Lung Cancer

Introduction
Lung Cancer: Basic Facts
Lung Cancer: The Numbers
Creating a World-Class Team for the Treatment of Lung Cancer
How this Team has Raised the Bar for Lung Cancer Patients Around the World
What are the Current Priorities for the Team?
Glossary


Introduction
Lung cancer is still a major killer.  While the treatment for many cancers has led to significantly lower mortality rates, lung cancer mortality rates remain very high.  In fact, lung cancer causes more deaths annually in Canada (20,500) than breast cancer (5,400), prostate cancer (4,400), and colorectal (9,100) combined*.

Princess Margaret Cancer Centre is a world leader in the treatment of lung cancer, and through the efforts of a stellar team led by Dr. Frances Shepherd, the hospital has changed the standard of care for lung cancer around the world.

When Dr. Shepherd first started treating lung cancer almost 25 years ago, surgery was the main form of treatment, and for patients with advanced disease, surgery was often not an option.  No drug therapies were believed to be effective. Fortunately, the situation is different today.  The mortality rate remains stubbornly high, but new drugs and treatment strategies are being developed, tested and made available to patients at all stages of lung cancer.


This feature will provide background information on the lung cancer team at The Princess Margaret, their major accomplishments, and their current priorities.

Lung Cancer: Basic Facts
Lung cancer can arise in any part of the lung, but 90 to 95 percent of cases are thought to arise from the epithelial or lining cells of the larger and smaller airways entering the lungs (the bronchi).  There is also a type of lung cancer called mesothelioma, believed to be caused primarily from exposure to asbestos, which arises from the pleura which is the thin layer of tissue that surrounds the lungs.
Image of human lungs
Lung cancer is a disease predominantly of the elderly, as almost 70 percent of people diagnosed with the condition are over 65 years of age.

One of the reasons that lung cancer is so lethal is that it tends to spread, or metastasize, quickly and early on, making it one of the most difficult cancers to treat.

Causes of Lung Cancer
Lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use.  In many developed countries, the incidence of lung cancer is beginning to decline slowly, following intense public education programs and tactics highlighting the dangers of cigarette smoking.  However, ex-smokers are still at risk.

Second-hand smoke is also a recognized risk factor.  Research indicates that living with a smoker raises a person’s risk for the disease by 24 percent.

While asbestos use is now banned in Canada, people may still be exposed to the material in older buildings that have not been renovated.  Also, Canada still mines and is a major exporter of asbestos.

Radon gas is a natural decay product of uranium.  About 12 percent of lung cancer deaths are attributable to exposure to radon gas**.

Genetic predisposition plays a recognized role in a person’s likelihood of developing lung cancer.  Studies have shown that the disease is more likely to occur in both smoking and non-smoking relatives of those who have had lung cancer than in the general population.

Types of Lung Cancer

There are two primary types of lung cancer:  small cell lung cancers (SCLC) and non-small lung cancers (NSCLC), and the difference between the two types is based on the microscopic appearance of the tumor cells.

SCLC makes up 20 percent of the cases of lung cancer, and they are the most aggressive and rapidly growing and spreading of all lung cancers.  They are highly related to cigarette smoking, with only 1 percent of these tumors occurring in non-smokers.

NSCLC make up most of the remaining 80 percent of lung cancer cases, and they are further categorized by differences in the microscopic appearance of the tumor cells.
 
If every smoker in Canada were to quit smoking tomorrow, lung cancer would still be one of the most common causes of cancer and cancer-related deaths for decades to come. That is because ex-smokers continue to be at high risk for many years after they have given up smoking.
Lung Cancer: The Numbers
Within five years of a lung cancer diagnosis, 85 percent of the patients have died.  This is a very sobering number.  As is the statistic that 450 Canadians will be diagnosed with lung cancer this week, and 394 Canadians will die of lung cancer next week.  There has been very little change in the mortality rate of lung cancer over the past 20 years.

Tobacco consumption for men began to drop in the mid-1960’s and for women in the mid-1980’s. Despite this, the incidence of lung cancer and mortality rates for women have been increasing since 1979 and continue to do so.  For men, the incidence of lung cancer and mortality rates began to level off in the mid-1980’s, and both rates have dropped each year since 1999.

