Sai-Ching Yeung

University of Texas MD Anderson Cancer Center | MD Anderson · Department of Emergency Medicine

Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common...

Stoma creations are common procedures in surgical specialties. They can be created either as a temporary or a permanent measure. Despite advancements in surgical technique and stoma care, complications are common. Patients experiencing stoma-related complications often present to the emergency department. Emergency physicians are not expected to be...

Liquid biopsy is a valuable tool in oncology with its advantages of non-invasiveness, longitudinal sampling, and capturing the intra- and inter-tumor heterogeneity. Small extracellular vesicles (sEVs) are released by cells into various biological fluids, providing a window to ascertain the cellular status of the source cells. Although many aspects...

Pain remains an undertreated complication of cancer, with poor pain control decreasing patients’ quality of life. Traditionally, patients presenting to an emergency department with pain have only had two dispositions available to them: hospitalization or discharge. A third emerging healthcare environment, the emergency department observation unit (...

Radiation therapy (RT) to the chest increases the patients’ risk of cardiovascular disease (CVD). A complete understanding of the mechanisms by which RT induces CVD could lead to specific preventive, therapeutic approaches. It is becoming evident that both genotoxic chemotherapy agents and radiation induce mitochondrial dysfunction and cellular sen...

Background The increasing use of computed tomography (CT) has identified many patients with incidental adrenal lesions. Further evaluation of these lesions is often dependent on the language used in the radiology report. Compared to the general population, patients with cancer have a higher risk for adrenal abnormalities, yet data on the prevalence...

Cancer and its treatment can lead to oncologic emergencies. This article discusses the approach to acute emergency problems in cancer patients. A list of emergent problems has been selected for focused discussion. Sudden cardiopulmonary arrest is discussed along with considerations in resuscitation of cancer patients. Arrhythmia, superior vena cava...

Transformation of normal cells results in activation and/or suppression of a number of hormonally active genes, resulting in ectopic humoral paraneoplastic syndromes. Treatment of cancer also results in a number of endocrine or metabolic abnormalities, most of which are related to hormone deficiency or drug‐related toxicity. Targeted therapy may di...

Incidental venous thromboembolism (VTE) is common in cancer patients and identifying factors associated with these events can improve the management plan. We studied the characteristics of concomitant deep vein thrombosis (C-DVT) in cancer patients presenting with unsuspected pulmonary embolism (PE) and the association of C-DVT with VTE recurrence...

Cancer vaccines critically rely on the availability of targetable immunogenic cancer‐specific neoepitopes. However, mutation‐based immunogenic neoantigens are rare or even non‐existent in subgroups of cancer types. To address this issue, we exploited a cancer‐specific aberrant transcription‐induced chimeric RNA, designated A‐PaschiRNA, as a possibl...

Background: Central venous catheters raise the risk of catheter-related thrombosis (CRT) in patients with cancer, typically affecting the upper extremity. Management of CRT involves catheter removal and anticoagulation. However, robust evidence is lacking on the optimal timing of anticoagulation relative to catheter removal. Objectives: Our goal...

Purpose Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post hoc analysis aimed to evaluate the performance of ¹⁸F-FDG PET/CT to...

Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high‐acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations a...

Introduction Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. Materials and methods Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observa...

Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer pat...

Cancer Radiation therapy (RT) induces cardiovascular disease (CVD) even when the heart is shealed or not irradiated, but there is a paucity of available preventive measures for RT-induced CVD. Ionizing radiation (IR) induces senescence, which was originally discovered to suppress tumorigenesis by inducing cell cycle blockade and necrosis, and posit...

ERK5 is a dual kinase-transcription factor, which contains two transcriptional transactivation domains in the C-terminus and a kinase domain in the N-terminus. Many ERK5 kinase inhibitors have been developed, and are being tested in clinical studies for cancer and inflammatory diseases. Recent data has raised questions regarding the functional role...

The central role of ERK5 S496 phosphorylation in promoting senescence has been reported. Recently the conventional model of senescence as an event of cell cycle arrest has been challenged, given that senescence induced by various stresses reprograms cancer cells to acquire senescence-associated stemness (SAS), which allows them to escape senescence...

The crucial role of ERK5 S496 phosphorylation in reprogramming macrophage phenotype to pro-inflammatory senescent phenotype (PISP) has been reported, but the exact molecular mechanism remains unclear. This study focused on identifying the dysregulated molecular pathways and core genes that are differentially regulated in bone marrow derived macroph...

