Remembering Donald L. Morton, MD, 1934 – 2014

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Donald L. Morton, MD, 1934 – 2014


 

Remembering Donald L. Morton, MD, Pioneering Cancer Surgeon and Researcher


DONALD L. MORTON, MD

(1934-2014)

 

BY KURT SAMSON

Surgical oncology pioneer Donald L. Morton, MD, died in January of heart failure, at age 79. He played a leading role in developing and implementing sentinel lymph node (SLN) biopsy, which transformed the surgical management of many solid tumors, especially melanoma and breast cancer.

SLN biopsies today have been estimated to save the U.S. health system more than $3.8 billion per year in early cancer treatment, and averting numerous unnecessary surgeries.

Morton himself developed melanoma in the 1980s, but was able to recognize it early, and it was successfully treated.

For the last four decades of his life, he had been attempting to develop a therapeutic vaccine for melanoma, work that is being continued by his colleagues and other researchers.

“I think my greatest accomplishment,” he said at various times over the years, describing his childhood poverty, “was making it from rural West Virginia to the Westside of Los Angeles. I grew up during the Depression in a house that my dad built. We had no running water, no indoor plumbing, and no electricity.”

At the time of his death, Morton was Chief of the Melanoma Program and Director of the Surgical Oncology Fellowship Program at John Wayne Cancer Institute at Saint John’s Health Center, in Santa Monica, Calif., and Professor of Surgery Emeritus at UCLA.

Outside of the medical community, he gained public attention for treating John Wayne, who died of stomach cancer in 1979 and participated in an early immunogenic cancer vaccine study that Morton led.

The author of some 700 papers published in peer-reviewed journals, he was considered one of the most prolific researchers in the United States and received many national and international awards. Over the course of his professional career he served as President of several organizations, including the Society of Surgical Oncology, the World Federation of Surgical Oncology Societies, and the International Sentinel Node Society. In 2008, he received the prestigious Jacobson Innovation Award of the American College of Surgeons (ACS).

“Dr. Morton’s discoveries have profoundly changed the treatment of human cancer,” the ACS noted in making the award. “When he assumed the role of professor and chief of the Division of Surgical Oncology at UCLA School of Medicine in 1971, surgical oncology was not yet recognized as a specialty within general surgery. Dr. Morton’s division provided a model for other medical schools to duplicate.”

Regarding his SLN work, the ACS said, “His contribution has spared countless patients the morbidity of a complete regional lymph node dissection needlessly done in the absence of nodal metastasis. Intraoperative mapping of the sentinel node is a landmark achievement in surgical oncology.”

In 1991, Morton and John Wayne’s eldest son, Michael Wayne, founded the John Wayne Cancer Institute, where Morton became Medical Director and Surgeon-in-Chief until his death.

In the late 1970s, he changed how melanoma surgery was then approached by introducing the use of cutaneous lymphoscintigraphy to identify the regional lymphatic basin receiving drainage from a primary cutaneous melanoma. During the 1980s, he further refined lymphatic mapping to identify the pathway of sequential metastasis from a primary tumor to tumor-draining nodes within the regional nodal basin.

He defined the sentinel lymph node as the first tumor-draining node and hence the most likely initial candidate target of nodal metastasis. Extensive studies have confirmed that the pathologic status of the SLN accurately predicts the status of all nodes in the same drainage basin. SLN biopsy thus eliminates the need for more extensive staging lymphadenectomy, and improves the accuracy of nodal assessment by allowing closer scrutiny of a smaller specimen.

His novel studies of sentinel node mapping resolved the debate on the value of prophylactic lymph node dissection for melanoma, and SLN biopsy has become the standard of care for patients with early-stage malignant melanoma and breast cancer. The technique has also been successfully adapted for staging of other solid malignancies that can often spread to regional lymph nodes.

Morton received his medical degree from the University of California, San Francisco in 1958. He interned at UCSF Medical Center and began a surgical residency in general surgery, and then a fellowship at the National Cancer Institute. He then joined NCI as Senior Surgeon in the Surgery Branch, eventually becoming head of the Tumor Immunology Section.

 

Educator, Mentor

Over the course of his long career, Donald Morton trained hundreds of surgical oncology students, many of whom have gone on to make significant contributions themselves. One of them, Robert Wascher, MD, is now Chief of Surgical Oncology at Cancer Treatment Centers of America’s Western Regional Medical Center, in Goodyear, Arizona.

Speaking to OT about his mentor, Wascher said, “If you look at the trajectory of his life, it is quite amazing. This man, who began as a child from an impoverished coal-mining community in West Virginia, grew up to become one of the founding titans of surgical oncology.

“As a clinician, research scientist, and educator he liked to think outside the box. He was possessed of a tenacity that was, undoubtedly, a product of his hardscrabble youth. He was a tireless clinical investigator, and I believe that he still holds the record for being the most prodigiously funded researcher in the U.S., if not the world.”

