The goal of radiation therapy is to irradiate as many  cancer cells as possible while sparing normal, healthy cells. Improvements in  radiation therapy include targeting specific tumor sites and counteracting  involuntary movements, such as breathing, that make it difficult to zero in on a  specific location, such as lung tumors. 

Intensity-modulated radiation therapy (IMRT) uses multiple beams of radiation instead of a single high-dose beam, which can damage healthy tissue surrounding the tumor. While many IMRT devices use three-dimensional images, such as in computed tomography, newer devices include the aspect of time (4D IMRT). This form of image-guided radiation therapy localizes the target during each treatment to account for real-time organ motion. Because the location of the tumor can change with the patient’s breathing or other small movements, taking several images over time can help the radiologist pinpoint when and where the tumor is located during treatment.

In stereotactic radiosurgery, several weak beams of radiation originating from different angles intersect to produce a concentrated high dose of radiation at the tumor site. The procedure involves no surgery and little radiation to the surrounding tissue. CyberKnife® and Gamma Knife® use stereotactic radiosurgery to treat brain tumors (see page 39).

For breast cancer, partial breast irradiation employs radiation therapy within the lumpectomy cavity. It reduces side effects and cuts treatment time from six weeks to one week. With MammoSite®, a balloon filled with saline is placed inside the breast and a radioactive “seed” is delivered to the lumpectomy site. Other forms of brachytherapy, or radiation given internally, allow radiation to be given near or at the tumor site and radiated outward via radioactive seeds, wires or needles. Internal radiation techniques are used to treat breast, head and neck, gynecological and prostate cancers, among others.

Articles

Features

Targeted therapies disrupt the inner workings of cancer.

v4n4 - Cancer's Molecular Machinery

Because many treatment options exist for non-Hodgkin’s lymphoma,  separating the illness into subgroups is important. Past classification systems  separated NHL by appearance or how fast it grew, but the more recent system from  the World Health Organization categorized more than 20 NHL subtypes by chemical  and genetic information, making it easier to diagnose and treat each disease  class. 

In the past, doctors didn’t understand why combination  chemotherapy worked on only 40 percent of patients with diffuse large B-cell  lymphoma, one of the most common types of NHL. Gene expression profiling  answered this question when separate groups were found, including germinal  center B-cell-like and activated B-cell-like. The five-year survival rate of  patients with activated B-cell-like lymphoma is less than half that of patients  with germinal center B-cell-like lymphoma. Because patients with activated  B-cell-like lymphoma have a lower survival, aggressive or investigational  treatments, including high-dose chemotherapy with stem cell transplant, are  considered earlier in the course of therapy.

Genetic information used to classify NHL can be very specific.  Mantle cell lymphoma, which only accounts for about 5 percent of NHL cases, is  characterized by overexpression of the cyclin D1 protein, translocation of genes  on chromosomes 11 and 14 and presenting CD5 antigen on B cells. Historically,  this disease has been very resistant to treatment. However, phase II data  recently published in the Journal of Clinical Oncology has shown activity with  Velcade in patients with relapsed mantle cell lymphoma.

Researchers have struggled for years to classify, diagnose and  treat the various types of NHL. Gene profiling will contribute to the increasing  number of NHL subtypes, but it will also help in diagnosis and treatment for  individual patients.

Content

v4n4 - Classifying NHL Aids in Treatment Choices

The first cancer-specific voices heard in the country were women who organized  and vocalized about breast cancer in their communities, stepping forward to fill  voids not addressed.

[Stop the Silence] When Karen Jackson was diagnosed with breast  cancer in 1994 she found a lack of “sisterhood” in traditional support groups.  She also became aware of the startling national statistics about  African-American women and breast cancer, prompting her to create the Sisters  Network (

), an organization committed to  increasing local and national attention on the devastating impact breast cancer  has in the African-American community.

As the first African-American breast cancer survivorship and  education organization, Sisters Network has spread across the country with 40  affiliates. Jackson developed several national outreach initiatives, including  the Gift for Life Block Walk to educate women and encourage prevention and the  Stop the Silence campaign to create a dialogue about cancer and other  life-threatening illnesses.

Sisters’ outreach initiatives continue to promote the importance  of breast health through personal empowerment, support, education programs and  research. In 1999, Sisters broke new ground by hosting the first National  African American Breast Cancer Conference to specifically address the impact of  breast cancer on black women. With the eighth conference scheduled for April  2006 in Houston, the conference attracts more than 500 participants.