Below are some additional numbers from the Canadian Cancer Society representing 2009 estimates for lung cancer and highlighting gender differences.
 
  Men Women
Cases 12,800 10,700
Incidence rate* 66 47
Incidence rank 2nd 2nd
Deaths 11,200 9,400
Death rate* 58 40
5-year survival 13% 17%

*age-standardized to the 1991 Canadian Standard Population (per 100,000)
 
New cases and death charts for lung cancer
 

It is estimated that lung cancer researchers receive one-tenth the funding that breast and prostate cancer researchers do, and yet it kills more than both combined.  It has no celebrity supporters, no gala fundraisers, and no line of clothing where 10 percent of the proceeds go to support the cause.  It is a sadly under-funded cancer.

Lung cancer patients are generally poor advocates for raising funds for the disease because the majority of them are smokers or ex-smokers and blame themselves for getting the disease in the first place.


Creating a World-Class Team for the Treatment of Lung Cancer
Creating a world-class team in any field of discipline isn’t something that can be done quickly, and Dr. Shepherd had to be patient—searching and waiting for the best and brightest scientists and clinicians who shared her passion.

The first order of business when recruiting new people is to find the funding.  For this, Dr. Shepherd turned to the Princess Margaret Hospital Foundation for assistance.

Research Chairs
Starting in 2000, the Foundation sought out and made connections with donors and with family foundation managers to secure funding for five research chairs and collaborated with the Toronto General & Western Hospital Foundation for the establishment of a sixth chair.  A chair appointment is one of the highest academic honours, and in a teaching hospital like The Princess Margaret, it provides the reliability of an endowed fund to recruit and retain renowned medical researchers who are able to conduct ground-breaking cancer research. 

By 2008, the chairs were established, and the lung cancer team, already rich in talent, was funded to perform breakthrough research through a greater understanding of the genomics of lung cancer, plus innovative patient programs for early detection, new drug development and testing of new surgical techniques.
 
Timeline for lung cancer discoveries
 

The funding to set up a new chair is a minimum of $3 million, with a certain percentage paid out each year to cover the operating expenses for the research program(s) led by the chair holder.

Once a chair is established and a recognized scientist or leader is recruited, ‘fundraising’ for the chair does not stop.  It continues in a number of ways.  The chair holder and his team are able to apply for research grants from governments, corporations, and public agencies, and they are more likely to be successful due to the large initial investment that the chair represents.  So the funding from Foundation donors is usually leveraged many times over.  The Foundation also continues to raise funds for the Chair to ensure that the research is funded to deliver results that can improve patient care as soon as possible.

Fellowships
The period of medical training following residency is called a Fellowship.  It provides an opportunity to further specialize in an area of interest, and, most importantly, to work alongside some of the world’s experts in specific areas of research and new treatment development.  Fellowship programs allow the hospital to recruit and train the best and brightest physicians from universities around the world to add to our body of research knowledge and skill set.  More importantly, increased staff means more personalized attention for our patients from the brightest physicians.

Some of the funds generously provided by foundation donors have been directed to the establishment of fellowships, including the Oberlander Fellowship in Lung Cancer Research and Michael V. and Wanda Plachta Fellowship.

Endowed and Expendable Funds
The Lung Cancer Research Team
Individual funds have also been set up by donors with a connection to lung cancer. They may have been established in gratitude for the services of the hospital or in memory of a dear friend or family member.  These funds support programs that the lung cancer team feels are key to the work of detecting lung cancer earlier and finding more effective treatment strategies. Endowed funds are set up, in theory, for perpetuity.  Each year, a small portion of the fund is paid out and made available for use by the hospital.  Expendable funds can be used primarily at the discretion of the hospital senior staff.  

Programs supported by these funds include:
  • Lusi Wong Lung Cancer Early Detection Research
  • Mesothelioma Research Program
  • Menkes Family Innovation Fund in Thoracic Surgical Oncology

The successful collaboration between the Princess Margaret Hospital Foundation and Dr. Shepherd is to be celebrated.  Since the beginning of 2000, almost $20 million has been raised for lung cancer, and this money is fuelling important work that is saving and extending lives.
 
