The physicians and scientists of the Massachusetts General Hospital Cancer Center are focused on finding new ways to detect, treat, and eventually prevent the many forms of human cancer. The Cancer Center faculty are pioneers in their respective fields and have contributed to our understanding of how cancer progresses and how it is most effectively treated. A few key areas are:

Cancer Advances Play Video

Cancer Genetics
Cancer genetics has rapidly become the basis for understanding how cancer originates.  It has also led to the discovery of mutations in the genetic material in the cell (DNA) that causes cancer to emerge as a genetic trait in some families. 

Cancer Center physicians and researchers were among the first to identify “genetic markers’” that can help to identify an individual’s risk factors for different types of cancer including cancers of the breast, ovaries, and melanoma.

Discoveries in Cancer Genetics include:

Sandra Orsulic, PhD

C. elegans

Inherited cancer gene used to predict familial breast cancer.

• Discovery of  germ-line p53 gene mutations as the cause of the multi-cancer Li-Fraumeni Syndrome, an inherited form of cancer such as: osteosarcoma, soft tissue sarcoma), breast cancer, brain tumors, adrenocortical carcinoma, and leukemia.
• Identification of the E2F gene - a master regulator of cell cycle progression. The cell cycle defines the basic mechanisms by which cells divide to make more cells and proliferate – a central characteristic of cancer.
• Use of Drosophila (fruit flies) and C. elegans (nematodes) as genetic model organisms to discover new genes that regulate cell proliferation and contribute to human cancer.
• Discovery of the contribution of specific recurrent BRCA1 mutations to the development of breast cancer in young women of Ashkenazi descent.
• Identification of a two-gene marker in breast cancer tissue that can accurately identify women who are at high risk for recurrence of the disease after Tamoxifen therapy.
• Discovery of the first critical gene in pancreatic cancer, called hedgehog, which appears to play an early and critical role in initiating this type of cancer.
• First application of molecular genetic classification of brain tumors, using genetic molecular markers that indicate whether chemotherapy is likely to be effective in treating a specific type of cancer.
• Discovery by researchers from the Massachusetts General Hospital and the Broad Institute of Harvard and MIT, that most human genetic variation is organized into large units called “haplotype” blocks. This research has led to an international effort to construct a human haplotype map, with the ultimate aim of identifying the genetic changes associated with susceptibility to common diseases, including cancer.

Radiation and Proton Beam Therapy
The Francis H. Burr Proton Therapy Center represents the forefront of technological advancement in radiation therapy.  This facility builds on more than 40 years of pioneering work and experience gained by the physicians and physicists at Harvard University's Cyclotron Laboratory where more than 9,000 patients were treated with proton therapy from 1961-2002.

The goal of radiation therapy is to eradicate or shrink the tumor cells without damaging the surrounding tissue.  Radiation therapy uses photons, electrons, and protons. Higher energy x-ray beams set at a specific distance from the body are used to destroy malignant tissues by causing a break down in the genetic structure or DNA of the cells. These cells are permanently damaged and cannot repair themselves.

At the Proton Therapy Center protons (charged particles) are accelerated using a large magnetic field that guides the proton beam to provide radiation with unique precision for the treatment of many adult and pediatric cancers.

Proton Radiosurgery used for eye melanomas

4-D CT Imaging of the Chest.

New Approaches to Radiation and Proton Beam Therapy include:

• Development of the Stereotactic Alignment Radiosurgery (STAR) device, which uses x-ray imaging technology to ensure high precision targeting for proton radiosurgery.  This is primarily used for the treatment of eye melanomas.

• Development of 4-D CT imaging (the four dimensions being width, height, depth, and time).  This new technology provides precise information on position and motion with which to plan and administer more targeted radiation treatment of the tumor with less radiation to healthy tissue.  This is especially important in the treatment of lung and prostate cancers.

• Development of Respiratory Gating, used for patients whose tumors demonstrate a significant degree of movement with 4-D CT. This technology permits the therapeutic beam to be automatically synchronized with the tumor’s motion and is turned off (or “gated”) when the tumor is not in the desired position. The Cancer Center is one of only a few sites in the U.S. to offer this new technology to patients.
  
  This tool makes it possible for our clinicians to achieve better tumor control; have fewer complications; and use higher and potentially more effective doses of radiation. Lung esophageal and prostate cancers are currently treated with this new technology.

Surgical Oncology
Surgical Oncologists are specialists in cancer surgery who offer the latest surgical advances and innovations to cancer patients. At the Cancer Center, patients benefit from new technologies and innovations such as lymphatic mapping for cancers, radiofrequency ablation of tumors, isolated hepatic perfusion for liver tumors, gene therapy approaches, sphincter sparing surgery for rectal cancer, thermal imaging of breast tumors, and isolated limb perfusion for melanoma.