[Singing Truth] The emotion-filled strains of “No One Else,” a  song for breast cancer patients, reflect Latina singer Soraya’s philosophy about  her personal battle with the disease.

“In my darkest hour, when I could barely see, I found the essence  of a woman I never dreamed that I could be,” sings Soraya, who was diagnosed  with stage 3 breast cancer at age 31 in June 2000, two weeks before she was to  begin a national tour promoting her third album.

The singer put her career on hold to fight the disease, undergoing  a bilateral mastectomy, chemotherapy, radiation and reconstruction. Since her  recovery, Soraya has focused on breast cancer awareness efforts, particularly  among Latinas who have higher mortality rates because they are less likely to  get mammograms and seek medical help. Ironically, Soraya agreed to serve as  Latina spokesperson for the Susan G. Komen Breast Cancer Foundation in 1999 just  a few months before she was diagnosed. For Komen, she has participated in  awareness campaigns in the United States, Puerto Rico, Mexico, Costa Rica and  Central and South America.

“I am walking out of this experience as a better woman,” says  Soraya, who lost her mother, grandmother and an aunt to breast cancer. “That is  my message to every woman who must endure this disease. It is possible to get  your life back. It may not be the same life, but it is your life and it can be a  quality life. Keep your self-esteem high.”

For her work, Soraya received Billboard’s  2004 Spirit of Hope award. In 2004 her self-titled album Soraya earned the Latin  Grammy in the new singer-songwriter category. Her newest album El Ota Lado de Mi  (The Other Side of Me), a journey of genres and cultures, received a 2005 Latin  Grammy nomination for Best Female Pop Vocal Album.

v4n4 - Women Take the Lead

The patient navigator program, created and implemented by Harold Freeman, MD,  for the women of Harlem, has now received funding for duplication across the  country for cancer patients. 

The Healthcare Association of New York State and Pfizer, Inc.  collaborated with Dr. Freeman to develop the unique toolkit called Patient  Navigation in Cancer Care: Guiding Patients to Quality Outcomes. The pilot  navigator program in Harlem was the stimulus for other navigation programs for  women with breast cancer in New York and across the country.

Funding for the distribution and implementation of the program  comes from a number of sources. In June 2005, President Bush signed the Patient  Navigator Outreach and Chronic Disease Prevention Act of 2005, bipartisan  legislation that formally recognizes the challenges in overcoming disparities in  detection, prevention and treatment of chronic diseases—including cancer. The  act authorizes $25 million in federal grants for establishing patient navigator  programs across the country.

“The grants will provide money to set up  demonstration sites for patient navigation,” says Dr. Freeman, whose program at  Harlem Hospital Center showed that one-on-one navigation could make the  difference in whether or not women receive treatment.

The toolkit provides the organization sponsor or “champion” with  guidance in promoting the program, as well as a training manual and resources  for patient navigators. Navigators are chosen from the community and trained in  how to overcome barriers for patients from the moment they have a suspicious  finding. This includes navigating the healthcare system, finding financial  assistance and recognizing cultural issues that have to be addressed. In  essence, the newly diagnosed patient has a friend to walk with them each step of  the way.

“It is important that no time is lost from the time of an initial  finding, such as a screening examination,” Dr. Freeman says. “In poor  communities many women who receive a mammogram and have abnormal findings are  lost to follow-up or experience significant delays in diagnosis and treatment.  ”

The Centers for Medicare & Medicaid Services matched the  $25-million funding from the Act, and the Center to Reduce Cancer Health  Disparities at the National Cancer Institute has also provided $25 million.  “These monies, provided over five years with other private sector funds, mean a  significant amount will be put toward this program,” Dr. Freeman says.

Pfizer will distribute Patient Navigation  in Cancer Care to interested healthcare professionals through its sales force.  For more information on the kit, go to www.patientnavigation.com, and for  details on the grant submission process visit 

v4n4 - Guiding Their Way

New approaches take shape in cancer detection, treatment and  response evaluation.

Breakthrough discoveries have changed how doctors think about  cancer. Scientists are developing a way to manipulate gene expression to allow  certain therapies to work. New methods that tell doctors if a drug is working  show promise. And in the next decade, sub-microscopic machines may be sent into  the body to diagnose and treat cancer at the earliest stage. Armed with these  novel strategies, experts predict an inevitable paradigm shift.