Lung Cancer Researchers org chart
 

Dr. Shepherd has made time to take on leadership roles in national and international lung cancer organizing bodies.  She has been Chair of the National Cancer Institute of Canada Lung Cancer site.  She is Past President of the International Association for the Study of Lung Cancer and sits on the Expert Advisory Panels of both the American Coalition of Cancer Cooperative Groups and Cancer Research UK.

She has also authored over 200 publications, most in high impact journals.  Perhaps a unique achievement—in 2005, she was the lead or senior author of three articles published over a three week period in the prestigious New England Journal of Medicine.

Dr. Frances Shepherd
Senior Staff Physician
Scott Taylor Chair in Lung Cancer Research
Professor of Medicine, University of Toronto
 
Dr. Frances Shepherd
Dr. Shepherd has been recognized internationally for her pioneering work in the treatment of lung cancer.  She has been the co-investigator or principal investigator in more than 100 trials, and has established high quality lung tumor banks to support important laboratory experiments and long-term studies.  Dr. Shepherd chairs and/or sits on numerous national and international lung cancer advisory boards.

In her storied career, she has been the recipient of many awards.  Most recently, she received the Order of Ontario, the Premier’s Summit Award in Medical Research, and the International Association for the Study of Lung Cancer Scientific Award.


Dr. Andrea Bezjak
Radiation Oncologist
Lung Cancer Site Group Leader
The Addie MacNaughton Chair in Thoracic Radiation Oncology
Professor, Departments of Radiation Oncology and Health Policy, Management and Evaluation, University of Toronto
 
Dr. Andrea Bezjak
Dr.Bezjak provides leadership and oversight of the lung cancer program at PMH.  Her area of specialty is radiation therapy, and she currently leads an innovative image-guided precision radiotherapy program.  She is the principal investigator for a phase I/II study on the use of stereotactic radiation therapy for non-small cell lung cancers in medically inoperable patients. 

She is also collaborating with other scientists at The Princess Margaret in assessing the effect of radiotherapy on normal tissues.


Dr. Natasha Leighl
Medical Oncologist
Assistant Professor, Department of Medicine, University of Toronto
 
Dr. Natasha Leighl
Dr. Leighl focuses on the management of lung cancer and on patient-physician communication and treatment decision-making in advanced cancer.  She is involved in clinical studies of new therapies and the economic impact of supporting new drugs in a publicly-funded medical system.  She has developed a number of decision aids to assist patients in making choices about their treatment.


Dr. Heidi Roberts
Radiologist
Associate Professor of Radiology, Department of Medical Imaging, University of Toronto
 
Dr. Heidi Roberts
Dr. Roberts is the principal investigator for the Lung Cancer Screening Study, where low-dose computed tomography (CT) is used to check for lung cancer in high-risk smokers. This study is part of a multi-centre study based in New York, the International Early Lung Cancer Action Program, and Toronto is the only Canadian site. Almost 4000 individuals have been screened here at The Princess Margaret, and malignant tumors were detected in approximately 2 percent.


Dr. Ming-Sound Tsao
Senior Scientist and Pathologist
M. Qasim Choksi Chair in Lung Cancer Translational Research
Professor of Laboratory Medicine and Pathobiology, University of Toronto
 
Dr. Ming-Sound Tsao

Dr. Tsao is a pathologist specializing in lung cancer translational research.  His laboratory focuses on the identification of genes and proteins that are predictive of good (and poor) prognosis in lung cancer patients that have had their tumors surgically removed and are receiving chemotherapy in addition to surgery.

Prognostic genes are potential targets for the development of new anti-cancer drugs.


Dr. Geoffrey Liu
Clinician Scientist
Alan B. Brown Chair in Molecular Genomics
Assistant Professor of Medicine, University of Toronto
 
Dr. Geoffrey Liu

Dr. Liu’s major research focus is in the area of molecular prognostic factors and pharmacogenetics of aerodigestive tract cancers.  He is the principal investigator of several large scale projects in esophageal, lung and head and neck cancers, and leader of six clinical trials for patients with these types of cancer.

