DEAR MAYO CLINIC: I've heard that ovarian cancer is hard to detect. Can you tell me more about the symptoms and if there are any screenings?

ANSWER: Ovarian cancer is relatively rare. However, it's often fatal in later stages of the disease. The cancer begins in the ovaries and spreads to the abdomen and pelvis if it isn't diagnosed and treated early. It primarily affects older women; about half of those diagnosed are age 63 or older.

Here are some statistics for ovarian cancer:

• In the U.S., it's the second-most common female reproductive organ cancer after uterine cancer.
• The risk of getting ovarian cancer in a woman's lifetime is about 1 in 91. Nearly 21,000 women are diagnosed with ovarian cancer every year.
• Roughly 250 women die of this disease each week.
• Even though uterine cancer is 3 times more common, the number of women dying from ovarian cancer each year is almost the same (around 13,000 deaths). This death rate points to the difficulty of detecting this aggressive form of cancer.

Recognizing the symptoms

As with any cancer, early diagnosis of ovarian cancer can improve the chances of successful treatment. If you are experiencing these symptoms, see your healthcare clinician:

• Quickly feeling full when eating
• Abdominal bloating or swelling
• Weight loss
• Frequent need to urinate
• Changes in bowel habits
• Discomfort in the pelvic area

Understanding the risk factors

A family history of ovarian cancer and personal factors can increase your risk of ovarian cancer, including:

• Obesity
• Hormone replacement therapy
• Personal history of cancer or endometriosis
• Increasing age or reproductive history and infertility

Some factors that can decrease your risk include:

• Oral contraceptive use
• Pregnancy and breastfeeding
• Removal of the ovaries and fallopian tubes
• Hysterectomy or tubal ligation
  

Detecting ovarian cancer

There are well-established screening programs for certain cancers, such as breast, colon and cervical cancer, which can help prevent these cancers from developing. Screening also can detect cancer at an early stage when treatments are more effective.

Unfortunately, there isn't a universal screening program for ovarian cancer. That's because testing options often lead to high rates of false-positive and false-negative results. Also, ovarian cancer doesn't predictably develop precancerous cells, and it's difficult to get tissue samples from the ovaries.

The most relevant tools for finding ovarian cancer are imaging tests, such as an ultrasound, and tumor markers that can be found in the blood, such as cancer antigen 125, or CA 125.

Ultrasounds are good at identifying cysts or other masses growing on the ovaries. The challenging part is that these masses are quite common, and most are not cancers. While the appearance of an ovarian mass can give some clues about its chance of being cancerous, with an ultrasound, it's often difficult to tell the difference between masses that are cancers and those that aren't.

What is CA 125?

CA 125 is a protein in the blood that can be elevated when ovarian cancers are present. However, it also can be elevated with other conditions, such as menstruation, uterine fibroids and endometriosis, leading to false-positive results. 

Early detection is the goal of a good screening program, but CA 125 can miss a significant number of early-stage ovarian cancers.

Ultrasounds and CA 125 tests have been evaluated as potential screening tools. Unfortunately, they can't consistently detect ovarian cancer early enough to improve patient outcomes. They also have a high false-positive result rate, increasing the risk of unnecessary stress, anxiety and surgery.

However, in some situations, these tests are used to screen for ovarian cancer, such as in patients with genetic mutations that put them at high risk for cancer and in patients previously treated for ovarian cancer.

By Sandeep Basu, M.D., Breast Cancer Care, Hematology and Oncology, Mayo Clinic Health System, Eau Claire, Wisconsin

Related post:

• Mayo Clinic researchers capture first signs of ovarian cancer risk

The post Mayo Clinic Q&A: Get the facts on ovarian cancer appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Clinicians typically classify meningiomas — the most common type of brain tumor — into three grades, ranging from slow-growing to aggressive.

But a new multi-institutional study suggests that appearances may be deceiving. If a tumor shows activity in a gene called telomerase reverse transcriptase (TERT), it tends to recur more quickly, even if it looks low-grade under the microscope.

"High TERT expression is strongly linked to faster disease progression," says Gelareh Zadeh, M.D., Ph.D., a neurosurgeon at Mayo Clinic and senior author of the study. "This makes it a promising new biomarker for identifying patients who may be at greater risk of developing aggressive disease."

