Cancer

Baylor St. Luke’s Medical Center is the clinical home for the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, one of only three NCI-designated Comprehensive Cancer Centers in Texas and site of the largest clinical genetics program in the nation. This allows us to interrogate cancer cells down to the very genes that cause them, thereby providing new treatment targets.

Combining compassionate care for the patient and family with expertise in precision medicine, research, and surgical technique is the area in which our team excels, and we look forward to transforming our vision of a cancer-free life into reality.

Improving the Accuracy of Breast Cancer Surgery

Baylor St. Luke’s Medical Center is the first hospital in the Southern U.S. to use the Sentimag Magnetic Localization System with both the Magseed technology and the newly FDA-approved Magtrace liquid tracer to locate and remove tumors in patients with invasive breast cancer. Dr. Alastair Thompson and Dr. Stacey Carter, and Dr. Elizabeth Bonefas, breast surgeons at Baylor St. Luke’s, performed the procedure.

The Magseed is a small metal seed the size of the tip of a pen that is used to mark and remove small tumors that are difficult for the surgeon to feel. The seed is placed directly into the center of the tumor any time before surgery under mammogram or ultrasound guidance. This enables the surgeon to accurately locate the center of the tumor and ensure it is removed in one piece while preserving as much healthy tissue as possible. The Magseed replaces the need for a wire localization technique, which can be painful and uncomfortable for the patient.

“This procedure is really transformational for the patient because it allows us to do a small day case, fine-tuned delicate surgery rather than doing a big operation,” said Dr. Thompson. “Additionally, the tumor with the seed in it and the surrounding tissue get looked at immediately by our pathologists to give an assessment while the patient is still asleep. It helps us get away from the 1 in every 3 patients across the United States that has to undergo a second operation for a re-excision.”

Patients undergoing a lumpectomy often need to have their lymph nodes removed to determine whether the cancer has spread beyond the initial tumor into the lymph nodes. The Magtrace iron-oxide solution can be injected prior to a sentinel lymph node biopsy while the patient is asleep to help surgeons identify the sentinel nodes with the highest reading.
Using the system’s handheld wand and base unit display, surgeons are able to find the sentinel lymph nodes for surgical removal based on the strength of the magnetic signal. The magnetic Magtrace replaces the need for the old method that typically involves the injection of a radioactive substance and a blue dye agent, which can stain the skin near the injection site and cause allergic reactions.
Oncology Magseed

100 New Genes Associated With Different Types of Cancer

The Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center, in partnership with the Baylor College of Medicine Human Genome Sequencing Center, is a member of the Cancer Genome Atlas project, a government-funded organization created to identify cancer-causing genes.

The organization, which studies up to 500 samples for each cancer type, has identified more than 100 new genes to date and has received $114 million in grant funding for research to identify every gene and mutation linked to 50 types of cancer.

Progress has been made in sequencing tumors of the colon, pancreas, kidney, breast, and bladder. 

Advanced Tumor Analysis for State-of-the-Art Cancer Care

Our system-wide Molecular Tumor Board, spearheaded by oncologists and physician scientists, provides expert analysis of genetic markers in tumor DNA and genomic markers in patient DNA to refine diagnosis and prognosis. This provides targeted treatment options for cancer patients with the most complex diagnoses as well as for tumors that are refractory to standard treatment protocol. This also allows for recommendations of targeted prevention modalities for family members.

Our Tumor Board is virtual, allowing attendance by oncologists from all over CommonSpirit Health, the parent system of Baylor St. Luke’s Medical Center. We also offer continuing education in genetic testing and diagnosis and CME credits for participating physicians.