Dr. Liu also oversees a number of collaborations that The Princess Margaret has in place with the Harvard Medical School. In 2008, Dr. Liu received the William E. Rawls Prize which is given to a young investigator whose work has led to important advances in cancer control within the past decade.


Dr. Andrew Hope
Radiation Oncologist
Assistant Professor, Department of Radiation Oncology, University of Toronto
 
Dr. Andrew Hope
Dr. Hope focuses his clinical practice on the management of lung and head and neck cancers.  He is involved in research on normal tissue toxicity and focuses on developing methods to predict, prevent, or heal side effects of radiation therapy.


Dr. John Cho
Radiation Oncologist
Assistant Professor, Department of Radiation Oncology, University of Toronto
 
Dr. John Cho
Dr. Cho has a particular interest in the treatment of malignant pleural mesothelioma, a rare tumor of the lining surrounding the lung and associated with asbestos exposure. He is the principal investigator of on-going studies testing new ways of treating mesotheliomas. He also conducts research in stereotactic lung radiation therapy for early stage lung cancer patients too unwell for surgery.  This therapy involves very high doses radiation delivered in a short amount of time.


Dr. Alex Sun
Radiation Oncologist
Assistant Professor, Department of Radiation Oncology, University of Toronto
 
Dr. Alex Sun
Dr. Sun's research interest is in the use of PET/CT imaging for the management of lung cancer. He is the clinical principal investigator of a National Cancer Institute of Canada funded grant focusing on how to incorporate PET/CT into radiation treatment planning and delivery.  His other research focus is the role of PCI (prophylactic cranial irradiation) in lung cancer. He is the Canadian principal investigator of the recently completed North American Intergroup clinical trial evaluating the role of PCI in NSCLC.


Dr. Anthony Brade
Radiation Oncologist
Assistant Professor, Department of Radiation Oncology, University of Toronto
 
Dr. Anthony Brade
Dr. Brade's research focuses on ‘combined modality’ therapy—using radiation in combination with chemo- and targeted drug therapies.  He is the principal investigator on a number of local and international clinical trials that are evaluating new strategies for patients with locally advanced non-small cell lung cancer plus brain metastases who are receiving palliative radiotherapy. 


Dr. Marc de Perrot
Scientist and Surgeon
Associate Professor of Surgery, University of Toronto
 
Dr. Marc de Perrot
Dr. de Perrot oversees a screening program launched in 2005 that uses computed tomography (CT) imaging to see and diagnose mesothelioma at an early stage.  A biobank of mesothelioma tumors has been created and is being used to test new treatment options which include the development of new drugs that target specific molecules within mesothelioma cells, ‘whole lung radiation’ prior to surgery to prevent the cancer from spreading, and therapy that boosts the body’s own immune system to attack the disease.


Dr. Igor Jurisica
Senior Scientist
Associate Professor, Departments of Computer Science and Medical Biophysics, University of Toronto
 
Dr. Igor Jurisica
Dr. Jurisica leads a department responsible for analyzing the enormous volume of multi-dimensional data generated in patient trials and in high-throughput biology experiments. This department has assisted in conducting genomic analysis of lung tumor samples to isolate a particular gene ‘signature’ that explained why some patients with early-stage non-small cell lung cancer responded well to chemotherapy in combination with surgery, while others did not.

Dr. Jurisica manages an important strategic partnership with IBM, where IBM provides needed computing power and software in return for the PMH data experts testing new hardware and software.


Dr. Shaf Keshavjee
Thoracic Surgeon and Senior Scientist
Head of Thoracic Surgery and Director of Thoracic Surgery Research
Pearson-Ginsberg Chair in Thoracic Surgery
 
Dr. Shaf Keshavjee
Dr. Keshavjee is developing a technique where donor lung tissue is modified so that it is less susceptible to injury upon transplantation.  By increasing the expression of a specific gene, the donor tissue is protected from injury due to lack of blood flow, inflammation and the immune response. 

