I see general oncology patients and patients with rare liver cancer. My clinical focus is tied to my research in neuroblastoma.
Neuroblastoma is the pediatric cancer whose genetics we know most about. Many neuroblastoma patients do well, but others have a very aggressive form of the disease. But until now, the tools for determining who's at greatest risk of relapse haven't been precise. We need to find genetic markers that could help identify the patients who could potentially benefit from more intensive therapy. Finding the genes involved in aggressive neuroblastoma also will help us develop targeted therapeutic agents.
My colleagues and I are looking at the biology of the neuroblastoma cell – the critical cell pathways that will help us identify how to better treat the disease and prevent relapse. Our goal is to understand what can interrupt and treat the disease: what genes and changes in the neuroblastoma cell explain why they became a cancer.
The genetics of cancer has long been an interest of mine. As I progressed through my medical education, the concept of cancer being a disease of the genome (DNA) became more and more apparent to me. I realized there were genes that control how fast cells grow and when they stop growing. I saw how this connected with medicine -- and found I wanted to unite my clinical and scientific interests in the study of genomics.
Our clinical research at Children's Hospital focuses on critical changes in the genome and the specific chromosomes associated with the worst patient neuroblastoma outcomes. Using microarrays DNA technology, we are trying to understand how cells change. Next, we will be able to move beyond learning about a single gene to sequencing the entire genome.
Our goal is to identify certain cell subtypes within neuroblastoma. Every child's cancer is different, but understanding the subtypes means we can better target the individual cancer cell abnormality and tailor the therapy to each individual patient. More specifically, our genome work involves analysis of tissue samples from children with neuroblastoma to determine the relationship between disease progression and an abnormal deletion in the "q" arm of chromosome 11. We found that patients with chromosome 11q and chromosome 1p deletion are more likely to have aggressive neuroblastoma. Identifying these genetic markers is helping us better design therapies to potentially improve patient survival.
When it comes to caring for our patients with neuroblastoma and other pediatric cancers, my approach with patients and families has always been to make the child the focus of the care. I help the child communicate what he or she is experiencing. And since there is a lot of uncertainly revolving around cancer treatment, I try to anticipate what our patients and their families are thinking -- and let them know the possibilities and status of their situation.
One of the most attractive things about working in oncology at Children's Hospital, along with our top clinicians and researchers, is the broader staff involved. The nurses, social worker and psychologists are all specifically dedicated to work with our special cancer population.
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