My name is Donna Fox and I was diagnosed with renal cell carcinoma in January of 2008. My cancer has returned six more times.

How has it affected my mindset and outlook on life? That's a tough question to which there is no simple answer. I was shocked by my original diagnosis as I had no obvious symptoms despite a three and 1/2 lb. tumor growing inside me. At the time there was no chemotherapy or radiation to treat kidney cancer. There was a clinical trial, but the potential side effects frightened, me so I declined.

I never said "why me" and I guess I believe it certainly could be me so I spent time communicating with family and friends and trying to keep normalcy in my life. I didn't want my life to be different post cancer but as for my outlook....I began to take stock of what I was doing and where I was going and decided to just keep it simple. I really did not change many things in my life and after I recovered from the surgery I felt fine so getting back to "normal" was not difficult. I never used the words "new normal."

I enthusiastically became a member of a cancer support group which was the best thing I ever did. We all had different cancer diagnoses but the fears and the feelings were the same. There was such joy and laughter in that group that I could not be sad or hopeless. 

Because my cancer has returned so many times with five additional surgeries and one cyberKnife treatment I value each day. I try, desperately I might add, to surround myself with positive people which is not always easy. I hold on to my spiritual beliefs and laugh whenever I can and bring joy to those around me whenever I can.

I have no idea what the future or the next set of CT scans will show but I do know this......I will continue to be me plain and simple and laugh when I can because to me laughter is the best!

For more news on cancer updates, research and education, don’t forget to 

How Cancer Changed My Mindset

Donna Fox

There was no evidence that CAR T directly caused secondary malignancies, despite FDA warnings, citing prior treatments as the cause, according to research.

A Study Investigates If CAR T Therapy Directly Causes Secondary Malignancies

Despite the Food and Drug Administration (FDA) requesting that approved BCMA- or CD-19-targeted CAR T-cell therapies come with a warning following reports of T-cell malignancies, including CAR-positive lymphoma, among patients who received the treatment, researchers have announced that they have found no evidence that the therapy caused secondary cancer in modified T cells.

That’s according to research published in 

 from the Perelman School of Medicine at the University of Pennsylvania and Penn Medicine’s Abramson Cancer Center.

CAR T-cell therapy, as defined by the National Cancer Institute, utilizes a patient’s T cells, part of the immune system, which are extracted, changed in a laboratory to attack cancer cells, grown in the laboratory and infused back into the patient. The treatment, according to a news release from Penn Medicine, involves the use of engineered viruses to deliver genetic instructions that enable a patient’s T cells to target and eliminate cancer cells. There is, according to the release, a risk of a cancer-associated gene mistakenly being turned on and causing unregulated growth, which is known as insertional mutagenesis.

Researchers drew on data from 783 adult and pediatric patients who received treatment with CAR T-cell therapy at Penn Medicine and Children’s Hospital of Philadelphia in clinical trials, and found 18 cases of secondary cancers, noting that there was no evidence that these cancers were caused by intentional mutagenesis. Instead, researchers cited suppression of the immune system from prior cancer treatments as the cause of the secondary cancers.

 associated with CAR T-cell therapy in Nov. 2023, and 

 to pharmaceutical companies behind CAR T-cell therapies asking that their labeling contain a warning of secondary malignancies and that patient counseling information and medication guide also mention the risk for cancers.

 study’s co-senior author, Dr. Joseph Fraietta, about the findings and what they mean for patients. Fraietta is an assistant professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania.

After looking at over 38 clinical trials of cell therapies and engineered T cell therapies — not only CAR T-cell therapies — with over 2,200 years of total patient follow-up, the frequency of secondary malignancies is very low, actually. Across our trials, none of them were directly attributed to the engineered cell product. In other words, the cell product really didn't grow out and cause any issues.

I hope [the study] puts CAR T-cell therapies more into context in terms of the relative risk with other sorts of therapies as well. And notably, this is our experience at the University of Pennsylvania, although similar studies by other groups, these large safety data sets, they're coming out. But with that, there are also isolated instances of some of these products causing secondary malignancies, but they're very few and far between. I'm not sure how the FDA will look at it, because there's still a risk. However, these secondary malignancies that are directly attributed to the CAR T-cell products are infrequent.

Transcript has been edited for clarity and conciseness.

Dr. Joseph Fraietta is an assistant professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania.

Dr. Joseph Fraietta

“Is it OK if I take care of you today?”