Continuing To Specialize in Mesothelioma Treatment

The late Dr. David Sugarbaker, a pioneer in advancing the treatment of pleural mesothelioma, founded the Mesothelioma Treatment Center (MTC) and recruited Dr. R. Taylor Ripley, who now serves as the Director. With only a handful of centers treating mesothelioma regularly in the U.S., the MTC has one of the busiest programs; last year alone, the center saw over 100 patients.
With access to leaders in the field of mesothelioma care and treatment, unparalleled resources and collaborations, and rapid access to care, Baylor St. Luke’s offers advanced therapies not available anywhere else in the world.
With a multidisciplinary patient approach, the center is comprised of social workers, nutritionists, chaplains, exercise physiologists, and nurse practitioners, in addition to the expert surgical team. For patients who undergo surgery, offerings include an Extended Pleurectomy and Decortication (EPD), sparing the lung and avoiding a pneumonectomy.
Clinical trial options include immunotherapy and adenoviral trial, “A Phase 2, Open-Label, Single-Center Study of MTG201 in Combination with Nivolumab in patients with Relapsed Malignant Pleural Mesothelioma” (ClinicalTrials.gov: NCT0401334). Eligible patients will have unresectable disease and have received first-line cytotoxic chemotherapy without immunotherapy.
Enrollment has also started for the NRG-LU006 (ClinicalTrials.gov: NCT04158141), in which patients will receive IMRT to the chest wall after EPD. Additionally, Baylor St. Luke’s participates in the IASLC Mesothelioma Staging Project as well as multiple translational trials.
Robert Taylor Ripley, MD
Director, Mesothelioma Treatment Center Baylor St. Luke’s Medical Center
Bryan Burt, MD
Director of General Thoracic Surgery Research at Baylor College of Medicine

The Scarless Approach to Thyroid Surgery

Baylor St. Luke’s Medical Center is the only center in Texas that offers the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Unlike traditional thyroidectomies that require an incision in the neck, the TOETVA leaves no visible scars.
Dr. Raymon Grogan, Section Chief of Endocrine Surgery at Baylor St. Luke’s Medical Center, is one of only a few experts on the TOETVA procedure in the United States, and he was the first surgeon to perform this operation in the Midwest and in all of Texas.
He and his team recently performed an analysis on 1,000 patients who underwent thyroid surgery and concluded that 56% of them were eligible for and could have received the scarless procedure.
Raymon Grogan, MD

Chief of Endocrine Surgery at
Baylor St. Luke’s Medical Center

Advanced Endoscopy & Procedures for GI Cancers

Baylor St. Luke’s Center for Advanced Endoscopy is one of the largest referral practices for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in Houston.
Our program’s gastroenterologists perform endoscopic submucosal dissection (ESD) of esophageal and colorectal tumors, endoscopic mucosal resection (EMR) in patients with Barrett’s esophagus and early-stage cancer, as well as diagnostic and therapeutic ERCP for the management of benign and malignant biliary strictures. The Center also involves medical oncology and offers endoscopic bariatric therapies, including minimally invasive, laparoscopic, robotic, and transanal surgical procedures for benign and malignant pathology of the colon, rectum, and anus.
Capable of performing the most complex procedures, the Baylor College of Medicine General Thoracic Surgery team at Baylor St. Luke’s Medical Center is among the roughly 1% of hospitals in the nation that perform esophagectomy at a high-volume level. With a 30-day mortality rate of less than 1%, the team has committed to growing the program significantly while maintaining outstanding outcomes. With the arrival of new leadership, the team has increasingly performed minimally invasive esophagectomies, placing Baylor St. Luke’s as a high-volume center.
Minimally invasive esophagectomy has proven to result in 70% lower odds of major complications and 60% lower rate of pulmonary complications without compromising overall survival. This includes a 70% decreased risk of pneumonia as opposed to open esophagectomy.

Pioneers in Pancreatic Cancer Treatments

The Elkins Pancreas Center at the Dan L Duncan Comprehensive Cancer Center, a department of Baylor St. Luke’s, specializes in the treatment of pancreatic cancer, pancreatitis, and other pancreatic diseases through traditional and minimally invasive surgery, gene therapy, and clinical trials.
Here, we offer the full range of pancreatobiliary procedures, including the Whipple, to address conditions like chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. In fact, Baylor St. Luke’s was among the first hospitals in the nation to offer the robotic Whipple procedure.
The Elkins Pancreas Center is recognized as a Pancreatitis Center of Excellence by the National Pancreas Foundation.