An early warning sign

Meningiomas — tumors of the meninges, the protective tissue that surrounds the brain and spinal cord — are generally considered benign. But a small subset of these tumors has a mutation in the TERT gene, which is linked to faster growth and a shorter time before the tumor returns after treatment.

TERT is the active part of telomerase, an enzyme that maintains telomeres, the protective ends of chromosomes. In most healthy adult cells, TERT is switched off. But if it becomes switched back on, it can fuel cancer development by driving unchecked cell growth.

In this study, the researchers wanted to see whether high TERT expression, even in the absence of the TERT genetic mutation, also predicted worse outcomes. They looked at more than 1,200 meningiomas from patients across Canada, Germany and the U.S., and they found that nearly one-third of them had high TERT expression despite not having the mutation.

These patients had earlier tumor regrowth compared to those without TERT expression, though their outcomes were better than patients with full-blown TERT mutations.

"TERT-positive tumors behaved like they were one grade worse than their official diagnosis," says Dr. Zadeh. "For example, a grade 1 tumor with TERT expression acted more like a grade 2."

Guiding treatment decisions

The findings suggest that testing for TERT activity could help doctors predict which patients are at higher risk for recurrence and may need closer monitoring or more intensive treatment.

"Because meningiomas are the most common primary brain tumor, this biomarker could influence how thousands of patients are diagnosed and managed worldwide," says Dr. Zadeh.

"TERT expression can help us more accurately identify patients with aggressive meningiomas," Chloe Gui, M.D., a neurosurgery resident at the University of Toronto, Mayo Clinic research collaborator and the study's lead author, explains on a podcast hosted by The Lancet Oncology. "This information allows us to offer treatment tailored to the tumor's behavior." "This information allows us to offer treatment tailored to the tumor's behavior."

The team is currently investigating ways to incorporate TERT expression into the clinical workflow. The research is part of a larger effort at Mayo Clinic called the Precure initiative, focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions.

Review the study for a complete list of authors, disclosures and funding. 

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Tia Ford, Mayo Clinic Communications, newsbureau@mayo.edu

The post New genetic biomarker flags aggressive brain tumors appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A Mayo Clinic study finds that a shortened, less intense course of radiation and chemotherapy after minimally invasive surgery for HPV-positive oropharyngeal squamous cell carcinoma (HPV+OPSCC) results in less toxicity, substantially lowering the rates of treatment-related side effects while maintaining high cure rates. The findings were published in The Lancet Oncology.

"This is a game-changer for patients," says Daniel Ma, M.D., senior author of the study and head and neck radiation oncologist at Mayo Clinic Comprehensive Cancer Center. "We've significantly reduced the burden of long-term side effects without compromising the effectiveness of the treatment. This shorter, less intensive regimen allows patients to return to their lives more quickly and with a better quality of life."

Standard treatments for HPV-related oropharyngeal cancer typically involve seven weeks of daily radiation and chemotherapy, or surgery followed by six weeks of radiation and chemotherapy. While highly effective, these treatments often lead to significant long-term side effects due to high toxicity, such as jawbone failure, dry mouth, changes in taste and challenges with swallowing. "These greatly affect the quality of life for patients, many of whom are young, in their 40s and 50s," says Dr. Ma.

In the randomized phase 3 study, Mayo Clinic researchers compared the standard treatment to a new approach involving minimally invasive transoral surgery followed by a two-week course of gentler radiation therapy called de-escalated regimen of adjuvant radiotherapy (DART). DART uses about half as much radiation and a reduced dose of chemotherapy, one-fifth of the standard dose.

The results demonstrated that the less intensive treatment approach significantly reduced both severe (grade 3 or higher) and moderate (grade 2) toxicities, indicating fewer adverse events and improved symptom burden for patients following treatment. Importantly, disease control rates were comparable to the standard treatment for intermediate-risk patients.

For specific high-risk patients, namely those with five or more lymph nodes and disease extending outside of the lymph nodes, the standard treatment showed slightly better disease control, potentially due to chemotherapy-related factors rather than radiation. The researchers add that these patients should still receive the standard six-week treatment.