Morton was a true innovator, Wascher said, but above all remained interested and committed to the work of the students that he had trained: “What stands out in my mind is not only his amazing contribution to the care of cancer patients through his development of the sentinel lymph node hypothesis, and the techniques of sentinel lymph node mapping and biopsy, but also his lifelong commitment and generosity towards his students and colleagues.”

For all of the professional awards and recognition that Morton received in his life, Wascher said that he believes his greatest contribution was in educating and mentoring students.

“I am certain that Dr. Morton was most proud of the many young surgeons that he personally trained who went on to become successful and renowned surgical oncologists, research scientists, and department chairs in their own right. He was very paternalistic towards all of us. Although he could be very demanding of his fellows, he was always committed and caring towards us.

“Following my graduation, in 2003, from the surgical oncology fellowship that he founded, and that he sustained until literally a few days before his passing, he continued to regularly check in with me regarding my professional progress, as well as my family and me. For those of us who were fortunate enough to have had Dr. Morton as our mentor and teacher, his passing leaves an enormous void in our hearts and in our lives.”

 

Oncology Times

2/28/2014

Copyright 2014

Lippincott Williams & Wilkins

All rights reserved

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, more than 3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Vitamin D May Improve Breast Cancer Survival



A new study links higher Vitamin D levels with improved survival in patients with breast cancer.


 

 

VITAMIN D MAY IMPROVE BREAST CANCER SURVIVAL

As I extensively discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, Vitamin D is the last vitamin left standing tall based upon the findings of recent high quality cancer prevention research studies.  Other than Vitamin D, virtually every other vitamin has been shown, by solid clinical research data, to have little or no favorable impact on cancer risk.  Based upon extensive research, Vitamin D appears to be particularly effective in reducing the risk of cancers of the GI tract, including, especially, colorectal cancer.  When it comes to breast cancer, the clinical research findings for Vitamin D tend to be mixed, with some studies showing a decreased risk of developing breast cancer (and improved survival in patients already diagnosed with breast cancer) associated with higher blood levels of this hormone-like vitamin, while others studies have failed to show that these beneficial effects are associated with increased Vitamin D levels.  Now, a new update from the December 2012 San Antonio Breast Cancer Symposium (the largest annual meeting dedicated exclusively to breast cancer research in the world) strongly suggests that higher Vitamin D levels, when combined with chemotherapy and the bone-strengthening drug zoledronic acid (ZOMETA®), are associated with improved survival in patients with breast cancer.

The ongoing prospective AZURE breast cancer study was not directly designed to evaluate the role of Vitamin D in the treatment of breast cancer, but among the more than 3,000 women who were enrolled in this British study, some received Vitamin D supplements and some did not.  Therefore, a secondary aim of this study was to assess the impact of Vitamin D levels on clinical outcomes in this large group of women with breast cancer.

Out of the 3,360 women who volunteered to participate in the AZURE trial, blood samples of 872 of these women were available; and these blood samples were, therefore, evaluated by measuring Vitamin D levels.  As this study was conducted in the United Kingdom, where sunlight is notoriously scarce, it was not surprising to learn that only 10 percent of the women in this AZURE trial subgroup had blood levels of Vitamin D at or above the “sufficient” level of 30 nanograms per milliliter (ng/mL).

The primary aim of the AZURE study was to assess the impact of the bone-strengthening drug zoledronic acid on clinical outcomes in patients previously diagnosed with breast cancer.  As published in the New England Journal of Medicine last year, there appeared to be no significant differences in outcomes between women randomized to receive zoledronic acid and women who received placebo (sugar) pills while undergoing chemotherapy for breast cancer.  However, in this new update from the AZURE trial, postmenopausal breast cancer patients who were randomized to receive zoledronic acid and who had blood levels of Vitamin D above 30 ng/mL were 11 percent less likely to develop spread (metastasis) of their breast cancer to their bones when compared to the postmenopausal women who also took zoledronic acid but who also had low Vitamin D levels.  (As breast cancer metastasizes to the bones more commonly than any other site in the body, this apparent Vitamin D-associated 11 percent reduction in bone metastases in postmenopausal patients being treated with chemotherapy and zoledronic acid would be expected to improve survival as well.)

At Cancer Treatment Centers of America, where I work as a Surgical Oncologist, and as the director of our breast cancer program, we routinely measure Vitamin D levels on all patients, and those who are found to be deficient in this important vitamin are routinely placed on Vitamin D supplements.  The updated findings of the AZURE breast cancer trial, as well as similarly positive research findings for other types of cancer, suggest that this approach to monitoring and, when necessary, supplementing Vitamin D levels may be an important adjunct to standard cancer therapies.

 

 

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Dr. Wascher’s latest video:

Dark as Night, Part 1


Dark as Night, Part 1

Dark as Night, Part 1



At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 2.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 



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