Revolutionizing Pituitary Tumor Treatment

As one of the most active pituitary centers in the nation with published superior surgical outcomes, we safely discharge over 90% of our pituitary surgery patients after just one night in the hospital. We utilize a multidisciplinary approach that combines patient management protocol with a less-invasive endovascular surgical technique in which surgeons enter through the nasal passage to remove the pituitary tumor. The patient management protocol emphasizes patient education, early mobilization, and scheduled inpatient and outpatient endocrine assessments that have been shown to decrease hospital stay, complications, and readmission.
The first in Houston to use CyberKnife® technology to perform stereotactic radiosurgery in a clinical setting for the treatment of intracranial tumors, the Baylor St. Luke’s Medical Center team has built a legacy of advancing the standard of care with pain-free solutions. CyberKnife® combines intelligent robotics and image guidance to provide a treatment that is so precise that radiation can be sculpted to small complexly shaped lesions near critical structure — including arteriovenous malformations, acoustic neuroma, trigeminal neuralgia, and ocular melanoma.

Leading Bladder Cancer Research

As part of our affiliation with Baylor College of Medicine, our urology team takes part in innovative research that we translate into state-of-the-art clinical options for those we serve.
Applying Genomics to Bladder Cancer Treatment
Dr. Seth Paul Lerner, urologist at Baylor St. Luke’s, and his colleagues at Baylor College of Medicine study the genomic underpinnings of diverse characteristics in patients with muscle invasive bladder cancer as part of the Cancer Genome Atlas Research Network.

He and his team found a connection between cancer subtype and outcomes. “We were able to show that mutation signatures, molecular subtypes, load of new cancer-associated molecules, and known clinical and pathological factors have a very clear influence on overall patient survival,” says Dr. Lerner.

Taking these factors into account allows for more personalized and effective treatment for patients. “Of the 11 patients we identified as having a neuronal subtype, all of those evaluable for objective response responded to the treatment (two complete response, six partial response), or 72% overall. This translated to a very high survival probability, which is unprecedented in advanced bladder cancer,” says Lerner.

“Although this is a small group of patients, it is very exciting to see that our basic research can be directly translated to the clinical setting, allowing us to determine which subtype of bladder cancer has a better chance to respond well to a specific treatment.”

Seth Paul Lerner, MD
Targeting Estrogen Receptors to Reduce Bladder Cancer Recurrence
Patients with low/intermediate-risk bladder cancer often experience recurrences. In the second phase of this study, researchers, including Baylor St. Luke’s and Baylor College of Medicine urologist Dr. Guilherme Godoy, sought to reduce the rate of recurrence by prescribing oral tamoxifen.

This prototypic selective estrogen receptor modulator (SERM) was given to prevent carcinogenesis in these patients. Findings revealed that this regimen reduced and even eliminated marker lesions in participants.

Read the full study here.

DNA Fracturing Rewires Gene Control in Cancer

Understanding the mechanisms that mediate widespread DNA damage in the cancer genome is of great interest to cancer physicians and scientists because it may lead to improved treatments and diagnosis. In this study, a multi-institutional team led by researchers at the Dan L Duncan Comprehensive Cancer Center, in partnership with Baylor College of Medicine, has brought attention to genomic structural variation as a previously unappreciated mechanism involved in altering DNA methylation, a form of gene control, in human cancers.

The researchers brought together data from whole genome sequencing, gene expression, and DNA methylation from more than 1,400 human cancers. They report in the journal Genome Biology that structural variations consistently altered DNA methylation affecting hundreds of genes, overall reducing the global level of DNA methylation across cancers.