The study involved 228 patients treated at Mayo Clinic in Minnesota and Arizona. The researchers say that this study represents the largest cohort of postsurgical de-escalation patients in the published literature.

Further, ongoing research will continue to explore using biomarkers such as circulating DNA to find the best patient populations for this treatment strategy.

Review the paper for a complete list of authors, disclosures and funding. 

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

About Mayo Clinic Comprehensive Cancer Center 
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post Shorter, less intense radiation-chemo regimen effective for HPV-linked oropharyngeal cancer, Mayo study shows appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've always been active, but after being diagnosed with breast cancer and starting my treatment, I'm a little worried about getting back into my routine. Is it OK to exercise during cancer treatment?

ANSWER: Exercise decreases the risk of developing cancer. Studies have shown there is a 30%- 35% reduction in the risk of breast cancer among the most physically active women compared with those who are least active. Exercise also plays a protective role in many other cancers, including lung, endometrial, colon, kidney, bladder and esophageal.

However, exercise can also be helpful during and after cancer treatment. According to the American Cancer Society, research shows that exercise during cancer treatment can improve physical functioning and quality of life.

Moderate exercise can:

• Increase strength and endurance.
• Strengthen the cardiovascular system.
• Reduce depression.
• Decrease anxiety.
• Diminish fatigue.
• Improve mood.
• Raise self-esteem.
• Lessen pain.
• Improve sleep.

Of course, there may be certain issues that prevent or affect a person's ability to exercise due to disease or type of treatment, including:

• Anemia — having a low number of red blood cells or quantity of hemoglobin or protein.
• Weak immune system.
• Some forms of radiation treatment.
• Some surgeries limit certain exercises.

Some people should use extra care to reduce the risk of injury, including older people and those with bone disease, arthritis, or nerve damage, also called peripheral neuropathy.

Exciting studies show that regular physical activity is linked to increased life expectancy after a cancer diagnosis. In many cases, it also decreases the risk of cancer recurrence. Multiple studies in cancer survivors, with the strongest evidence in breast and colon cancer survivors, have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive.

The American Cancer Society, the American Institute for Cancer Research, the American College of Sports Medicine, and the U.S. Department of Health and Human Services all advocate physical activity for cancer patients and survivors.

The American Cancer Society recommends cancer survivors take these actions:

• Participate in regular physical activity.
• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.
• Exercise at least 150 minutes per week.
• Include strength training exercises at least two days per week.

Not everyone is ready to head to the gym during or after cancer therapy. However, reconnecting with an activity you like to do can increase your enjoyment and ability to stick with an exercise program. Exercise may include a bike ride with friends or chasing your dog around the park.

Walking is a great activity for almost everyone, and swimming can be a wonderful alternative for those with joint issues. Yoga is fantastic for strengthening, flexibility and balance concerns.

Kaye Sturz, D.N.P., Hematology/Oncology, Mayo Clinic Health System, Eau Claire, Wisconsin

The post Mayo Clinic Q&A: Reconnect with exercise during cancer treatment appeared first on Mayo Clinic News Network.

For years, cancer researchers have been trying to halt a type of molecule that's involved in several cancers. The molecules — enzymes known as trypsins — split proteins that help tumors grow and spread.

Mayo Clinic cancer biologist Evette Radisky, Ph.D., previously found that one trypsin, called mesotrypsin, plays a role in breast, prostate, pancreatic and lung cancer. Like other enzymes, the molecule has an active site that kicks off reactions with other molecules. Researchers have tried to block the active site but haven’t found a molecule with a specific enough lock-and-key fit to jam the active region.

Recently, however, Dr. Radisky's lab at Mayo Clinic in Florida discovered a new way to block mesotrypsin. They found a "hidden pocket" in the molecule.

"The hidden pocket is separate from the active site, but we found that blocking it has a similar effect of locking the enzyme in an inactive state," says Dr. Radisky, principal investigator of the study that appeared in Science Advances. The team now is taking steps to discover drugs that fit the hidden pocket.

