctor takes X-rays of your colon, and a specialist looks for signs of cancer.
  • Barium enema every five years. For people who can’t safely have a colonoscopy, a liquid is inserted into the rectum that allows trained technicians to see abnormal growths on an X-ray.

You Can Reduce Your Risks


Whether you have a family history of colorectal cancer or not, there are steps you can take to reduce your risk of developing the disease. These lifestyle changes include:

  • Get screened. Screenings find polyps that can be removed before they become cancerous.
  • Exercise. Overweight people have a higher risk of colon cancer.
  • Watch your diet. Eating lots of red meat or processed meats (like hot dogs) may increase your risk of colon cancer.
  • Don’t smoke (or stop smoking). Smokers have a higher risk of colon cancer. An added bonus of quitting smoking is that you will also reduce your risk of developing many other diseases and cancers.
  • Limit alcohol. Heavy drinkers have a higher risk of colon cancer.

Even people who are active, eat healthy diets and have no family history of colorectal cancer may develop the disease. If you start to experience any unusual bowel movements, pain or excessive bloating be sure to schedule an appointment with your general practitioner or gastroenterologist. If they find colorectal cancer present you will need to see a colon cancer specialist for treatment. If you live in or near Maryland, Maryland Oncology Hematology has nine locations making it possible for you to meet with a colorectal cancer specialist near you.




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