Numerous studies have revealed the critical role of premature senescence induced by various cancer treatment modalities in the pathogenesis of aging-related diseases. Senescence-associated secretory phenotype (SASP) can be induced by telomere dysfunction. Telomeric DNA damage response induced by some cancer treatments can persist for months, possib...

Purpose Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post-hoc analysis aimed to evaluate the performance of ¹⁸F-FDG PET/CT to...

Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. To evaluate the characteristics and clinical outcomes of cancer patients with ICH, we identified all patients with ICH who visited The University of Texas MD Anderson Cancer Center emergency department between 1 September 2006 and 16 February 2016. Clinical an...

Background The tRNA-derived small RNAs (tsRNAs) are produced in a nuclease-dependent manner in responses to variety of stresses that are common in cancers. We focus on a cancer-enriched tsRNA signature to develop a salivary exosome-based non-invasive biomarker for human esophageal squamous cell carcinoma (ESCC). Methods Cancer-enriched small RNAs...

Background Programmed cell death 1 (PD-1) blockade induces tumor regression in patients with advanced esophageal squamous cell carcinoma (ESCC); however, little is known about the efficacy of PD-1 blockade as neoadjuvant therapy in resectable ESCC. We aim to assess the safety and feasibility of using the combination of neoadjuvant PD-1 blockade wit...

This review tackles the rapidly growing body of evidence evaluating the relationship between the gut microbiome and the response to ICI therapy. Additionally, this review highlights the impact of antibiotic-induced dysbiosis on ICI efficacy and discusses the possible therapeutic interventions to optimize the gut microbiota composition to augment im...

Background Studies suggest a high prevalence of pain in head and neck cancer (HNC) patients at diagnosis, during and after treatment; however, these studies had small sample sizes and did not comprehensively assess factors known to influence pain. We surveyed a large cohort of HNC survivors to determine variations in the prevalence of pain, its tre...

Purpose Emergency department (ED) visits by patients with cancer frequently end in hospitalization. As concerns about ED and hospital crowding increase, observation unit care may be an important strategy to deliver safe and efficient treatment for eligible patients. In this investigation, we compared the prevalence and clinical characteristics of c...

The discovery of immune checkpoint inhibitors (ICIs) has revolutionized the care of cancer patients. However, the response to ICI therapy exhibits substantial interindividual variability. Efforts have been directed to identify biomarkers that predict the clinical response to ICIs. In recent years, the gut microbiome has emerged as a critical player...

Background The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine w...

Pain is common in patients with cancer seeking emergency department (ED) care. Fifty percent of ED patients with cancer present with pain and 39% report pain at final ED pain assessment. Thus, ED practitioners seemingly remain challenged to manage pain in this population. Such findings support calls encouraging safe, effective, and timely pain mana...

Cancer patients have increased risk of infections, and often present to emergency departments with infection-related problems where physicians must make decisions based on a snapshot of the patient’s condition. Although C-reactive protein, procalcitonin, and lactate are popular biomarkers of sepsis, their use in guiding emergency care of cancer pat...

Introduction: Intracranial hemorrhage is a devastating complication of cancer and its treatment. Objective: To evaluate the characteristic, risk factors and clinical outcomes in cancer patients with intracranial hemorrhage presenting to the emergency department. Methods: We collected a decade of retrospective data on all patients with the diagnosis...

Purpose Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes....

Purpose: Breast cancer and cardiovascular diseases often share the same risk factors. It is increasingly important to identify risk factors for cardiovascular (CV) events in high-risk breast cancer patients and explore optimal treatment regimens. Patients and methods: Early HER2-positive breast cancer patients at our institution between January...

BACKGROUND The combination of trastuzumab with anthracycline chemotherapy drugs is associated with synergistic cardiotoxicity. The aim of the study is to compare the efficacy and late-onset cardiac toxicity of neoadjuvant chemotherapy (NC) regimens, Trastuzumab plus Paclitaxel followed by 5-Fluorouracil, Epirubicin, and Cyclophosphamide (PH-FECH) v...

Weight loss and cachexia are common problems in colorectal cancer patients; thus, parenteral and enteral nutrition support play important roles in cancer care. However, the impact of nonessential amino acid components of nutritional intake on cancer progression has not been fully studied. In this study, we discovered that gastrointestinal cancer pa...