A mystery in the data

"It was a serendipitous finding," says the study’s lead author, Mathew Coban, of the pocket's discovery. As a research technologist in the Radisky lab and a master's degree student at Mayo Clinic Graduate School of Biomedical Sciences, Coban had aimed to understand the structure of mesotrypsin through X-ray crystallography.

The complex technique, which records scattered X-rays as shadows, can describe the overall folds of amino acids in the enzyme and suggest complementary molecules that fit like a puzzle. While reviewing the X-ray crystallography results, Coban noticed a segment of the enzyme that looked out of place. The research team thought it might be an error in the data and set the results aside.

But Coban continued to wonder about the strange area. He had the idea to begin looking for alternate nooks in the mesotrypsin enzyme that could potentially contribute to a stable, non-active enzyme.

What Coban found was a site that was hidden. The team dubbed it a "cryptic pocket." The pocket, adjacent to the active site, opened at moments when mesotrypsin stabilized itself. The next step was clear. "If the pocket is there some of the time, maybe a drug would be able to bind at that site and trap the enzyme in its inactive state," he says.

Finding a drug that binds

The team worked with a colleague, Thomas Caulfield, Ph.D., a former Mayo researcher and drug discovery expert, to conduct a computational screen of potential drug compounds that might fit in the cryptic pocket. They found a single molecule that could bind in the cryptic pocket and inhibit the activity of mesotrypsin.

Importantly, the researchers note, the molecule blocks mesotrypsin selectively, without affecting other trypsins. This could mean less toxicity or fewer side effects for a patient. The finding also means that other cryptic pockets may exist in other trypsin molecules related to cancer, presenting new potential drug targets.  

The team is continuing to look for drug molecules that fit mesotrypsin even better. "Based on the structural information of mesotrypsin that we have now, we've been able to do more computational prediction to identify additional, more potent compounds that we’re now testing in the laboratory," says Dr. Radisky.

"This has been an important step in the understanding of this key enzyme. Our next steps will be to start testing how well our candidate drug molecules fit the cryptic pocket and block cancer invasion and metastasis in models of disease," she says.

The study was funded by grants from the National Institutes of Health, Mayo Clinic Medical Scientist Training Program and Department of Energy Office of Science User Facility.  The authors declare that they have no competing interests.

The post Mayo Clinic researchers discover ‘hidden pocket’ in cancer-promoting enzyme appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I received a notice from my health system that I'm due for a colorectal cancer screening. I'm 45. Do I really need to have this done now? 

ANSWER: It's easy to be confused or overwhelmed by screening recommendations for common types of cancer. Your healthcare team is a trusted resource for keeping you up to date on screenings, including screening for colorectal cancer. 

Why, when and how should you be screened for this cancer? Test your knowledge of colon cancer screening with these myths and facts.   

Colorectal cancer is rare. 

Myth: Colorectal cancer is the second-leading cause of cancer-related death in men and women combined. Roughly 1 in 26 women will have colorectal cancer, and about 1 in 24 men will have colorectal cancer. To put that in perspective, when watching a football game, of all the players on the field, about one player would be diagnosed with colorectal cancer in their lifetime. 

Colorectal cancer can happen when you're young. 

Fact: The rate of colorectal cancer is increasing in people under 50. Rates of colorectal cancer in people under 50 have doubled since 1990. In people over 65, the diagnosis rates have been decreasing, most likely because of colorectal cancer screening.

Many younger adults don't consider themselves at risk. That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

Screening for colorectal cancer starts at age 45.  

Fact: In 2021, the recommendation for colorectal cancer was updated to begin screening at age 45. This is because the rate of diagnosis is increasing at younger ages.  

Colorectal cancer can be prevented with screening. 

Fact: The goal of colorectal cancer screening is to prevent cancer, not just find it when it has already developed. Most colorectal cancer develops from a polyp, a small, precancerous growth. The presence of polyps can easily be identified using colonoscopy screening tests. Polyps can be removed during a colonoscopy to prevent them from developing into cancer.

You can also help keep your colon healthy by:

• Add bulk to your diet with lots of veggies and whole grains.
• Eat healthy fats found in olive oil, salmon, avocados and nuts.
• Strive for 30 minutes of exercise most days of the week.
• Watch your weight. Carrying extra pounds has been shown to increase your risk for colon cancer.
• Drink alcohol in moderation, and don't smoke.