To improve lung function after transplantation, Dr. Keshavjee has developed a lung preservation solution to preserve donor lungs enroute to transplant.  This new solution has become the standard technique used by transplantation programs around the world.


Dr. Tom Waddell
Cardiothoracic Surgeon and Scientist
Chair in Regenerative Medicine Priority Platform
 
Dr. Tom Waddell
Dr. Waddell’s current research projects are advancing the understanding of how epithelial cells, which comprise the interior lining of the lungs, can be engineered to defend themselves against infectious or immune attacks. Growing new epithelial cells in the lab opens the door to breakthrough, healing treatments for injured lungs.

Dr. Waddell has also developed clinical trials examining the role of the epidermal growth factor receptor (EGFR) signalling pathway in early lung cancer, and is pioneering new techniques in xeno-transplantation (animal to human transplant of tissue or organs).


Dr. Linda Penn
Senior Scientist
Head of the Division of Cancer Genomics and Proteomics
Co-Director, Microarray Centre
 
Dr. Linda Penn
As Co-Director of the Microarray Centre, Dr. Penn is supporting the work of hundreds of scientists.  Last year alone, the Centre supported over 250 different research projects. As an expert in microarray technology, she and her team are an integral part of the effort to analyze how genes are expressed and to zero in on gene abnormalities.

How this Team has Raised the Bar for Lung Cancer Patients Around the World
It has been an incredible decade for the lung cancer team, and one that has catapulted them to the world stage.  Their work has transformed the views of the international medical community on the treatment of advanced-stage lung cancer, and for early stage lung cancer, they are pushing hard for treatments that can deliver full remission. The team represents an incredible breadth in expertise—from basic molecular science to the use of sophisticated imaging diagnostics to pioneering and evaluating new drug therapies and radiation techniques—and it is the effective collaboration of this transdisciplinary team that has led to the following major achievements:
 
  • Conducted clinical trials that showed chemotherapy following surgery improved the cure rate at 5 years by an unprecedented 15 percent.  Dr. Shepherd’s trial led by the Canadian National Cancer Institute and including all of the major cancer cooperative groups of the U.S. National Cancer Institute was considered one of the most important, ‘high priority’ trials of the U.S. National Cancer Institute.  It was the first trial in four decades to show a convincing survival benefit from chemotherapy combined with surgery and this has become a new standard of care around the world
     
  • Showed conclusively that second-line chemotherapy (treatment that is given when initial treatment (first-line therapy) doesn’t work or stops working) significantly prolonged survival, improved symptoms and quality of life, reduced the need for narcotic use and palliative radiotherapy, and was cost effective in non-small cell lung cancer
     
  • Showed a survival advantage for a new and exciting class of drugs called epidermal growth factor receptor (EGRF) inhibitors—in this case a molecularly-targeted agent called erlotinib
     
  • Isolated a specific gene ‘signature’ or biomarker that identified which non-small cell lung cancer patients would benefit from chemotherapy in combination with surgery
     
  • Had the foresight to establish early on a trial-related frozen tumor bank to support molecular analyses related to the adjuvant chemotherapy trial.  They have also established plasma, DNA and RNA banks associated with their well-profiled patient populations
     
  • Through molecular analyses of samples from the tumor bank, the lung cancer team is establishing molecular profiles that will identify which patients will benefit (and which will not) from specific treatment protocols. This work puts the PMH at the forefront of personalized therapy for lung cancer
     
  • Since 2005, over 900 workers exposed to asbestos have been carefully screened for mesothelioma, and a biobank of mesothelioma tumors has been established
     
  • Pioneered the use of low dose computed tomography (CT) to screen individuals at high risk for lung cancer.  Over 4,000 have been screened
Thanks to over two decades of clinical trials, patients with lung cancer now have options other than returning home to ‘get their affairs in order’.

What are the Current Priorities for the Team?
The transdisciplinary lung cancer team will continue their sentinel work in search of better outcomes for lung cancer patients through the following approaches.