That was the question Robin asked, soon after my arrival and check-in at the Infusion Center for a routine blood transfusion. Pleasantly surprised to see her in an unexpected location, and amused by the question, I readily agreed! After all, I knew Robin quite well, as she was my primary nurse while hospitalized for a bone marrow transplant six months earlier. I soon learned she had recently transferred from the Bone Marrow Transplant (BMT) program to the Infusion Center.

Over the next few hours, as Robin administered expert nursing care, we caught up on each other’s lives and celebrated my post-transplant health improvement. It was a nice way to spend a morning; hospital visits are rarely (if ever!) better than this one.

Robin gained my unequivocal trust at our very first encounter during my hospital stay. Disguised as a relaxed and friendly conversation, she interviewed me to better understand my history as a lymphoma patient, the precise circumstances of the ongoing BMT process, and perhaps most importantly, my concerns and fears. Though other healthcare providers were coming and going, she made no attempt to prevent them from hearing the conversation; that is, until the questions became more personal. At that point, Robin inspected my IV access port, allowing her to continue the conversation with one-on-one privacy. It was skillfully done with the utmost calm, gentleness, and sincerity, and gave me space to answer questions with complete honesty.

Over the next two weeks, at every encounter, trust in Robin’s abilities as a skilled nurse, as well as an empathetic and compassionate human being, was reinforced. She became a confidant to me and my wife, Sue, patiently answering our questions and helping us navigate a difficult and often frightening process.

A simple gesture, though one that provided a great deal of tranquility, was Robin’s practice of telling me her schedule at the beginning of each work shift. As she regularly worked 12-hour days, it was comforting to know the same person would care for me for an extended period. This is not to imply concerns for those days and times when others were on duty, as I received consistently high-quality and professional care from everyone in the transplant unit: nurses, nurse aides, doctors, NPs, and PAs, as well as myriad others like custodians and the cafeteria staff who delivered my meals. Rather, it was the bond of trust, through the repetition of skilled nursing care and many, many conversations, that made Robin stand out among an amazing group of caregivers.

At my company, we pride ourselves in “taking care of people”. The expectation for each employee is to give full attention to the needs of our clients and do the best job possible while at work. For myself, as a project manager, this means producing construction documents that reflect our clients’ physical space requirements, and then working with contractors to get designs built accurately and within budget. Analogous to Robin’s work as a nurse, it focuses effort on the needs of others.

A profound difference between my work as an architectural consultant and nursing care at UW Health, however, is the personal and very “hands-on” aspect of nursing. This is particularly true for those of us requiring extended care for difficult and sometimes life-threatening conditions. The care and compassion displayed by Robin was truly extraordinary and will always be remembered. The DAISY Award sculpture entitled “A Healer’s Touch” is apropos for her attention to detail. As Robin passed the foot of my bed at the end of each visit, she would often give my big toe a gentle wiggle, as if saying “Don’t worry, Jeff, I have you covered – you’re safe”.

I can think of no one who better exemplifies the ideals of “taking care of people” and the mission of The DAISY Foundation.

The narrative highlights the exceptional care provided by a nurse named Robin during a patient's bone marrow transplant and subsequent visits to the Infusion Center. Robin's empathetic and skilled approach fostered a strong bond of trust with the patient and his wife, offering comfort and reassurance throughout the treatment process. Her dedication to patient care, characterized by personal attention and compassion, exemplifies the ideals of "taking care of people" and aligns with the mission of The DAISY Foundation, which honors extraordinary nursing professionals.

A Healer’s Touch During My Experience With Cancer Care

Jeff Gaard 

A dear friend I have known for many years gave me a call on his way home from the hospital on one Saturday night. His wife just had breast cancer surgery. He was uplifting as always and happy to talk, sharing news about her and what they had to do in the following months. We talked about our faith and how our lives have gone through some detours.

As I listened to him, I paused … I was reliving some of the moments of the past year. It has been almost a year since my first appointment with my breast cancer surgeon, Dr. Pat Whitworth. I can still smell the cool October air.

On October 16, 2019, my life drastically changed, and I had to embrace a completely new journey. The past 11 months have brought many transformations with a lot of sweet “aha” moments and pure tears of joy. It has been a year of deep forgiveness and healing. It was my personal journey to find my anchors and evaluate many priorities in my life, let go of the things that did not matter anymore and say yes to the happy me.

Looking back at the past year, my quest was to embrace the change and find love tucked in my heart that I somehow lost a few years ago following my divorce. As I write this, the sunshine that peeks through the curtains reminds me of the good days ahead … Sometimes you might ask yourself, “Why do I go through all these challenges and trials.”

Then I realized, I was providing support to a dear friend and his wife who too had breast cancer. At the end of the call, my friend asked what I did differently that brought me out of the fear zone and into the warrior mode.