Family history is the only risk factor for colorectal cancer.  

Myth: While a family history of colorectal cancer influences your risk of developing cancer, other important risk factors increase the risk of developing colorectal cancer. Medical conditions including obesity and inflammatory bowel disease (IBD), and lifestyle choices, such as a diet high in red meats, smoking and alcohol use, increase risk. Because colorectal cancer is common, all adults over 45 should be screened regardless of family history.  

African Americans have a higher risk of developing colorectal cancer, and American Indian/Alaska Native people have the highest risk of colorectal cancer.   

A positive stool-based screening for colorectal cancer is the same as a cancer diagnosis.  

Myth: A stool-based test looks for more than cancer, and it can identify precancerous lesions or polyps. These tests don't address the polyp if a polyp is present in the colon. A follow-up colonoscopy is needed to identify the polyp and potentially remove it.  

If you have more questions, talk with your healthcare team about screening options for colorectal cancer at age 45.  

Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota  

The post Mayo Clinic Q&A: What do you know about colon cancer? appeared first on Mayo Clinic News Network.

When Dr. Bobby Mukkamala found himself on the other side of the exam table, he relied on the cutting-edge surgical techniques at Mayo Clinic to get him back to his professional work. 

While presenting at a professional meeting, Dr. Bobby Mukkamala, normally an eloquent speaker, began speaking incoherently for about 90 seconds. 

"Given my age of 53 at the time, I thought it was a 'senior moment,'" says Dr. Mukkamala, an otolaryngologist and head and neck surgeon from Flint, Michigan. 

His colleagues suspected he was having a stroke and convinced Dr. Mukkamala to go to a nearby emergency department for evaluation. Doctors suggested he may have had a transient ischemic attack, or ministroke. They recommended an MRI when he returned home.

That scan revealed something far more serious: a brain tumor. His journey as a patient had begun — and it would ultimately lead him to Mayo Clinic. 

Finding the right brain cancer care

After sharing the news with his family, Dr. Mukkamala tapped into his professional network. "Within a week of my diagnosis, I had half a dozen Zoom calls with neurosurgeons around the country," he says. "They were all wonderful with similar but slightly different perspectives on how to approach my case."

One call, however, stood out — his conversation with Dr. Ian Parney, (pictured here) a neurosurgeon at Mayo Clinic in Rochester, Minnesota and member of Mayo Clinic Comprehensive Cancer Center.

Dr. Parney knew the tumor was large, complex and near critical speech areas in the brain. "It was important to Dr. Mukkamala to protect those areas," says Dr. Parney.   

Unlike other surgeons who recommended two brain surgeries, Dr. Parney recommended a single awake craniotomy with speech mapping. During the procedure, the patient answers questions, and brain activity is monitored. This helps surgeons avoid damaging parts of the brain responsible for speech. His extensive experience — about 200 similar brain tumor procedures per year — gave hope to Dr. Mukkamala that the single operation was the best choice.

"Dr. Parney spent time answering every question we had," Dr. Mukkamala says. "That is what healthcare should be. As soon as we got off the call, my wife and kids said, 'That's it. That's where you're going.'"

Using advanced surgical techniques to guide care

In December 2024, Dr. Mukkamala underwent an awake craniotomy with speech mapping. The surgical team also used an intraoperative MRI. This advanced imaging technique provides real-time, high-resolution MRI scans while the surgery is in progress. 

"We do an MRI during the procedure to get the most accurate image so that we can remove the tumor safely," says Dr. Parney. Integrating functional imaging into image-guided systems in the operating room is a technique that Dr. Parney's team develops and tests to improve patient safety. He also correlates these techniques with novel strategies such as intraoperative electrophysiological mapping (using electrodes or electrical simulation to identify and preserve functions) and fluorescence-guided resection.

In Dr. Mukkamala's case, as part of the speech mapping, Dr. Nuri Ince, a professor of neurosurgery and biomedical engineering at Mayo Clinic, provided a novel electrocorticography technique that showed critical areas of function without requiring direct cortical stimulation (electrical signals to the brain's outer layer), as is usually necessary.