“Genomic structural variations occur when a piece of DNA that is in one part of the genome is moved to another part of the genome, which shows up as a breakpoint in the sequence. Therefore, when sequencing a DNA segment, one may find two pieces of DNA from other regions fused together, which disrupts the genetic instructions encoded in DNA,” said corresponding author Chad Creighton, MD, and co-director of Cancer Bioinformatics at the Dan L Duncan Comprehensive Cancer Center.

In this study, Creighton and his colleagues looked at the effect genomic structural variation has on both DNA methylation and gene expression in human cancers. They analyzed data from two different large science consortiums, the Cancer Genome Atlas and the Pancancer Analysis of Whole Genomes. These data include molecular alterations across the entire genome; that is on both protein-coding genes and on their regulatory regions for thousands of cancers. The datasets include the same information from non-cancerous tissues for comparison.
Working with so many patient samples gave more statistical power to the researchers’ analyses and enabled them to find new genes that might be involved in cancer.

“This time, we had more cases and deeper sequencing than what was previously available,”
Creighton said.

In the first part of the study, the researchers discovered that genomic structural variations played a major role in altering DNA methylation in a sizable fraction of cancers. DNA methylation is one way to control gene expression; it’s part of the epigenome. The epigenome refers to all the chemical modifications to DNA and associated proteins that regulate the expression of genes within the genome.
“Methylation changes were happening in a non-random way across multiple cancer types,” Creighton said.
“Some of these genes were known before to be linked to cancer, but we also identified genes that were not previously associated with this condition. Some genes may be directly involved in the disease; others might be ‘passengers.’”
Overall, structural variation was associated with a global decrease in DNA methylation.
“We know that in cancer the epigenome is altered. In the current study, we found that structural variation is one important mechanism that is altering the epigenome. This was not appreciated before,” Creighton said.

“We think this may be one of the first surveys of cancer genomics that shows where these changes in DNA methylation happen and in what types of cancer.”

In the second part of the study, the researchers found that there is variability across cancers in terms of the amount of structural variation present within a given cancer. Some cancers may not be heavily altered, while others have widespread structural variation. These findings enabled the researchers to stratify cancers in terms of how much structural variation they have.
This and other analyses told the researchers a lot about what is going on in these cancers. For instance, Creighton and his colleagues found that cancers that have a high level of DNA alterations also tended to have a decrease in immune cell infiltration. This finding may have implications for cancer immunotherapy.
“We think that our study is unique in the sense that we found that structural variation plays a major role not only in introducing mistakes in DNA sequences but also affecting DNA at the epigenetic level,” Creighton said. “We propose that the effect of structural variation on DNA methylation is something to consider when looking for the genetic causes of a cancer.”

Mechanism Reprograms Breast Cancer to Become Metastatic

A team led by researchers at the Dan L Duncan Comprehensive Cancer Center, in partnership with Baylor College of Medicine and Harvard Medical School, has unveiled a new mechanism to help explain how endocrine-resistant breast cancer acquires metastatic behavior, opening the possibility of new therapeutic strategies.

The study, published in Proceedings of the National Academy of Sciences, shows that hyperactive FOXA1 signaling triggers genome-wide reprogramming that results in enhanced resistance to treatment and metastatic behaviors.
The researchers also identified HIF-2a as a key mediator of FOXA1-directed reprogramming and showed that an inhibitor of HIF-2a, currently under clinical development for treatment of advanced renal cell carcinoma and recurrent glioblastoma, can effectively reduce migration and invasion of endocrine-resistant breast cancer cells expressing high FOXA1 activity.

“About 75 percent of breast cancers have estrogen receptors; hence they are called estrogen receptor- positive (ER+). Original ER+ breast cancer cells depend on estrogen to grow, and therapies that make the estrogen unavailable to cells, called hormone therapies, can result in long-term remission in some patients. Tamoxifen, one of several types of hormone therapy, works by binding to and blocking the estrogen receptor on cancer cells.”