There was a pause then I answered, “It was my choice to either let life happen to me or pray for God’s wisdom to make the right decisions and be proactive in my healing journey.”

We have a blind faith and maybe it is important to be faithful, but the truth is that healing does not happen by doing nothing. It takes bold faith and action. It requires discovering who you are and finding your way.

You can choose to find your calm and your anchor. You can choose to stay positive. You can also surround yourself with women who have been in your shoes and could give you solid advice.

There is an amazing level of inner strength that you feel coming from these warriors. They might be fragile and petite, but they are strong.

Every day is a battle. But we have a choice to make things happen every day. We can look at our life as an opportunity to grow even when it hurts, or we can give up and not care.

So, let’s highlight some things you must become to get through any life challenge, especially breast cancer.

Being a strong woman is more than being a female version of a Roman Gladiator. There is nothing that can be compared to the strength you find when cancer attacks your body and you learn to love yourself even more. Being strong is the only choice you have and first you will cry, break down, fall apart and then you will gradually put yourself back together. Every day I would affirm I choose life. Because tomorrow is not guaranteed. You give the best to yourself first.

Speak your desires into existence. Speak healing and love into your life. That is where your strength is hidden. It is the power of your words that changes your mindset, changes your energy, and changes your life. Those words can bring peace or cause stress.

The first time I came to Dr. Whitworth’s office, there was a poster on the wall about managing stress. 

 was an amazing way to identify where you were on your healing journey.

Gratitude has led me to experience more love and the hardest thing I had to do was to learn to accept love as well. Many strong women often do not know how to love themselves fully and they have a hard time accepting love and care from others. Often it is a cultural thing or a family thing. In my Russian culture, women were taught to never complain and take care of their lives. We were taught to survive and get through times of crisis with a smile.

When you learn to accept love, you will feel worthy. And when you feel worthy of being loved and appreciated for who you are, your life will change. Your transformation will happen fast when you learn to accept love and love yourself. Because everything you will do in your life will come from the place of love for who you are, including your healing, your relationships, your career, and your business. Everything will change.

Allowing others to help you and accepting care and love is something I had to learn in the past few years. You want to be Wonder Woman, ready to take on any challenge. When you agree with the idea that having help is totally cool, you finally realize once you accept love you can give more love back into the world. Your heart is finally healing and everything else falls in place. You are more motivated to do things you have delayed for a long time and you are motivated to change your lifestyle.

Good support system and solid medical team

I have been very blessed to have an amazing surgeon. He is an incredible doctor who has been a big blessing in my life and has encouraged me to practice mindfulness and work on reducing stress.

I am grateful for my friends that provided an amazing holistic health education.

I am grateful for my church friends who supported me in so many ways. I am so grateful for my dear friends who reminded me how strong I was and who prayed for me and my healing.

I am grateful for my book agent Julie who inspired me to write and share real life experiences.

I am grateful to my sons who are my rock and joy. They are my miracles. They are my true loves.

I am grateful to my parents from whom I have managed to hide the truth about the breast cancer diagnoses for many months and finally gave in and revealed the news. I am grateful they stayed calm.

I am grateful for this journey and for my life.

Are you grateful for your inner circle? Make sure to tell them today.

When you truly embrace your strength, find gratitude and self-love and surround yourself with loving and positive people, magic things can happen.

Tatyana Gann is a publicity strategist, mindset coach, writer, lifestyle advocate and breast cancer thriver. Her aim is to inspire women to tell their story to heal their mind and body. Tatyana resides in Nashville with her two sons. You can follow her on Instagram 

Looking to change your mindset when facing down breast cancer? Here are 3 hacks to keep you calm and happy. 

3 Mindset Hacks That Can Keep Women Facing Breast Cancer Calm and Happy

Tatyana Gann

We are going to move to the last piece here: thinking about how we can do better overall. Tim and Jamie, overall, what do you think? I know you think that we do great, but think about the overall world of cancer we live in. What do you think oncologists and the oncology team can improve in terms of managing patients, in terms of education, and in terms of treatment care? There are also a lot of financial implications, and we have not touched upon those. There is a whole hour that we could spend talking about that effect. Then, of course, how do we make sure that we end up meeting your needs? Any high-level thoughts about this?

It is all those things you just touched on. You worry about it. You always hear the scary stories of people who have exhausted their life savings to live two months longer, so that is something definite that we decided. I could have kept working, but my goal was to retire at age 55, so I stayed true to that. Keeping Jamie’s job and the insurance takes a bit of the burden off me as far as getting to the right providers. I did not have to change. We have gone through three insurance companies, and we have been able to stay with the same providers. That has helped a lot for consistency and everything.