RNA interference, or small interfering RNA (siRNA), silences genes  by preventing the development of proteins, such as HER2 and vascular endothelial  growth factor, that are overexpressed in cancer cells.

Cancer cell DNA contains mutant genes called oncogenes that  promote uncontrolled cell growth. Inside all cells, DNA carries the cell’s  genetic information inside the nucleus. Because DNA cannot pass through the  nuclear membrane, messenger RNA (mRNA) takes pieces of information that code for  a certain protein from the DNA. Outside the nucleus, the mRNA acts as a signal  to turn on cellular production of the protein.

With intravenous siRNA therapy, it binds to the mRNA before it can  signal protein production, and through a series of events, the mRNA is destroyed  before the information is used to make the protein responsible for cancer  growth. Targeting the mRNA itself is potentially a more efficient approach than  blocking the activity of growth factor proteins.

Some siRNAs currently in preclinical research could be used in  combination with chemotherapy to battle drug resistance. Sirna-027 targets the  VEGF receptor, which is involved in promoting growth of new blood vessels.  Another siRNA in development by Sirna Therapeutics targets the VEGF pathway in  cancer. In preclinical trials, it reduced tumor growth by half by inhibiting the  protein production of VEGF when compared with controls. Testing of siRNAs in  cancer patients is expected to begin in early 2006.

Currently, physicians determine if therapy is successful by  measuring the size of the tumor and if it has grown, stabilized or shrunk.  Advances in imaging can help doctors determine if cancer therapies are working  within weeks instead of months. Image-guided interventional clinical trials are  evaluating the role of therapies directed by imaging techniques.

Annexin V is  a protein that binds to dead or dying cells, including cancer cells. When  annexin V is linked to a radioisotope marker, an imaging scan can show if cancer  cell death is occurring. Researchers can use this information to decide if  therapy should be continued or a new therapy tried.

Because annexin V is attracted to apoptosis (programmed cell  death), scientists are researching whether annexin V can be tagged with a toxin  that will be delivered directly to the cancer cell. The more apoptosis at the  tumor site, the more annexin V will be attracted to cancer cells and the better  the drug will work.

Positron emission tomography (PET), an imaging tool used to  diagnose cancer, is now being tested to determine if cancer therapy is working  much earlier than conventional imaging scans, such as computed tomography and  magnetic resonance imaging. PET scans use a fluorescent marker, such as FDG  (fluoro-deoxyglucose), to show tumor growth. Because cancer cells have a higher  metabolic activity than healthy cells, deoxyglucose is gobbled up by cancer  cells faster than normal cells. When deoxyglucose is marked with a radioisotope,  cancer cells can be located. When predicting therapy response, doctors can  compare PET scans taken before and after therapy to determine if metabolic  activity of cancer cells has increased or decreased rather than waiting for the  volume of the tumor to change.

Other fluorescent markers are being explored in addition to FDG.  Fluoro-L-thymidine (FLT) can show tumor changes earlier than FDG-PET. One study  found that a 10-minute FLT-PET scan taken two weeks after the first round of  chemotherapy can help predict if a specific chemotherapy regimen will have  long-term benefit in breast cancer patients. It has shown the best results when  used to judge response in large and aggressive tumors.

Imagine tiny machines that could enter the human body, diagnose  cancer immediately upon its development, treat the cancer, monitor the progress  of the treatment and detect any recurrence. It sounds like science fiction, but  nano-technology applications for cancer may be a reality within the next decade.  Nanotechnology in development for cancer applications include:

Cantilevers are minuscule bars anchored at one end that have been  designed to aid in cancer detection at an extremely early stage. The cantilevers  are designed to bend when they bind to DNA sequences or proteins present in  specific types of cancer, indicating to the physician that cancer is  present.

Nanopores, miniature holes that allow DNA strands to pass through  one at a time, let researchers find errors in the DNA code that are associated  with cancer.

Nanotubes are carbon rods about half the diameter of a DNA  molecule. These devices enable researchers to trace the shape of DNA. Computers  then make a map based on the DNA shape that enables researchers to locate  mutations that may develop into cancer.

Quantum dots are nano-sized crystals used to create probes to  detect DNA sequences associated with cancer.