Innovations in Surgical Oncology include:

• Performance of the one of the world’s first esophagectomies (removal of cancerous esophagus) as a treatment for cancer.  Due to the large volume of these surgeries, the Cancer Center has one of the lowest complication rates for this highly specialized procedure.
• Development of limb-preserving treatment for patients with soft-tissue sarcomas through use of radiation and modified surgical approaches.
• First radiofrequency ablation of a liver tumor performed in the US. In this technology, a special needle electrode is placed in the tumor under the guidance of an imaging method such as ultrasound or computed tomography (CT) scanning. A radiofrequency current then is passed through the electrode to heat the tumor tissue near the needle tip and ablate (eliminate) it.
• Development of an organ-sparing treatment using chemo-radiation for carcinoma of the bladder.
• First to use radiofrequency current to ablate a renal cell cancer and now we have the longest experience with radiofrequency ablation of renal cell carcinomas. This minimally invasive technique as an outpatient procedure allows for the destruction of renal cancers while preserving the kidney.
• The use of nanoparticles and MRI to identify spread of cancer to lymph nodes in patients with prostate, bladder and renal cell cancers.
• Development of organ sparing surgery for patients with cancer of the penis.
• Intraoperative Radiation Therapy - This type of radiation is delivered in the operating room after the surgeons have removed a tumor.  It provides a way to deliver radiation therapy immediately after tumor removal and prior to suturing. The Massachusetts General Hospital Cancer Center is one of the few centers in the country that offers this treatment. 
• Isolated Liver Perfusion - This therapy involves completely isolating the liver from the body’s circulation and infusing, or “perfusing” it with an anticancer drug at very high doses. Hyperthermia (mildly heating the liver) further boosts the drug’s potency.
• Isolated Limb Perfusion - Designed for patients with melanoma in the arms or legs, this treatment is similar to isolated liver perfusion and allows high doses of drug to be delivered to the arm or leg affected by cancer, with the goal of sparing the patient from amputation.
• In collaboration with researchers supported by the National Cancer Institute, gynecological oncologists showed that intraperitoneal [IP] chemotherapy improves survival in women with ovarian cancer.  This type of treatment, which directs chemotherapy to the abdomen where tumor is present, is now commonly used in the Cancer Center.
• Delineation and precise diagnosis of the different cystic neoplasms of the pancreas, including the understanding of their potential to become aggressive cancers.
• Demonstration that certain cystic tumors of the pancreas share molecular genetic mutations with pancreatic adenocarcinoma.

Molecular Imaging 

MRI of the Prostate

Research in molecular imaging is aimed at improving the detection of microscopic cancers through the use of “nanotechnology”, or molecular probes and sophisticated scanners. This new approach enables clinicians to detect minute tumors that cannot be seen with conventional imaging techniques. This technology improves early detection, which results in more accurate staging of disease, improved surgical outcome, and increased long-term survival. Cancer Center researchers have developed techniques that improve the identification of microscopic malignancies in both prostate and ovarian cancers.

Discoveries in Molecular Imaging include:

• High-resolution MRI studies using an iron-oxide-containing contrast agent to more accurately detect tumor metastases in prostate and other forms of cancer. This technique enables physicians to more clearly distinguish between benign [non cancerous] and malignant [cancerous] nodes and to construct three-dimensional maps to guide surgical planning. This approach is also under investigation for tracking the spread of breast, bladder and kidney cancer.
• Development of a novel method that makes microscopic tumors glow under specialized light so that they can be easily seen with optical devices. This technology is being applied in ovarian cancer patients where recurrent cancer is difficult to detect using standard approaches.

Molecular Therapeutics or “Smart Drugs”
This new field of research addresses how cancer cells with mutations in their genetic material (DNA) makes them sensitive to "smart drugs" that target these specific DNA mutations. The goal of these “smart drugs” is to affect only the cancer while leaving normal cells unaffected. 

Cancer Center physicians and scientists are at the forefront of this next generation of cancer therapy, most recently with the discovery of a molecular marker which plays an important role in the response of lung cancers to targeted drugs. Identifying this and other molecular markers is key to identifying patients whose tumors will respond to novel treatments.

Discoveries in Molecular Therapeutics include:

• Discovery of molecular mutations in a gene called “epidermal growth factor receptor” or EGFR, which play an important role in the regulation of cell growth. EGFR mutations were first identified by Cancer Center scientists in a form of lung cancer that is more common in women, nonsmokers, and patients of Asian descent. Identifying this molecular marker has triggered an array of new studies involving drugs such as Iressa, Tarceva, and new generations of targeted drugs for lung cancer.
• Successful treatment of kidney cancers with a new targeted drug that inhibits blood vessel growth (angiogenesis), and which appears particularly effective in this type of cancer.
• Discovery of a molecular marker in a gene called MET, that may predict responses to a new targeted drug in cancers of the stomach and esophagus.
• Demonstration of the benefit of using aromatase inhibitors, a new class of estrogen blockers, over more traditional hormonal treatment in the prevention of breast cancer recurrence. These international studies led by an Cancer Center investigator have changed the standard of care for breast cancer.
• Discovery of cardiac complications associated with hormonal treatment of prostate cancer. The widespread use of these treatments in the therapy of prostate cancer needs to be matched by attention to potential side effects and warrant careful monitoring.

Historic Firsts at Massachusetts General Hospital:

• Creation of the first tumor clinic in the United States.
• Discovery of the link between DES (diethylstilbestrol) exposure in pregnant women and medical complications in their daughters 15-30 years later.
• Creation of treatment regimens for cervical, ovarian, and endometrial cancers that are now considered the ‘standard-of-care
• Introduction of laparoscopy for staging of pancreatic cancer
• First successful nonmyeloblative haploidentical bone marrow transplant for non-Hodgkin’s lymphoma
• Circulating Tumor Cell - development of a microchip-based device that can isolate, enumerate and analyze circulating tumor cells (CTCs) from a blood sample. Read More >