Rachel Schiff, PhD
However, most patients with metastatic disease, including those whose tumors responded initially to hormone therapy, eventually relapse and die due to the tumors’ acquired resistance to hormone therapy.
These findings reveal details of the intricate mechanism FOXA1 triggers to induce metastatic behavior in endocrine-resistant breast cancer, which other reports have suggested also is present in other types of cancer, such as prostate and pancreatic cancer. In addition, the findings support further exploration of the possibility that inhibiting HIF-2a or another enhancer that controls the expression of many genes in endocrine therapy-resistant breast cancer could be translated into effective therapeutic strategies.
Patient Story

Chris’ Story: From Stage Four to Survivor

Active and healthy his whole life, Chris was first misdiagnosed with exercise-induced asthma and then pneumonia. Years later, Chris discovered he had stage-four left thoracic and abdominal epithelioid mesothelioma. Because his mesothelioma had spread so deeply, his cardiothoracic surgeon did not feel comfortable operating and suggested chemotherapy prior to surgery to shrink the tumors.

Searching for further options, the family found Baylor College of Medicine’s Mesothelioma Treatment Center at Baylor St. Luke’s Medical Center. Dr. Taylor Ripley, the Director of the Mesothelioma Treatment Center, believed that chemotherapy prior to surgery would likely make him weaker. Instead, Dr. Ripley was willing to operate right away.
He performed the surgery in two parts. The first part removed the tumors in the pericardium and lungs. The second was scheduled with ample time for recovery and ultimately removed the remaining tumors in the abdomen. To finalize the treatment plan, Chris visits a local oncologist to continue with adjuvant chemotherapy. He also visits Dr. Ripley every three months for follow-up. But today, no evidence of the disease exists .
Patient Story

Cynthia’s Story: Living Cancer and Scar-Free

Cynthia Doyle was familiar with papillary thyroid cancer because it had affected several members of her family before. She knew her cancer was treatable with surgery, but she had witnessed the side effects. She wanted to avoid trouble with her voice and the scar on her throat so she began to hunt for scarless thyroid surgery.

Dr. Raymon Grogan, Section Chief of Endocrine Surgery at Baylor St. Luke’s Medical Center, one of the only doctors in the nation who performs transoral thyroidectomy, or TOETVA — a scarless thyroid surgery that allows for the safe and total removal of the thyroid or parathyroid glands without any external scarring to the neck. Shortly after surgery, Cynthia was informed her cancer was entirely removed with negative surgical margins.

Cynthia Doyle

“No one would ever think that I had such a serious surgery because I don’t have a scar,” Cynthia said. “I am extremely grateful for Dr. Grogan and his amazing team.”

Cancer Funding and Services Continue to Grow, Offering Patients Another Option in Houston

The Dan L Duncan Comprehensive Cancer Center, a department of Baylor St. Luke’s Medical Center, expanded in 2019 with new facilities, over $180 million in research funding, and a continued partnership with Baylor College of Medicine that includes the largest clinical genetics program in the nation. This partnership allows for the opportunity to analyze the genetic makeup of patients, identify the potential for cancer, offer preventive care, and develop custom treatments. 

Recruiting for Study To Observe COVID-19 in Cancer Patients

The National Cancer Institute is conducting a nationwide natural history study to learn how COVID-19 affects cancer patients and their treatment. The Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center is currently recruiting cancer patients in Houston for the study.
Researchers will collect clinical data, imaging studies, and research blood specimens from participants to learn more about the risk factors for developing a serious case of COVID-19 in people who are receiving cancer treatment. They will also study how COVID-19 impacts the course of cancer treatment and outcomes.

“We are looking to see if cancer type, treatment type, or demographic factors may contribute to different outcomes for COVID-19,” said Dr. Claire Hoppenot, co-principal investigator of the Baylor study site and assistant professor in gynecologic oncology at the Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center. “Right now, we don’t have a lot of answers about how COVID-19 will affect cancer treatment. In this study, we hope to learn what treatments are safe to give to a person with COVID-19 and what treatments may cause the infection to get worse.”