Dr. Parney and his colleagues were able to remove more than 90% of Dr. Mukkamala's tumor without damaging the speech areas. Six weeks after surgery, he was once again speaking professionally and confidently to large groups.

Coordinating multidisciplinary cancer care

Dr. Mukkamala's cancerous brain tumor was a low-grade IDH-mutant astrocytoma. This type of brain tumor arises from astrocytes (a type of glial cell in the brain) and carries a mutation in the IDH (isocitrate dehydrogenase) gene. 

After surgery, Dr. Mukkamala met Dr. Ugur Sener, a neuro-oncologist at Mayo Clinic, who prescribed a new targeted drug to treat any remaining cancerous cells. The less toxic therapy allowed Dr. Mukkamala to avoid chemotherapy and radiation, which are standard treatments for brain cancer that can cause side effects such as fatigue and nausea. 

"We've built one of the largest brain tumor practices in the world here at Mayo," Dr. Parney says. "We have the right resources and the right teams in place to provide cutting-edge therapies and holistic care."

Bringing new 'tumor wisdom' to the bedside

While his life today looks much like it did before his diagnosis, Dr. Mukkamala says his perspective is forever changed by his experience. "I used to be more science than emotion, but I've learned there's room for both," he says. 

Dr. Mukkamala was alone when he received the news that he had cancer, much like most of his patients were when he delivered hard news. "It never occurred to me before that it was a problem to share a diagnosis when a patient was alone," Dr. Mukkamala says. He now tries to ensure his patients have support. 

It's one of the many lessons he attributes to "tumor wisdom." "My brain may be a little smaller," says Dr. Mukkamala, "but I think it's happier and wiser."

The post How advanced surgical skills returned a physician to the podium after brain cancer appeared first on Mayo Clinic News Network.

Researchers are leading the nation in using powerful and precise radioactive drugs to treat people with complex cancers.  

ROCHESTER, Minn. — Mayo Clinic has treated the first person in the U.S. using a novel radioactive medicine for advanced breast cancer as part of an international multisite clinical trial.

The medicine used in this clinical trial contains actinium-225, a highly potent alpha-emitting radiopharmaceutical therapy that was first developed for a subtype of gastroenteropancreatic neuroendocrine tumors, which are rare and can form in the pancreas and the gastrointestinal tract. The alpha-emitting radiopharmaceutical therapy is intended to work by passing through the blood to stick to cancer cells, delivering powerful and precise radiation without harming healthy cells.

The Mayo Clinic researchers are the first to apply this therapy in America to a patient with metastatic breast cancer. The phase 1b/2 open-label trial is being conducted at all three academic Mayo Clinic sites in Rochester, Minnesota; Phoenix; Jacksonville, Florida; and approximately 20 other sites across the U.S. The first person treated was at Mayo Clinic in Florida.

The principal investigator at Mayo Clinic is Geoffrey Johnson, M.D., Ph.D., a professor of radiology and a leader in radiopharmaceutical therapies. He says these are innovative cancer treatments that use radioactive medicines designed to target and kill cancer cells with high precision.

Mayo Clinic has nearly 20 active radiopharmaceutical therapy clinical trials, with 10 more preparing to launch, targeting many different types of cancer. Mayo Clinic in Rochester treats more patients with modern radiopharmaceutical therapies, such as lutetium dotatate for neuroendocrine cancers and lutetium PSMA for prostate cancers, than any other center in the world.

Lutetium dotatate and lutetium PSMA are beta-emitting radiopharmaceuticals. They use beta particles, which are tiny subatomic particles, to radiate at a low level. In contrast, alpha-emitting radiopharmaceuticals use alpha particles that are 8,000 times more massive than beta particles, and travel only three cell diameters after they are emitted from the therapy.

"This means alpha emitters can deliver a much more powerful impact over a shorter distance. If you consider killing a cancer cell is like knocking down a brick wall, then the difference is like throwing a 10-pound dumbbell (beta) at the wall versus a fully loaded Mack truck (alpha)," says Dr. Johnson. "The alpha emitter's potential lies in its power and in its ability to precisely kill even a single cancer cell without injuring surrounding healthy tissue, making it a next-generation therapy."