You bring up a great question overall. Yes, we feel fortunate to have fallen into your hands, Dr. Bekaii-Saab, and Kelley’s, and that is great care. Looking more holistically, that is an important question. As great a job as you guys do, sometimes the pieces are not all connected. You guys do a great job, but then I get a bill from an insurance company saying that they are not going to pay for something. Sometimes it feels like the left hand does not talk to the right hand, and I have to fight with an insurance company. I have to get the paperwork that they need because they do not understand that a medication is not indicated for this, but it is still used that way in the oncology world. All those little pieces, sometimes from a holistic perspective, are out there floating around. I do not know what the answer is, but it feels overwhelming to try to keep all the pieces together. I often think about even older patients who might not have the ability to pull all those pieces together. How do they manage with all this? We are fortunate that we are in the field we are and that we have the resources we have. Even with all that, it can be overwhelming to fight with an insurance company or to try to get documentation when you just did that last month. Those are the pieces that, as a society, we could do better at.

Absolutely. Reese, what about financial resources or directing patients to financial resources and navigating that? In addition to having a diagnosis of cancer and having to fight through that, you now have to worry about the finances and financial support as well as fighting insurers and filing for bankruptcy for some patients. There are a lot more tragedies than the eye can see. What tools are you able to use to help with this, or what tools may be needed in your viewpoint—if they are not out there—to educate folks more?

 Fight CRC [colorectal cancer] does not provide financial support directly, and we generally point to our partners at Triage Cancer who are in tune with the legal battles patients and their families may face as well as insurance issues and finances. We have an established relationship with them, and we will do webinars every year or so to update our community on the different things that they might need to know. I would say that, even though we do not provide the financial support or necessarily the legal advice directly, we work with others to do so. From an oncological and a medical perspective, staying abreast of what advocacy organizations do and what types of resources they offer is extremely important to be able to point patients to the resources that exist, because there is a lot out there. Sometimes, it is not necessarily projected as much as it could be, but there are resources out there that are available, and advocacy organizations know about them and are able to point patients and their loved ones to those resources.

Kelley, you help oversee, manage and ensure that the patients are navigated safely through their journey, and it takes a big team. You have the pharmacist and the nurse working with you and others as well. If you have to give guidance or give advice to other health care providers, patients or caregivers about the model that—from your viewpoint—facilitates this level of care the most, what would you say to your peers?

You have to have a conversation with your patients regularly about what they need. A lot of times, patients do not want to bother us with stuff: “I am having this thing, but I did not want to tell you because I know you are busy.” We have to listen to what our patients are telling us, and we have to educate them about letting us know what they need. We at the Mayo Clinic are pretty fortunate in that we have a lot of resources that other facilities may not necessarily have. We have social workers who are fantastic, and we have pharmacists who are brilliant. If a family member, patient or colleague outside oncology recognizes something that is happening, all they have to do is let us know. We may not have the answer for it, but we may be able to do something to make things better.

We are certainly blessed to have that level of support for our patients. There are a lot of folks who work in the background: the finance person, the nurse, the technician, the pharmacist, the nurse practitioner, the physicians, from the chemotherapy nurse to the nurse who is focused on education, the navigator. It is a big team. The complexities of the system around how we care for our patients is immense, and we certainly hope to continue improving things with the support of organizations and advocacy groups with Reese’s work. Of course, we do all this for our patients, for you, Tim, and certainly for their families, Jamie and their son.

With that, I am going to thank all of you for this wonderful exchange. It was very educational, and it is great to be able to have this discussion with all of you. Thank you.

Improving Colorectal Cancer Management

Reese Garcia, Fight Colorectal Cancer

There is never a good time to be told you have cancer. This is the story I told myself as I pulled into my driveway to share the news with my husband. Only minutes prior to arriving home I had learned that my husband had a cancerous tumor inside his stomach. He was mowing the lawn, one of his favorite things to do, and I had to ruin it by sharing with him the results of his most recent endoscopy.

I can’t say that we were completely surprised due to the many events and tests leading up to this news, but regardless, this isn’t the news that anyone asks for. I took a deep breath and headed for the backyard. He stopped the lawnmower and I asked him to sit next to me on the deck. I told him that the results of his biopsy showed that the spot in his stomach was gastric adenocarcinoma, an aggressive form of stomach cancer. Without much emotion on his face, he said, “OK, well I am going to finish mowing the lawn, and then we can talk more about it.”