Nanoshells are made up of beads coated with gold in various  thicknesses, which determines what wavelengths of light the beads will absorb.  Heat generated when the nanoshells absorb light has killed tumor cells in  laboratory cultures while leaving nearby cells unharmed. Some nanoshells absorb  near-infrared light, which can easily penetrate 1 or 2 inches of human tissue.

Before these devices can be used in the  clinic, scientists need to solve problems such as how to keep them in the body  long enough to do their job without making them so large that they accumulate in  the organs and become toxic. It is estimated that devices used for a single  purpose, such as quantum dots for cancer detection and nanoshells for cancer  treatment, may be available within five to 15 years. The multifunction machines  are expected within 15 to 20 years.

v4n4 - Science Fiction in the 21st Century

Women diagnosed with cancer during pregnancy face not only the isolation of  being a young woman with cancer, but also the flood of emotions that comes with  pregnancy. Although the co-incidence of cancer with pregnancy is rare, women are  connecting with one another while at the same time helping researchers gather  information about the little-known subject

When Andrea Urban, a 39-year-old actress from New York, learned  she was pregnant while taking Gleevec for chronic myelogenous leukemia, she  faced the difficult decision of whether to terminate the pregnancy or continue  taking the drug. Since her doctor could not offer her much information on the  effect Gleevec could have on a fetus, Urban researched the subject herself and  even contacted Gleevec specialist Brian Druker, MD. But he could not tell her  any more than she already knew.

“It caused malformations in rats but not in rabbits. That’s all we  knew,” she says. “It was a horrible decision about whether to keep the child or  not and how it would affect my health and the baby’s health.”

She turned to The Leukemia & Lymphoma Society’s website where  she found three pregnant leukemia patients. “I learned a lot there and it, along  with other factors, helped me decide to keep my child,” says Urban, who has been  taking Gleevec since her fifth month of pregnancy.

The Pregnant with Cancer Network, an international support group  founded by three pregnant cancer patients, connects women by cancer and region  and provides educational information, including journal articles and the  organization’s newsletters. When co-founder Patty Murray was diagnosed with  breast cancer during her first trimester in 1995 she wanted to talk to someone  who had been in her situation. “When I joined a support group, I was paired up  with a 60-year-old breast cancer survivor,” Murray says. “I needed to talk to  someone who was young, who had young children or babies or was pregnant.”

By word of mouth, she found two other women who also were  diagnosed while pregnant and delivered healthy babies within weeks of one  another. A year later, the three women founded the Pregnant with Cancer Network,  which now provides support to nearly 250 pregnant women with cancer each  year.

Women searching for support and information have also found  several researchers collecting information on the effects of cancer treatment on  the fetus, as well as long-term effects on children exposed to treatments in  utero. Because of the small population available for studies and the ethical  dilemmas involved, gathering data firsthand from patients has been one of the  best ways for researchers to learn more about the subject.

John Mulvihill, MD, receives calls and e-mails from doctors and  patients from around the world with updates and questions about different  treatments during different stages of pregnancy.

“We have to disappoint some patients that  are given modern, brand new drugs because there are no published cases, but then  we ask if the patient would be willing to submit an abstract of the medical  aspect, once the outcome of pregnancy is known,” Dr. Mulvihill says. “Although  it is not benefiting you, someone else may benefit from your experience.”

v4n4 - In Search of Support & Information

Cancer treatment can adversely affect cancer patients’ fertility  days, months and even years after treatment. Young cancer survivors have options  available to them for preserving fertility, and with new research, patients are  offered more choices before and after therapy.

Prostate and testicular cancer therapies can affect sperm  production, resulting in low sperm count or infertility. Chemotherapy for  lymphoma and leukemia can also damage reproductive organs.

For men wanting to preserve fertility, freezing sperm at a sperm  bank or fertility center has been a successful technique for decades. If sperm  count is low, a process called intracytoplasmic sperm injection is available,  where only one sperm is needed to fertilize an egg. Another technique,  testicular sperm aspiration, in which sperm is taken directly from the testicle  or from resected testicular tissue, is being studied as another possibility when  sperm count is low.

For women, certain chemotherapies and hormone treatments, as well  as radiation to the pelvic area, can damage the ovaries and other reproductive  organs and induce early menopause. Because women are born with a limited number  of eggs, or oocytes, damaging them during cancer treatment can leave a woman  infertile.