In preclinical studies, data indicates actinium-225 DOTATATE that targets the somatostatin receptor subtype 2expression demonstrated feasibility and potential efficacy for treatment of ER+ metastatic breast cancer in the laboratory. The drug was developed by RayzeBio Inc., a Bristol Myers Squibb Company, the sponsor of the active phase 1b/2 clinical trial.

Study Title: Phase 1b/2 Open-label Trial of 225Ac-DOTATATE (RYZ101) in Subjects with Estrogen Receptor-positive (ER+), Human Epidermal Growth Factor Receptor 2 (HER2)-negative, Locally Advanced and Unresectable or Metastatic Breast Cancer Expressing Somatostatin Receptors (SSTRs) and Progressed After Antibody-drug Conjugates And/or Chemotherapy (TRACY-1)

• Descriptor: Phase 1b/2 open-label trial of 225Ac-DOTATATE (RYZ101) alone and with pembrolizumab in subjects with ER+, HER2-negative unresectable or metastatic breast cancer expressing SSTRs.
• Sponsor: RayzeBio Inc.
• Link: https://clinicaltrials.gov/study/NCT06590857

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Brittany Cordeiro, Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer appeared first on Mayo Clinic News Network.

In April 2023, CV Rao had just returned from a work trip in Europe when he started experiencing abdominal pain on his right side. His wife, a doctor, recognized that he needed to see his primary care physician for an ultrasound scan. 

When the ultrasound didn't show anything, CV's care team ordered a CT scan. The results were alarming — a 7 centimeter tumor, the size of a large peach, was in his liver. 

"It was a shock to the system," CV recalls. 

The initial diagnosis suggested intrahepatic cholangiocarcinoma, a rare and aggressive cancer of the bile ducts.

CV quickly received a PET scan, an MRI and a biopsy at a local hospital which confirmed those suspicions. Within eight days, CV was undergoing chemotherapy to shrink the tumor so he might be eligible for surgery.

After six cycles of chemotherapy, the tumor was reevaluated. The good news was that the cancer was responsive to chemotherapy, and the tumor had shrunk by about 50%. Unfortunately, because the tumor surrounded major blood vessels, local surgeons still deemed it inoperable.

Seeking a second opinion

Determined to explore all options, CV sought a second opinion at Mayo Clinic. 

"I was working on 3D printing investments and kept running into Mayo's innovative approaches," he explains. "Everywhere I looked, they had this 3D printing effort where the surgeons were able to visualize what they were operating on using 3D printed organs."

This led him to believe that Mayo Clinic could offer a solution.

A new hope

Six months after diagnosis, CV and his wife, Madhavi, sat across from Harmeet Malhi, M.B.B.S., a hepatologist at Mayo Clinic in Rochester.

"We want to give every patient every chance. Undergoing surgery was his best chance at being tumor-free."

Harmeet Malhi, M.B.B.S.

After reviewing his imaging and personalized treatment plan with Dr. Malhi, CV and his wife met with Patrick Starlinger, M.D., Ph.D., a hepatobiliary and pancreas surgeon. 

"Dr. Starlinger looked at me and said, 'You came to the right place. We can help you with this,'" CV remembers.

All three liver veins appeared to be involved. This type of tumor usually is not removable because there must be at least one vein to drain the liver, according to Dr. Starlinger.

"We told him to continue chemotherapy to maximize his response, aiming to get the tumor even smaller. And then we planned for advanced, complex liver surgery."

Patrick Starlinger, M.D.

Although CV understood this would be a high-risk procedure, he remembers feeling reassured after speaking with Dr. Starlinger.

"Dr. Starlinger looked at his fellows and said, 'Would you say this is routine?' And they all said 'Yes, it's a routine surgery for us,'" CV says.

As a native of Austria, Dr. Starlinger explains, "In German, we have a word that means saying 'yes' to life, 'lebensbejahend,' and that's how CV approached this. Both CV and his wife had such positive attitudes and a willingness to fight this with all they had."

CV believes the same can be said of Dr. Starlinger's approach to his case. 

"The very first day, Dr. Starlinger walked in with a positive attitude, which is one of the things that you realize you absolutely need to get through things like this," CV says.