I, of course, must process information immediately, whereas he can put it aside and save it for later. Or can he? This is a question that I regularly consider. What goes on in his mind? Is he just mentally tougher than I am? Is it healthy that he can compartmentalize these things? Or maybe he just puts on a strong front for me? How do patients with cancer process such news?

When your spouse has cancer, you have cancer. It may sound extreme to say, but it’s the truth, and I have heard it a dozen times from families in similar situations. We chose to be married because we didn’t want to be apart. We chose to get married because we preferred living together, more than living separately. We are both independent people who are capable of being on our own, but we don’t want to be. His problems are my problems the same way mine are his. And so, together we face the life that cancer brought us. That, however, doesn’t mean we process news the same.

Many cancer survivors and patients I speak to are not as blindsided by the news as one might expect them to be. There were events or problems that led them into the doctor’s office to begin with. There were tests done looking for something, anything to explain the abnormal ailments that are disrupting their lives. That doesn’t mean the big ‘C’ word came to them any easier though. Some hear the news and feel confident that they will fight it, they know it will be hard, but they have witnessed others successfully fight cancer. Others are hit a little harder, they feel scared, they feel worried, the unknowns come at them and not only do their minds go into overdrive, but their bodies fill with adrenaline and they shake, quiver and some even say that suddenly they can’t hear and the room goes dark.

When I asked my husband later what he felt and where his thoughts went when I told him the news, he said he was sad, and he was worried. He was sad for me; it wasn’t fair to me that I would have to go through this. He was sad for his daughters. He was 8 years old when his mother died and he had to be raised by one parent, and he wanted nothing more than his children to have two parents. What a simple request?

He worried about how we would handle it if he died. He feared how all his loved ones would process the news. Initially, there was little concern for his own wellbeing. This is not unusual, as I speak to victims of cancer, I hear similar stories. There is little worry about how they will handle treatments or death, but more worry about how the ones they love will survive the rough roads of transitioning to a life without them. They worry about how their loved ones will handle watching them suffer through the pain and discomfort that comes with surgery, radiation, chemotherapy or any other cancer treatment.

Cancer makes your mind wander in many strange directions. If ever you wanted to know what an emotional rollercoaster really felt like, get on the cancer coaster and go for a ride. One minute you are sad, sad for your future, sad for you or your loved one’s state of being, and the next minute you are angry. You’re angry it even happened to you, and anger turns to guilt.

A cancer survivor may feel guilt that they survived the same prognosis as another patient they’ve met, or they may feel guilt for their spouse who has had to change their life to care for them. Amongst the bumps and the curves comes the question that never goes away even as a survivor, why me? How did I get cancer to begin with? What did I do wrong? A parent may fear that their child will get the same prognosis. There is no escaping all the emotions that come with cancer, and for many those highs and lows stay with them even if cancer doesn’t.

Stomach cancer is a rare breed of disease, it is one of the top three leading causes of cancer-related deaths. It isn’t a type of cancer you hear much about and it isn’t one you want to Google. As a person that likes data and has a love for science, cancer brings uncertainty and confusion. The same people that like to share statistics about how well the newest drug works are now telling you to ignore statistics. The statistics you read online don’t know you, they don’t factor in the many variables of your life. They don’t consider your unique self. Statistics only increase the level of uncertainty you feel when you are seeking answers.

There are many lessons that must be learned when you’re diagnosed with cancer and the biggest one of all is to be patient, live your life one day at a time, and stop looking ahead. Don’t plan, don’t prepare for the worst, that only wastes the time you have living what is left of your best life, yet the fear of optimism stalks you. My husband is strong, because since the removal of his stomach, he struggles to eat enough calories to fuel his body's needs, serving as a constant reminder to what he faced.

However, he didn't spend a lot of time angry that this happened to him. This changed when in the middle of a nationwide pandemic, we sat on the phone and listened to the oncologist tell us once more that he had cancer. Again, or still? It doesn’t matter, months earlier we were happy to hear that the surgery was successful in removing the tumor and all the margins were clear, yet it still didn’t stop the cancer from spreading. This time around, we talked. We sat down and we cried for a minute, then we remembered that nothing was going to happen tomorrow, or even next week. We knew what came with news like this; more tests. We knew because we had lived through this before. Even if we wanted it to, cancer doesn’t always move fast. It makes people suffer in the last years of their lives. We had processed the long-term effects of cancer once already; it didn’t take as long to process information the second time around. Is it possible to get “good at cancer?”