Background Current understanding of genetic factors associated with pain severity, and improvement of pain with opioids in advanced cancer patients (AC) is inadequate for delivery of personalized pain therapy (PPT). Therefore, the aim of this study was to determine the genetic factors associated with pain severity, daily opioid dose, and pain respo...

Recent innovation and discovery in oncologic and pharmaceutical industry have led to many new efficacious cancer therapeutics. In the past decade, the US Food and Drug Administration approved, at an accelerated pace, over a hundred novel agents in oncologic alone. These rapid advances present important challenges to emergency physicians, relating t...

Diarrhea in cancer patients has diverse etiologies: paraneoplastic syndromes, cancer treatment-induced adverse effects, and infections. Malignant diseases, such as neuroendocrine tumors (VIPoma, gastrinoma, medullary thyroid carcinoma, carcinoid tumors), may cause paraneoplastic syndromes with severe secretory diarrhea. Treatment-induced diarrhea c...

Cancer and its treatment can lead to endocrine and metabolic abnormalities. Some of these problems can be long term or delayed, and emergency care providers should be aware of these issues in cancer survivors, as well as for patients with active malignancies. Routine laboratory assessment of chemistry often reveals abnormalities in cancer patients...

Smoking is one of the most impactful lifestyle-related risk factors in many cancer types including esophageal squamous cell carcinoma (ESCC). As the major component of tobacco and e-cigarettes, nicotine is not only responsible for addiction to smoking but also a carcinogen. Here we report that nicotine enhances ESCC cancer malignancy and tumor-init...

Background Type II diabetes mellitus (DM2) is a significant risk factor for cancers, including breast cancer. However, a proper diabetic breast cancer mouse model is not well‐established for treatment strategy design. Additionally, the precise diabetic signaling pathways that regulate cancer growth remain unresolved. In the present study, we establ...

Important evidence indicates the microbiota plays a key role in esophageal squamous cell carcinoma (ESCC). The esophageal microbiota was prospectively investigated in 18 patients with ESCC and 11 patients with physiological normal (PN) esophagus by 16S rRNA gene profiling, using next-generation sequencing. The microbiota composition in tumor tissue...

220 Background: Programmed death-1 (PD-1) blockade may induce tumor regression in patients with advanced esophageal squamous cell carcinoma (ESCC), but little is known about the efficacy of PD-1 blockade in neoadjuvant therapy of resectable ESCC. Methods: Under an approved clinical trial protocol, a pilot study was conducted by enrolling patients w...

Background Procalcitonin (PCT) and lactic acid have emerged as biomarkers that increase in bacterial infections/sepsis and have been used in conjunction with clinical judgment to guide antibiotic administration. The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been used to classify the risk for patients with neutro...

Transcription-induced chimeric RNAs are an emerging area of research into molecular signatures for disease biomarker and therapeutic target development. Despite their importance, little is known for chimeric RNAs-relevant roles and the underlying mechanisms for cancer pathogenesis and progression. Here we describe a unique ASTN2-PAPPAantisense chim...

Objectives The purpose of this study was to evaluate the postrelapse survival of relapsed osteosarcoma with pulmonary metastases in patients who received pulmonary metastasectomy using intent to treat and propensity score analysis. Methods Patients with osteosarcoma who relapsed with pulmonary metastases between 2004 and 2018 who were treated in a...

Background We aimed to determine whether hypomagnesemia predicts osteoradionecrosis development in patients with squamous cell carcinoma of the oropharynx and oral cavity who received platinum‐based concurrent chemoradiation with or without induction therapy. Methods We reviewed data from patients with head and neck cancers who had undergone chemo...

Forkhead‐Box Class O 4 (FOXO4) is involved in critical biological functions, but its response to EGF‐PKB/Akt signal regulation is not well characterized. Here, it is reported that FOXO4 levels are downregulated in response to EGF treatment, with concurrent elevation of COP9 Signalosome subunit 6 (CSN6) and E3 ubiquitin ligase constitutive photomorp...

Lung cancer is the leading cause of cancer death worldwide. The Xuanwei-Fuyuan (XF) region of Yunnan, China has a high incidence of lung cancer from coal-related pollution. Effort to raise public awareness screening for lung cancer has been ongoing. We retrospectively analyzed overall survival (OS) of lung cancer patients of a tertiary cancer cente...

Background: Prior research has confirmed that persistent hypomagnesemia was predictive of shorter survival among patients with ovarian cancer who received carboplatin-based chemotherapy. In the current retrospective study, the authors examined the association between hypomagnesemia and survival in patients with head and neck cancer who received co...