Resecting the unresectable

CV's surgery was scheduled for November 22, 2023, the day before Thanksgiving. 

To prepare for the operation, Dr. Starlinger turned to a 3D printed model of CV's anatomy, just like the ones that had led CV to Mayo Clinic.

"3D models are incredibly helpful in complex surgical procedures because they allow for optimized surgical planning prior to the actual surgery," Dr. Starlinger explains.

At 6 a.m. on Nov. 22, CV was taken back to the operating room for the complex, 4.5-hour surgery. 

"We carefully dissected through the liver until we approached the right hepatic vein, which was really the critical portion of CV's operation," Dr. Starlinger says. "We had everything prepared to reimplant the only remaining liver vein, but with meticulous precision, using an ultrasound dissection device, we were ultimately able to peel the tumor off the majority of the right hepatic vein and perform a primary repair of the vessel."

Dr. Starlinger and the surgical team removed roughly 50% of CV's liver, along with the entire tumor. The surgery was a success.

Experiencing cherished milestones

Nearly two years after his diagnosis, CV is returning to the activities he loved. He has resumed skiing, attended his younger son's robotics competitions, and even traveled to Switzerland and Austria with his wife. 

"I can't wait to see my older son graduate and drop him off at college," he shares with a smile. "We are in a stage of life where a lot of life events are happening. It's amazing to do these things that are important to the family."

These moments, once clouded by uncertainty, are now cherished milestones.

Reflecting on his care at Mayo Clinic, CV expresses deep gratitude to the team that provided him with expert and compassionate treatment. 

"The Mayo Clinic staff is beyond what we've experienced elsewhere," he says. "During my seven days in the hospital, we interacted with many nurses, and through changes in shifts, it was just a uniformly amazing experience. Every, every single person we came in touch with was such a positive experience."

"We wish Dr. Starlinger the longest career possible because the number of lives he has and will save is incredible," he says. 

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The post Resecting the unresectable: The right place, the right team  appeared first on Mayo Clinic News Network.

For many cancer patients, treatment can be an isolating and overwhelming journey — marked by fear, fatigue and the constant burden of travel. But what if chemotherapy could be delivered at home? In this episode, we explore the movement to bring cancer care into the comfort of patients' homes. Could this shift not only ease the experience but also improve outcomes?

This week's episode of Tomorrow’s Cure features insights from Dr. Roxana Dronca, hematologist, oncologist and director of Mayo Clinic in Florida Comprehensive Cancer Center; and Dr. Arif Kamal, chief patient officer for the American Cancer Society. 

According to the American Cancer Society, someone in the U.S. is diagnosed with cancer every 15 seconds. That staggering statistic drives the urgent push for more patient-centered, accessible care models. But what does that look like in practice?

For Dr. Dronca, this mission is personal — her daughter's cancer diagnosis revealed just how taxing traditional care can be. Out of that experience came a passionate commitment to transform how and where cancer care is delivered.

"I think cancer care, part of the scariness of it is how unknown it is, how unfamiliar it is in its approach," said Dr. Kamal. "But what if we could soften it by making components of it actually feel as normal as we can?"

Mayo Clinic's response: Cancer CARE (Connected Access and Remote Expertise) Beyond Walls, a new model offering expert care outside of hospital walls. The initiative minimizes travel and maximizes access by combining in-home services with a Mayo Clinic-based command center staffed by advanced practice providers, nurses and hospitalists. This team remotely coordinates care, ensuring seamless integration with each patient's medical history.

"I see that there is no choice every time I speak about Cancer CARE Beyond Walls," stated Dr. Dronca. 

In today's world, "Patients live longer, they need more treatments and we have more cancer diagnoses. We're really being outpaced in our ability to offer treatment to everyone in our physical spaces. So, we either think creatively and design a system where we can get care to more patients and also make the care more patient-friendly, or we build more chemotherapy units."

At-home cancer care isn't just a vision — it's happening now. Join us as we explore this transformative approach to care and what it means for the future of oncology. Listen to the latest episode of Tomorrow's Cure to learn more. 

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The post Tomorrow’s Cure: The future of cancer care is at home appeared first on Mayo Clinic News Network.