I saw a shred of optimism leave my husband as he got the news the second time. A person can feel confident in beating cancer, round one, but cancer round two that has spread outside of the original location feels like cancer won, and you lost. Cancer makes a person vulnerable. You see people you love cry that you didn’t think were criers. You witness people that are smart and capable of taking care of themselves rely heavily on you. Not just physically, but mentally and emotionally too. You become not only an extra set of hands, but a set of ears too.

Patients with cancer need you by their side when they meet with their oncologist. No matter how capable they are, they can’t take in and remember everything they are told at a doctor’s appointment. Their ears are ringing and tunnel vision creeps in as the news of each scan layers on more fear. Some are too numb to cry. The crying will hit them later when they least expect it. Maybe while they are watching their children or grandchildren play. Maybe it will come to them simply while they are at the grocery store. Or while they are laying in their chair unable to sleep due to symptoms of chemotherapy. The emotions will come, and they won’t always be prepared.

In some instances, after processing the news of a cancer diagnosis, the patient may realize that the fear and worry they are facing isn't permanent, and that for them cancer isn’t a death sentence. Several breast cancer survivors shared with me that they quickly realized that they would survive their diagnosis, but not without discomfort.

The breast cancer survivors had to check all the boxes, face the treatments and in some cases, undergo surgery. With recovery time they could move on with their lives and with a new level of gratitude and respect for the disease and others who face it. It may sound simple. However, treatments such as chemotherapy take every ounce of goodness out of you before you can begin to recover. One cancer survivor told me she chose to keep her cancer journey private. She said she knew that she would survive, and she didn’t want to be treated differently by her grown children, so she didn’t tell them until she was nearly finished with treatment. This may be rare, but the reasoning behind her decision isn’t rare. When you are diagnosed with cancer, people around you simply don’t know how to act, or what to say. People say things that make your skin cringe, and your eyes roll to the back or your head. They want to offer you the latest and greatest cancer treatments they heard about on the internet. It can take a lot for a person living with cancer to avoid coming unglued when they hear, “Have you heard about fill-in-the-blank-miracle-cure?”

As the caregiver, it can often fill me with frustration when a person tells me to not forget to take care of myself. First of all, I feel that I am doing a pretty good job of that, but mostly, they are forgetting what happens at home, the condition of the person suffering, you can’t ignore that to go out for some “me-time.” Your purpose has become taking care of your loved one. Be it so that they can get through this and live a long healthy life with you, or to make them as comfortable as possible for the remainder of their days. There is simply nothing perfect to say to someone that is living with cancer. I have learned that the best thing to say is a simple, “I’m sorry.” Those two words sum it up, simplify it, and keep a person from saying the wrong thing at the wrong time.

What goes on in the mind of a patient with cancer depends on the individual. Most can confirm that they feel every emotion, sometimes all in one day. They are afraid, and there are very few moments in the day that they are not thinking about cancer. Cancer follows them around wherever they go. Sometimes it shows itself with pain, discomfort and other physical symptoms. But even when it is hiding, the possibility of treatments working or not flood their mind. Cancer doesn’t go away. Cancer victims never get a day off from thinking and breathing cancer. No matter how hard they try, cancer stalks them, and they just never know when it is going to strike again.

Cancer makes your mind wander in many strange directions. If ever you wanted to know what an emotional rollercoaster really felt like, get on the cancer coaster and go for a ride.

The Mind of Cancer

Brittney Garcia

An Overview of Myelodysplastic Syndromes

Work-up of Myelodysplastic Syndromes

Monocytosis in Myelodysplastic Syndromes

Risk Assessment & Genetic Testing in Myelodysplastic Syndromes

NGS in Myelodysplastic Syndromes

Treatment Approach in Myelodysplastic Syndromes

Therapy Options in Low-Risk Myelodysplastic Syndromes

Treatment Goals in Myelodysplastic Syndromes

Understanding the MEDALIST Trial

Luspatercept in the Treatment of Myelodysplastic Syndromes

Possible Treatment Options for Myelodysplastic Syndromes

A Multidisciplinary Team in Treating Myelodysplastic Syndromes

Management of Myelodysplastic Syndromes 

Guillermo Garcia-Manero, MD, MD Anderson Cancer Center

Primary urothelial cancer has variable histologies, making its treatment complex, leading to varied outcomes with high rates of recurrence in patients.

