OncoLog Volume 54, Number 01, January 2009

receiving cancer treatment at M. D. Anderson are diagnosed with Barrett’s esophagus early because they mention having frequent heartburn and are re- ferred for an endoscopic screening. “It is part of these patients’ total health care, so providing screening and treatment for Barrett’s esophagus sup- ports our mission,” said Marta Davila, M.D., an associate professor in and deputy chair ad interim of Gastroen- terology, Hepatology and Nutrition. “Esophageal carcinoma is on the rise, and if we can diagnose and treat a con- dition that leads to esophageal carcino- ma, then we can prevent major mor- bidity.” Depending on the stage of a patient’s Barrett’s esophagus, Dr. Davila can choose to observe it or treat it with options including endoscopic photody- namic therapy, radiofrequency (heat) ablation, cryoablation (freezing), and endoscopic mucosal resection. The Department of Gastroenterolo- gy, Hepatology and Nutrition also treats and manages hepatitic infections in can- cer patients. Hepatitis B and C infec- tions are often present in patients with liver malignancies—and, in fact, may be what caused the cancer. Patients with chronic hepatitis B infections usually receive antiviral thera- py while they are receiving chemotherapy or radiation therapy for their cancer. The immunosuppression caused by such cancer treatments can allow a dormant hepatitis B infection to reactivate, so it’s important that the antiviral therapy be given concurrently with cancer thera- py. Hepatitis C, meanwhile, is unlikely to reactivate during cancer treatment, so antiviral therapy for that type of infection is often given after cancer treatment is completed. “In some cases, it is beneficial for these patients to receive treatment for the viral infection as well as for the can- cer,” Dr. Davila said. “Treating the hepa- titis infection reduces the risk of cancer recurrence and improves patient out- comes.” In fact, the department recommends that patients with risk factors for viral hepatitis be screened for hepatitis B and C regardless of their cancer type. “In such patients, evaluation of liver function prior to cancer treatment may help us reduce future morbidity and mortality by

function, cause infertility, and cause pre- mature ovarian failure (premature meno- pause), which leads to early onset of such problems as osteoporosis and coronary ar- tery disease. M. D. Anderson’s gynecolo- gy service treats and counsels patients who have side effects and determines whether a gynecologic symptom indicates an undiagnosed condition, such as a uter- ine polyp. The general gynecology program is also available to help new patients who may be at risk of infertility from chemo- therapy. “While we don’t offer fertility programs per se, we can counsel those pa- tients,” Dr. Milbourne said. “We can’t al- ways give them the best thing in terms of fertility—a young woman with acute leukemia needs treatment right away, and there is no time for most fertility- sparing measures. But we may be able to protect her ovaries from toxicity with a drug that stops her menstrual period for the duration of chemotherapy. For other patients, we might be able to consult with the oncologist—if chemotherapy can be delayed for a few weeks, those patients may have a chance for in vitro fertilization.” When a patient is pregnant at the time her cancer is diagnosed, the gyne- cologists at M. D. Anderson can also serve as an interface between her oncol- ogist and obstetrician. Such an interface is essential since M. D. Anderson does not provide labor and delivery care and because cancer treatments can harm the woman and the fetus. Guidelines for treating pregnant cancer patients, developed under Dr. Milbourne, assist oncologists and obstetricians alike, and high-risk obstetrics specialists at The University of Texas Health Science Center at Houston are available for consultation. “Many, many of these pa- tients are told elsewhere, ‘You have to terminate your pregnancy,’” Dr. Mil- bourne said. “But for the many women who do not want to do that, we may be able to provide them with another option.” And in cancer care, another option can make all the difference. ● For more information, call Dr. Milbourne at 713-745-6986, Dr. Davila at 713-563- 8906, or Dr. Kroll at 713-563-4258.

treating viral hepatitis as appropriate,” Dr. Davila said. Gynecology The general gynecology program, staffed by three full-time gynecologists, is only about 6 years old but has already carved out an important role at M. D. Anderson. “Many of our patients have gynecology problems but not gynecologic cancer,” Dr. Milbourne said. “The need for our services has always existed, and we are meeting that need so the gyneco- logic oncologists can focus on oncology.” Female cancer patients can face many gynecologic and reproductive problems arising from their cancer or its treatment. Excessive or unusual vaginal bleeding is a common problem for patients receiving certain chemotherapy agents. Cancer therapy can also reduce libido and sexual Dr. Marta Davila, associate professor in and deputy chair ad interim of the Depart- ment of Gastroenterology, Hepatology and Nutrition, provides gastroenterology care ranging from the removal of precancerous lesions in the esophagus to the treatment of viral hepatic infections.

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