If radiation is administered to the pelvis, the ovaries can be  surgically moved from the field of radiation, called oophoropexy, which cuts the  risk of damage by 50 percent. Treatments that temporarily shut down ovarian  function during chemotherapy are also being investigated as a means to prevent  damage to the eggs. A multicenter trial to investigate if Zoladex® (goserelin)  protects ovarian function in breast cancer patients is currently ongoing.

With in vitro fertilization (IVF), an egg is fertilized and  frozen, or cryopreserved, until it is later thawed and inserted into the uterus.  Since IVF must be done before treatment, women needing immediate treatment may  not be able to wait the several weeks required to retrieve viable eggs. Hormonal  treatments are given to promote egg development, but there are natural methods  available that do not involve hormone injections. IVF with frozen embryos has a  high success rate, and women can use donor sperm.

While freezing unfertilized eggs is possible, the success rate is  much lower than embryo freezing. Once thawed, the egg is fertilized by  intracytoplasmic sperm injection and inserted into the uterus. Although freezing  unfertilized eggs is considered experimental, better freezing and fertilization  techniques are improving success rates and more clinics are offering the  treatment. Researchers are also exploring ways to freeze testicular and ovarian  tissue to be transplanted back into the patient after therapy.

Young cancer survivors also turn to adoption or surrogacy, which  can include using a donor’s egg with sperm from the patient’s partner or the  patient’s own fertilized egg if the uterus is damaged because of radiation.

Because many of these new fertility  procedures are experimental, most are not covered by insurance and the cost can  be as high as $20,000. Even traditional IVF can cost around $10,000. Depending  on your insurance plan, diagnosis of infertility and some treatments may be  covered. Financial assistance is available through organizations such as Fertile  Hope, which offers fertility information and resources for cancer survivors

v4n4 - Fertility Choices

Many cancer patients and survivors are compelled to share their  experiences to help others, from raising awareness in the community to becoming  involved in public policy. Whether it is writing letters or scheduling visits  with an elected official to discuss a cancer care issue, patients and survivors  are making their voices heard. 

It’s important to personalize communication by sharing the story  of your cancer diagnosis and treatment and sending pictures, newspaper clippings  or even holiday cards. When conveying your message to representatives, it may  actually be preferable to talk about the nuts and bolts of the issue with a  staffer and share your personal story with your representative.

“Elected officials depend on those staffers to have the in-depth  knowledge to advise the legislators about what their constituents want,” says  Bob Hall, director of government relations for the National Coalition of Cancer  Survivorship, an organization devoted to advocating for quality cancer care on  the federal level. “But people with cancer have such compelling stories that,  most of the time, representatives want to hear what they have to say as  well.”

At the national level, cancer survivors  are conveying their message through national letter-writing campaigns, calls and  visits to Capitol Hill. On the local level, it can be much more personal,  including speaking with local officials, getting them involved in local chapter  activities or events and scheduling meetings to talk about certain issues. Town  hall meetings are also a great way to talk to both local and national officials.  

“Even if it’s on an entirely different topic, that shouldn’t stop you  from asking a question about cancer care,” Hall says.

If you’re lobbying support for a certain bill, making phone calls  and sending letters—either hand-written or through an online writing  campaign&mdash;are ways to show where you stand on certain issues. Phone calls and  e-mails are tallied by the legislative offices, so each one counts.

E-mail is an excellent form of communication, and one that is  actually preferred by Capitol Hill. If e-mail is not an option, traditional mail  is also effective, but it may take longer because for safety reasons, all  letters going to Capitol Hill are irradiated, taking weeks if not months to get  to legislative offices.

Doing research beforehand is essential,  and it can also help in getting your message to the right person. “If you call  and know the name of the person you want to talk to, you can often get past the  gatekeeper,” says Hall. “With cancer care and cancer issues, that person is most  likely going to be the health legislative assistant.”

Knowing the voting  record of your elected official and background of the issue can also strengthen  your argument and give you credibility. Christine Brunswick, a breast cancer  survivor from Washington, D.C., and longtime lobbyist, warns that if you can’t  explain your position, your credibility plummets.

“Make sure you’re fully informed because  the most important thing you have as an advocate is your credibility,” says  Brunswick. If you can’t answer a question, she suggests replying, “I don’t know  but I will get you the information.” Then do it.