Screening, Early Detection and Prevention
Early studies using low dose screening computed tomography (LDSCT) suggest there is potential to reduce lung cancer deaths by detecting lung cancer at its earliest stage (when tumors are less than 1 cm in diameter).  However, advances in imaging technology are leading to the detection of more and more suspicious lesions, most of which are not cancerous.  The International Early Lung Cancer Action Program (which PMH participates in) found that the false-positive rate remains unacceptably high (only 0.9 to 1.8 percent of lung lesions detected in this program were proven cancerous).

The PMH lung cancer team hopes to improve the specificity and sensitivity of early lung cancer screening through the use of a targeted biomarker approach that combines genetic (DNA) and genomic (RNA) data and innovative bioinformatics technology. The combined use of genetic risk stratification factors with tumor-related imaging data to improve the positive prediction of the lung cancer screening program is highly original.

Because lung cancer is a disease of primarily older patients, many may not be eligible for aggressive curative surgery.  University Health Network (of which PMH is a part) has developed an innovative program to investigate alternative treatment for these patients.  Dr. Tom Waddell is leading a minimally-invasive surgical program, and the Thoracic Radiation Oncology Program led by Dr. Andrea Bezjak has developed an internationally-recognized program of Intensity Modulated Radiotherapy (IMRT). With IMRT the radiation dose conforms more precisely to the 3-dimensional shape of the tumor so higher radiation doses can be focused on regions within the tumor while minimizing the dose to surrounding normal critical structures.  Patients with small tumors identified through our early screening program are particularly well-suited for this type of potentially curative non-invasive treatment.

Dr. Bezjak and her team work closely with the highly innovative PMH radiation physics department led by Dr. David Jaffray to test new techniques and bring the benefits to their patients as quickly as possible.  Image-guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT) are other advanced radiation techniques being employed to increase the precision of the radiation delivery in order to spare nearby tissues and organs.

Population and Patient Genomic Profiling
In lung cancer, as compared to ovarian or breast cancer, there has been little work done in the area of genomic profiling.  Dr. Geoffrey Liu, as the Alan B. Brown Chair in Lung Cancer Molecular Genomics, is leading the effort to increase our understanding of the molecular epidemiology of lung cancer risk in collaboration with Dr. Igor Jurisica who leads our computational biology team.

The volume of data associated with the human genome is huge, and this creates a significant need for tools and for specialists who can figure out the most efficient way to integrate, analyze, visualize and interpret the data.  A microarray is a tool for analyzing how genes are expressed, and Dr. Jurisica and his team of sophisticated data analysts have developed considerable expertise in analyzing microarray data sets to identify markers reflective of changes associated with disease onset.  This high dependence on bioinformatics to inform biology and vice-versa creates a ground-breaking technological platform for facilitating discovery that is unlike previous biomarker approaches for risk prediction.

PMH cares for a large number of lung cancer patients, and we have carefully maintained a high quality biobank made up of tissue, blood, and fluid samples taken from these patients with their permission.  This bank provides Dr. Liu’s team with the samples they need to conduct their experiments to identify and study proteins and other markers that may be indicators of cancer.

Correlative Genomic and Molecular Research
Dr. Ming Tsao, the M. Qasim Choksi Chair in Lung Cancer Translational Research, and his team will continue to focus on identifying tumor-associated mutations, gene expression changes and aberrations that correlate with clinical outcome and response to therapy.  These ‘markers’ of lung cancer behaviour, once validated, could represent potential targets for the development of new molecularly-targeted anti-cancer drugs. 

Our lung cancer team is at the forefront of personalized therapy for lung cancer.  Their approach to research is designed to identify the patients most likely to tolerate and to benefit from certain treatment approaches, and, conversely, which patients are unlikely to benefit and only suffer toxic side effects.