Forkhead-Box Class O 4 (FOXO4) is involved in critical biological functions, but its response to EGF-PKB/Akt signal regulation is not well characterized. Here, it is reported that FOXO4 levels are downregulated in response to EGF treatment, with concurrent elevation of COP9 Signalosome subunit 6 (CSN6) and E3 ubiquitin ligase constitutive photomorp...

Background: Oral mucositis (OM) is a debilitating sequela for patients treated for squamous cell carcinoma of the head and neck (HNSCC). This study investigated whether oral microbial features before treatment or during treatment are associated with the time to onset of severe OM in patients with HNSCC. Methods: This was a cohort study of newly...

Background: Ovarian cancer is the leading cause of cancer-related death among women. Complete cytoreductive surgery followed by platinum-taxene chemotherapy has been the gold standard for a long time. Various compounds have been assessed in an attempt to combine them with conventional chemotherapy to improve survival rates or even overcome chemore...

Background Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms. Objective This study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile hea...

Background: Human intestinal tract microbiome dysbiosis plays an emerging pivotal role in tumorigenesis of gastrointestinal tract cancers. For esophageal squamous cell carcinoma (ESCC), the esophageal microbiota plays a critical role during the pathogenesis. The microbiome of esophageal can impact its host decades before the onset of ESCC, and can...

Background: Recently, obesity, insulin resistance/type 2 diabetes mellitus and fatty liver disease, i.e., key components of the metabolic syndrome, have been recognized as risk factors for hepatocellular carcinoma (HCC). Obesity and dysmetabolism serve as drivers of oncogenesis in the setting of abnormal hepatic morphology and physiology, and hepat...

Rapid advances in cancer immunotherapy using immune checkpoint inhibitors have led to significantly improved survival. Rapid identification of the toxicity syndromes associated with these therapeutic agents is very important for emergency physicians because the population of patients diagnosed with cancer is increasing and cancer therapies includin...

Objective Intranasal fentanyl (INF) quickly and noninvasively relieves severe pain, whereas intravenous hydromorphone (IVH) reliably treats severe cancer pain but requires vascular access. The trial evaluated the efficacy of INF relative to IVH for treating cancer patients with severe pain in an emergency department (ED) setting. Methods We random...

Purpose: The tumor immune microenvironment (TIME) has an important impact on response to cancer immunotherapy using immune checkpoint inhibitors. Specifically, an "infiltrated-excluded"/"cold" TIME is predictive of poor response. The antidiabetic agent metformin may influence anti-cancer immunity in esophageal squamous cell carcinoma (ESCC). Expe...

Background: Acupuncture intervention in actual practice is rarely reported and may be different from that applied in acupuncture research. Objectives: To review acupuncture practice in an integrative medicine clinic and characterize the association between targeted symptoms, traditional Chinese medicine (TCM) diagnosis, and acupoint selection. Meth...

Objectives The application of circulating tumor DNA (ctDNA) monitoring after resection in pathologic(p) stage I lung adenocarcinoma (LUAD) patients remains controversial and it is of great clinical interest to decipher the difference of genetic features between ground-glass opacity (GGO) and solid nodules (non-GGO) subgroups. We aim to assess the u...

Background: Diabetes mellitus type 2 (DM2) is a modifiable risk factor associated with pancreatic carcinogenesis and tumor progression on the basis of epidemiology studies, but the biological mechanisms are not completely understood. The purpose of this study is to demonstrate direct evidence for the mechanisms mediating these epidemiologic phenom...

3537 Background: Pathologic(p)stage I lung adenocarcinoma (LUAD) patients exhibit high levels of genetic heterogeneity and the association between the genomic characteristics of (p)stage I LUADs and tumor recurrence remains poorly understood. Circulating tumor DNA (ctDNA) monitoring after resection represents a useful tool to predict response to th...

Background The accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests. Objective We sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE. Meth...

Incidental pulmonary embolisms (IPEs) are common in cancer patients. Examining the characteristics and outcomes of IPEs in cancer patients can help to ensure proper management, promoting better outcomes. To determine the clinical characteristics, management, and outcomes of IPEs for cancer patients, we conducted a 1:2 ratio case-control study and i...

A dynamic residential community-based quarantine strategy: China’s experience in fighting against COVID-19 - Yan Guo, Yiran Li, Aliza Monroe-Wise, Sai-Ching Jim Yeung, Yixiang Huang