An Expert Explains Risk and Outcomes of Primary Urothelial Cancer Treatment

Primary urothelial cancer has variable histologies, making its treatment complex, leading to varied treatment outcomes with high rates of recurrence in patients, according to data from a retrospective study which was presented in a poster at the 

2025 ASCO Genitourinary Cancers Symposium

The investigation analyzed clinical outcomes in 82 patients across 10 international cancer centers; the most common histologies were urothelial carcinoma (40%), squamous carcinoma (32%) and adenocarcinoma (12%) and patients were diagnosed with stage 2 (30%), 3 (26%) or 4 (44%) disease. Treatment approaches varied, with 51% undergoing surgery alone, 19% receiving neoadjuvant chemotherapy followed by surgery and 11% undergoing concurrent chemoradiation followed by surgery. Furthermore, the overall disease-free survival rate was 54% after a median follow-up of 15.5 months, with 43% experiencing disease recurrence.

In an interview with CURE®, Dr. Rohan Garje, lead author of the study, delved deeper into these outcomes, discussing what the biggest challenges in treating invasive primary urethral cancer are, and how patients can best work with their healthcare team to improve their chances of a successful outcome. Garje is a medical oncologist and the chief of genitourinary medical oncology at Miami Cancer Institute in Florida.

The biggest thing I would say for patients is [to understand] that this is a rare cancer, so try to get an opinion from centers which are tertiary cancer centers. This is because that gives them access to potential clinical trials and also requests for multidisciplinary care. I believe that that is key.

One important thing is that there are some risk factors for primary urethral cancer, including patients with history of urethral strictures, sexually transmitted disease or urethral trauma. In females [this increased risk] comes from birth related injuries to their urethra, making them high-risk for this cancer. Keeping an eye on those symptoms, having a routine follow-up with their primary care physician or urologist [is vital]. I know it's a rare, rare cancer, but [do not] ignore symptoms. Once a workup has been done, if there is some concern for cancer, seeking care at a tertiary treatment center or a multidisciplinary approach is key for better outcomes.

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An Expert Explains The Risk and Outcomes of Primary Urothelial Cancer Treatment

Dr. Rohan Garje is a medical oncologist and the chief of genitourinary medical oncology at Miami Cancer Institute in Florida.

Dr. Rohan Garje

Dr. Paul Gellhaus says PSA testing and modern biopsy methods ease fears and reassure patients, making early prostate cancer detection safe and valuable.

Early Prostate Cancer Detection: Why PSA Screening Matters

Dr. Paul Gellhaus, urologic oncologist and medical director of robotic surgery at City of Hope Cancer Center Phoenix, emphasizes that fear often keeps patients from prostate cancer screening.

Many avoid testing because they worry about discomfort or unnecessary treatment. But early detection through a prostate-specific antigen (PSA) test can catch cancer before symptoms appear, improving outcomes.

He compares it to going to the dentist — uncomfortable but worth it to prevent bigger problems. Even if a biopsy is needed, modern techniques minimize pain and embarrassment. For most men, a negative biopsy with a normal PSA provides long-term reassurance.

What's most important for patients to take away from Prostate Cancer Awareness Month, and what would you like to see them really, really learning?

Yeah, I think there's a lot for patients. I think there's a lot of fear. They don't want to find something, because if they find something, then they have to treat it, and maybe they never needed this from the start. The process is uncomfortable, embarrassing, maybe painful. But the reality is, it's kind of like going to the dentist — you got to get it done; otherwise, you're going to get a cavity, and it's going to be worse. So there's a lot of value in doing preventative care.

I think what's confusing to the layperson, the everyday patient, is they think, "Oh, I don't have symptoms. How could I possibly have cancer?" That goes for a lot of cancers, but for prostate, it's actually confusing. There's a benign enlargement that causes lots of urinary symptoms. But the portion of the prostate that tends to develop cancer is very minimally symptomatic — or has no symptoms at all — and that can be misleading.

The point of screening, the whole point, is to detect it early, early enough before symptoms happen. So go get a PSA. If the PSA is normal, you don't have to have a rectal exam, which a lot of guys are freaked out about because of embarrassment and discomfort. If your PSA is elevated, there are ways to do prostate biopsies that aren't painful or embarrassing to experience.

If your biopsy is negative and your PSA is below a certain amount, your risk of dying of prostate cancer in 20 years becomes less than 1%, and that is incredibly valuable. So, I think it's worth it. It's worth it to get checked, and if it's positive, confirm whether it's cancer or not, and then you can relax and not worry about this. For the vast majority of people, if your biopsy is negative, you can feel reassured — not 100%, but for the vast majority.