Glossary
Adjuvant
utilizing drugs, radiation therapy, or other means of supplemental treatment following cancer surgery

Aerodigestive
the combined organs and tissues of the respiratory tract and the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe)

Biobank
a place that stores any biological specimens taken from patients or healthy individuals

Bioinformatics
the use of computer science, mathematics, and information theory to model and analyze biological systems, especially systems involving genetic material

Biomarker
a specific physical trait used to measure or indicate the effects or progress of a disease, illness, or condition

Bronchi
the two main branches of the trachea, leading directly to the lungs

Chemotherapy
the treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue

Computed Tomography (CT)
a diagnostic procedure that uses special X-ray equipment to obtain cross-sectional pictures of the inside of the body.  The CT computer displays these pictures as detailed images of organs, bones, and other tissues.  CT scans provide greater clarity and reveal more details than regular X-ray exams

EGFR
Epidermal growth factor receptor that induces cell differentiation and proliferation.  It is thought to be involved the development of cancer, as the EGFR gene is often amplified, and/or mutated in cancer cells

Epithelial
any animal tissue that covers a surface, or lines a cavity, and that, in addition, performs any of various secretory, transporting, or regulatory functions

Endowed fund
A fund for which the original principal is never used and the gift exists in perpetuity

Erlotinib
a drug used to treat non-small cell lung cancer, pancreatic cancer and several other types of cancer. It is a tyrosine kinase inhibitor, which acts on the epidermal growth factor receptor (EGFR)

Expendable fund
a fund where the principal can be used directly to fund a particular or general activity

Fellowship
the period of medical training following residency which provides an opportunity to further specialize in an area of interest, and work alongside experts in specific areas of research and new treatment development

Genetics
the science of heredity and variation in living organisms

Genomics
the study of the genomes of organisms including the intensive efforts to determine the entire DNA sequence of organisms.  Research of single genes does not fall into the definition of genomics; rather, this is the area of molecular biology or genetics

Image-guided radiation therapy (IGRT)
a procedure where a CT scan or ultrasound is produced and viewed just before a patient receives his or her daily radiation therapy treatment. This allows the radiation to be delivered more precisely, sparing more healthy tissue

Intensity-modulated radiation therapy (IMRT)
a type of therapy where the radiation dose conforms more precisely to the 3-dimensional shape of the tumor. This allows higher radiation doses to be delivered to regions within the tumor while minimizing the dose to surrounding normal critical structures

K-Ras
a protein which in humans is encoded by the KRAS gene, and is an early player in many signal transduction pathways

Mesothelioma
a malignant tumor of the covering of the lung or the lining of the pleural and abdominal cavities, often associated with exposure to asbestos

Metastasis
the spread of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces

Microarray
A technique for performing many DNA experiments in parallel and analyzing how genes are expressed

Molecular epidemiology
a branch of medical science that focuses on the contribution of potential genetic and environmental risk factors to the distribution and prevention of disease within families and across populations

Pharmacogenetics
the branch of pharmacology that examines the relation of genetic factors to variations in response to drugs

Pleura
a thin serous membrane in mammals that envelopes each lung and folds back to make a lining for the chest cavity

Radiation therapy
the medical use of ionizing (positively charged) radiation as part of cancer treatment to control malignant cells.  Radiation therapy can be used as a curative treatment or, where cure is not possible, to provide relief from painful side effects.  Radiation may be the primary (or sole) therapy or combined with surgery, chemotherapy, or hormone therapy.

Stereotactic
locating points within the body using an external, three-dimensional frame of reference or internal reference (e.g., a tumor) based on the Cartesian coordinate system (x, y, z axes)

Stereotactic body radiation therapy (SBRT)
a type of therapy that delivers very high doses of radiation with precision accuracy. A number of features contribute to this precision including body immobilization devices and a 4D CT scan that allows radiation therapists to visualize motion of the tumor and surrounding organs during the breathing cycle.

Translational research
research that extends from medical laboratories right into hospital clinics, linking basic scientists and medical doctors in order to bring new therapies to patients more quickly

Xenotransplantation
transplantation of an organ, tissue, or cells between two different species


If you would like to help
If you would like to make a financial contribution to ensure that the important research and work of Dr. Shepherd and her team continues, please contact Greg Lichti,Vice President at the Princess Margaret Cancer Foundation, at 416-946-2168 or greg.lichti@pmhf.ca.


*Source: Canadian Cancer Statistics 2009 published by the Canadian Cancer Society.
**Source: MedicineNet.com