To do their job, elected  officials need to hear from their constituents on issues that are important to  them, such as quality cancer care and survivorship issues. “We pay their  salaries and they want to hear from us so they can do their job better,” says  Hall.

v4n4 - Communicating with Policy Makers

Doctors are making House calls. And Senate calls, too. Frustrated  by the problems they see in the nation’s healthcare system, they’re joining with  patient advocates to call for reform.  

Dean Gesme, MD, an oncologist at Iowa Cancer Care in Cedar Rapids,  is one of these medical activists. A past chairman of the National Coalition for  Cancer Survivorship, Dr. Gesme has grown increasingly frustrated at the  inequities and inefficiencies in the care provided to cancer patients. For  example, he’s a believer in educating patients—taking 20 extra minutes to talk  to a patient about his or her kind of cancer, asking a nurse to spend an hour  with a patient prior to the first chemotherapy infusion, discussing side effects  and ways to cope. Yet Medicare does not pay for patient education. So “the  incentive isn’t there to do it,” he says. “The bottom line is I get paid the  same amount if I don’t.”

Tag-team lobbying, he has found, sends the message that the  quality of cancer care needs to be improved. The cancer survivor tells a  personal story and the doctor provides in-depth information on healthcare  issues. This collaborative effort is educational for doctors as well. “Working  with patient advocates keeps me better grounded in quality-of-life issues,” Dr.  Gesme explains—everything from the burden of out-of-pocket expenses to the  difficulty of holding a job during treatment.

Unfortunately, the politicians he has met are often “suspicious”  of working with physicians. The root of the problem, he believes, is money. The  government’s goal is to contain costs; meanwhile, legislators typically think  doctors are seeking to boost their income. One solution is to add a nurse to the  lobbying team. “They aren’t viewed by staffers and others on Capitol Hill as  quite so ‘tainted,’ if you will,” he says.

Dr. Gesme admits doctors as well as legislators need an attitude  adjustment. “I’ll be the first to say there’s a lot of pressures on Congress  that I don’t fully understand,” he says. “I need to be a little more open and a  little less defensive.”

To other doctors  joining the effort, he recommends humility. Working with patient advocates,  you’re bound to hear stories about the best—and worst&mdash;doctors they’ve  encountered. “Have a thick skin,” he counsels. “And put your guard down.” The  result can be beneficial not just for legislative efforts but also for the  doctor-patient relationship. By entering a new sort of partnership, he says,  doctors can gain a keener sense of what patients need from the healthcare  system.

v4n4 - Doctors Get Involved

	The 2005 Nobel Prize in Medicine was awarded to two scientists who discovered that the bacterium 

 is a risk factor for a rare type of non-Hodgkin’s lymphoma called mucosa-associated lymphoid tissue (MALT) lymphoma, a type of B-cell lymphoma that accounts for about 5 percent of all lymphoma cases.

	Whereas most lymphomas originate in lymph nodes, MALT is commonly found in the stomach, but also can appear in the thyroid gland, lungs or eyes.

 lives in the mucosal lining of the stomach, safe from the stomach’s digestive juices. It also is protected by urease, an enzyme the bacteria create to counteract stomach acid. Although cells of the immune system travel to the stomach to fight off the bacteria, the unsuccessful attempt can produce too many lymphocytes, increasing the risk of lymphoma.

 is found in about half of all people worldwide, it only causes problems in 10 to 15 percent of those infected. Between 80 to 90 percent of stomach ulcers and over 60 percent of all MALT cases are due to the bacterium. Many patients with gastric MALT lymphomas also have H. pylori gastritis, or inflammation of the stomach

	A person’s genetic makeup may also make them more susceptible to H. pylori-related diseases, which include gastritis, peptic ulcers and possibly stomach cancer. While antacids may help stomach pain temporarily, they won’t kill the bacteria. Scientists are studying whether antibiotics can prevent or treat H. pylori-caused diseases, including MALT. Using the antibiotic clarithromycin with omeprazole, a proton pump inhibitor, can treat most cases of H. pylori-related MALT. In cases where clarithromycin and omeprazole do not produce a remission or the disease has spread, surgery and radiation therapy are other treatment options.

The 2005 Nobel Prize in Medicine was awarded to two scientists who discovered that the bacterium Helicobacter pylori is a risk factor for MALT lymphoma.

Winter 2005 | CURE