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Fear often deters patients from prostate cancer screening, despite the benefits of early detection through PSA tests. Early diagnosis can catch cancer before symptoms appear, improving outcomes. Many patients avoid testing due to concerns about discomfort or unnecessary treatment. However, modern biopsy techniques minimize pain and embarrassment. A negative biopsy with a normal PSA provides long-term reassurance for most men. Screening is crucial as prostate cancer can be asymptomatic, and early detection significantly reduces the risk of mortality, making it a valuable preventative measure.

Dr. Paul Gellhaus is a urologic oncologist and medical director of robotic surgery at City of Hope Cancer Center Phoenix.

Dr. Paul Gellhaus 

During my first year of medical school, we spent a week learning about cancer-causing genetic mutations. Unfortunately, this topic was something I was already intimately familiar with. My family and I have a past medical history riddled with many types of cancer. At the heart of our genetic history lies a mutation in the CDKN2A gene, which normally functions as a tumor suppressor gene. Individuals with a defective CDKN2A have a significantly higher risk of cancer, especially melanomas and pancreatic cancers. In medical school, I was disappointed to learn that my family’s generational struggles were attributable to the simple deletion of a few amino acids.

Around the same time, I received a call from my dermatologist, Dr. H. It was 5 p.m. and Dr. H herself made the call. I held my breath until she broke the news: “Madison, we received the results of your most recent biopsy, which revealed that you have melanoma in situ in the left thigh.” This was my first cancer diagnosis. I tried my best to maintain my composure, listening to her plan to surgically remove the malignant cells, with generous margins of 5mm. I would have a very large incision on my leg. I called my mom first to tell her the news and she was devastated. We both knew what this meant for my future: I most likely possessed the CDKN2A gene like my father. Shortly after this call, I remember driving somewhere and that is where the tears came. I knew that my life would never be the same.

After that day, everything changed. In medical school, I realigned my mindset and goals to become a physician to help others like me. First, I had to take care of my health. I thought to myself: if I am not alive, I will not be able to become a physician to help others. My diagnosis became less of a burden and more of a motivator to excel in my future career. This larger calling gave me purpose and propelled me forward through my studies, during and after my surgery. While I was mostly couch-bound after my surgery, I dedicated my time on the couch to studying for my first set of medical school finals. Through hard work and determination, I was able to excel on these examinations.

After completing my final exams, I set out to obtain an official diagnosis of the CDKN2A mutation through the cancer genetics clinic my family follows with. Approximately six months later, I had my blood drawn and received a call from a genetic counselor with the formal diagnosis of the CDKN2A mutation. Meanwhile, Dr. H mandated frequent skin checks and biopsies of suspicious lesions.

Around this time, I became motivated to pursue research involving those impacted by the CDKN2A mutation. I obtained a position conducting pancreatic cancer research. Through my work, I saw the passion in every one of my colleagues and it inspired me. Performing this research provided me with invaluable research experience and a newfound hope to find better solutions for patients like me, like my father and grandfather.

Roughly a year later, after completing and passing my first set of medical board exams, I went for my latest skin check with Dr. H. At this visit, she biopsied a suspicious lesion on my right thigh. A few weeks later, I got the call. This time, I was at my research lab, obtaining some data. I stepped away from my work, pacing in the hallway, as Dr. H dropped the news: “It’s melanoma again. However, this time, it was stage 1 superficial spreading melanoma, <0.2 mm deep.” Sadly, Dr. H notified me that she was no longer comfortable removing a melanoma at this stage. Thus, I had to go to a melanoma center for this surgery. A month later, during the surgery, I told my surgeon about my passion for medicine and helping others impacted by my condition. She noted that she admired my strength and asked me if I wanted to watch the surgery in real time. As she operated, she explained each step to me. I loved it. One week after having the tumor removed, I started my clinical rotations. After this, I had even more motivation to care for others impacted by medical situations like mine.

Two months later, I attended a pancreatic cancer conference on a scholarship for students diagnosed with cancer. At this conference, I presented the research I conducted for the past year on pancreas cancer. Being at this conference, I was able to network and meet clinicians doing amazing things for their patients affected by such a deadly cancer. I plan to pursue a career caring for others impacted by cancer.

This post was written and submitted by a CURE reader. The article reflects the views the author and not of CURE®. This is also not supposed to be intended as medical advice.

A medical student with a family history of cancer, linked to a CDKN2A gene mutation, shares her journey from diagnosis to becoming a physician. After being diagnosed with melanoma, she realigned her goals to help others with similar conditions. Her experience motivated her to pursue research in pancreatic cancer and gain invaluable insights. Despite facing another melanoma diagnosis, she remained determined, using her experiences to fuel her passion for medicine. Her journey highlights the transformative power of personal challenges in shaping a career dedicated to cancer care and research.

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