When a patient first comes to Roswell Park Comprehensive Cancer Center, a majority of them – 80-90% – will be diagnosed with some form of cancer. The other 10-20% may first need to spend some time with Martin Mahoney, MD, PhD, and his team in the center’s Undiagnosed Cancer Clinic, a dedicated group that includes interventional radiologists who can provide test results quickly to help determine the type and stage of cancer and set the patient up for the best possible outcome.
Hello, I'm Doctor Martin Mahoney, a physician scientist based here at Roswell Park Comprehensive Cancer Center. I'm also based out of the Department of Internal Medicine, which serves as the home for my uh clinical focus. Today. I'd like to acquaint you with a unique service line here at Roswell Park, the undiagnosed Cancer clinic. We take a more holistic approach. We review the abnormal results, we examine the patient and we try to expeditiously uh schedule that tissue biopsy in order to begin to alleviate a lot of that anxiety around these abnormal lab or imaging findings. Using a, a case example, what might occur when you refer your patient to the undiagnosed clinic. This is a female uh patient that presented uh maybe three or four years ago. She was in her late fifties at the time. Uh She was referred in by her primary care physician for uh a palpable left groin mass which according to her had slowly increased in size over a period of several weeks when we met with her, uh we asked about fevers, chills or night sweats. She reported none of those symptoms. She in fact said her weight had been stable and that other than this palpable groin mass, uh she had no other complaints or concerns at that initial visit. She also reported that she was up to date with cancer screening, including pap test, mammogram, and colonoscopy. In terms of her past medical history, she had a history of an insight to uh melanoma excised from her right chest wall several years ago and continued to follow up with dermatology. When we reviewed the imaging, we did confirm uh an abnormal inguinal lymph node on the left and set that patient up for a ultrasound guided lymph node biopsy. When we got the results of the biopsy back, it showed that she did have a poorly differentiated squamous cell carcinoma. However, uh our pathology team did do immunohistochemical staining on that tissue specimen and were able to include a urothelial origin or an ovarian origin uh and suggested a possible lung primary or cervical primary site. There are some guidelines we follow from the National Comprehensive Cancer Network. In this case. Since the inguinal lymph nodes were involved, these guidelines recommend uh ct imaging of the abdomen and pelvis. Uh proceeding with proctoscopy examination, checking C A 125 levels. We opted to refer her on to our colleagues in gyn oncology. During their examination, they were able to detect the presence of a rectal mass approximately two centimeters by three centimeters. And this is a representative uh slice uh through the lower pelvis. And you can see on the nuclear medicine study, uh FDG avidity more prominent on the left in comparison to the right, that's identified by the arrows as well as some uptake in the bladder anteriorly, as well as the anal canal uh represented there uh with the avidity or brightness uh in the in the more uh posterior aspect. Also the body imaging uh from the CT scan on the left uh calls attention to the uh bilateral inguinal uh lymph nodes more prominent as I've mentioned on the left staging uh work up did uh identify that this was clinical T two N one A disease patient was treated with concurrent chemo radiation uh with administration of Cappy toine and mitoMYcin subsequently received some adjuvant therapy on a randomized clinical trial. And the good news is at last update, she remains under surveillance of, she sees G I medical oncology once a year and a relatively recent uh endoscopy again, no evidence of disease. So a very good outcome for uh a a very concerning uh presentation of a left uh palpable inguinal mass. So why Roswell, I think uh some distinguishing features are our ability to rapidly schedule appointments. Uh These are emotionally charged visits. It's for patients and their families. So we're able to promptly get them scheduled uh and get the work up going. Some other unique features we offer here, we have an interventional radiology team. All they do for us are tissue biopsies. We are highly likely to uh secure a tissue diagnosis on the first biopsy uh appointment. In addition, our team of pathologists are highly skilled uh in reviewing material helping to establish the diagnosis. And when they're not quite able to establish the diagnosis, they're still able to uh have conversations with myself and my team to expeditiously reach that final diagnosis. If I had to provide an estimate, I would say that between 80 90% of the patients referred to our center are eventually diagnosed with some type of malignancy. We are able in the other 10 to 20% to either continue to monitor or to uh in some cases, do a issue of biopsy and establish that it's not a malignancy. Keep us in mind when labs or imaging suggests a possible cancer diagnosis, we can offer prompt scheduling, efficient work up and uh getting that patient to our uh consulting specialists to initiate ongoing therapy.
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