Current studies show the COVID-19 mortality rate in cancer patients is fairly high. But Hoppenot said that data could be skewed because the people with the most severe COVID-19 cases are the ones who have been diagnosed and end up in the hospital. Asymptomatic people and those with less severe symptoms may not be diagnosed and included in the data.
“The goal of this study is to get a better lay of the land. The more information we have about what is happening with this disease, the better we’ll know what we need to focus on as far as interventional measures and adjustment of treatment,” Hoppenot said.
Researchers will examine patient blood samples to try to identify genetic risk factors and biomarkers for severe COVID-19. The study will also create a bank of blood samples for future research as more is learned about COVID-19.
Claire Hoppenot, MD
Assistant Professor in Gynecologic Oncology at the Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center

Offering Alternative to Laparoscopy for Rectal Cancer Patients

For rectal cancer patients who are not candidates for laparoscopy, Baylor St. Luke’s Medical Center offers Transanal Total Mesorectal Excision (taTME), a “bottom-up” minimally invasive robotic surgery. This procedure is an alternative to conventional surgery for patients with lower rectal cancer. The benefits include better visualization for the surgeon, allowing for more aggressive removal while avoiding the anus.

New Tumor Sequencing Test Changes Patient Treatment Options

The Cancer Exome Sequencing test, available through the Medical Genetics Laboratory at Baylor College of Medicine, is a cutting-edge capability with important implications for the design of therapeutic protocols for cancer patients. The test identifies the genetic mutations in a patient’s tumor that can be used to predict how aggressive a tumor is or determine how likely it is that a tumor will resist or respond to targeted agents or other cancer therapies.

While the use of technology is still in the investigative phase, oncologists at Baylor St. Luke’s Medical Center have reason to believe this exciting new tool will revolutionize the treatment landscape for patients.
One patient with late-stage breast cancer, which recurred and metastasized to the liver, had test results that revealed the tumor’s genetic makeup was more commonly found in a lung tumor. Armed with this new information, the patient was successfully treated with a therapy tailored specifically for her disease. More than two years later, she is still alive.

Specializing in Mesothelioma Treatment

The late Dr. David Sugarbaker, a pioneer in advancing the treatment of pleural mesothelioma, founded the Mesothelioma Treatment Center (MTC) and recruited Dr. R. Taylor Ripley, who now serves as the Director. With only a handful of centers treating mesothelioma regularly in the U.S., the MTC has one of the busiest programs; last year alone, the center saw over 100 patients.
With access to leaders in the field of mesothelioma care and treatment, unparalleled resources and collaborations, and rapid access to care, Baylor St. Luke’s offers advanced therapies not available anywhere else in the world.
With a multidisciplinary patient approach, the center is comprised of social workers, nutritionists, chaplains, exercise physiologists, and nurse practitioners in addition to the expert surgical team. When needed, lung-sparing surgical techniques, such as pleurectomy and decortication, are employed as opposed to the traditional extrapleural pneumonectomy.
We also offer the innovative NovoTTF-100L System, a new form of therapy that produces electric tumor-treating fields to destroy cancer cells. This is a portable, wearable device that is used in conjunction with chemotherapy, and it provides patients with access to treatment when no comparable therapy is available.
Extensive preoperative evaluations and clinical trial availability ensures patients can be accommodated within just a week with the best course of action available for each individual.

"When someone is diagnosed with metastatic disease, for example, we send a sample of the cells, or a biopsy, for genetic testing. If we find there are certain mutations present, we are able to tailor the treatment with drugs that target those mutations. The results of this type of tailored treatment have been remarkable and represent a giant leap forward in lung cancer care," says Dr. Bryan Burt, thoracic surgical oncologist at Baylor St. Luke’s Medical Center and Director of General Thoracic Surgery Research at Baylor College of Medicine.

Bryan Burt, MD

Director of General Thoracic Surgery Research at
Baylor College of Medicine