Cancer Treatments

A new service available at Mercy Medical Center St. Mary's is Hyperbaric Oxygen Therapy (HBOT). This treatment may help heal bone or tissue injury resulting from radiation therapy. Click here for more information.

3D Conformal Radiation Therapy (3D-CRT)
3D conformal radiation therapy (also called three-dimensional radiation therapy) uses computer technology to create a three-dimensional picture of the tumor so that multiple radiation beams can be shaped exactly (conform) to the contour of the treatment area. This is particularly useful when the tumor has an irregular shape. It allows doctors to give the highest possible dose of radiation to the tumor, while sparing the surrounding normal tissue as much as possible.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is a state-of-the-art cancer treatment method that delivers a higher concentration of radiation doses directly to cancer cells with a more precise targeting mechanism than is possible with conventional radiotherapy. IMRT can deliver higher radiation doses directly to cancer cells while sparing more of the surrounding normal tissues.

IMRT uses computer-generated images to plan and then deliver tightly focused radiation beams to cancerous tumors. Clinicians use it to exquisitely "paint" the tumor with a precise radiation beam that conforms as closely as possible to the shape of the tumor.

IMRT can be used to treat tumors that might have been considered untreatable in the past due to close proximity of vital organs and structures. Treating such tumors requires tremendous accuracy. For example, in the case of head and neck tumors, IMRT allows radiation to be delivered in a way that minimizes exposure to the spinal cord, optic nerves, salivary glands or other important structures. In the case of prostate cancer, exposure to the nearby bladder or rectum can be minimized. IMRT is being used to treat tumors in the brain, breast, head and neck, liver, lung, pancreas, prostate and uterus.

Prostate Brachytherapy
Prostate Brachytherapy (or commonly called prostate seed implant PSI) is a powerful modern treatment for prostate cancer that can help preserve a patient's quality of life. A PSI involves the surgical implantation of radioactive seeds into the prostate gland. This minimizes the chance of affecting nearby tissue while still delivering a highly conformal radiation dose to the prostate to destroy the cancerous cells. Between 60 and 120 seeds are delivered into the prostate through hollow needles under ultrasound visualization, an extremely accurate way of guiding needle and seed placement. The radioactivity kills the tumor cells. The seeds are similar in size to a grain of rice.

Brachytherapy, unlike most treatments, relies on a team of specialists to complete the procedure. The team includes urologists, radiation oncologists, medical physicists and medical dosimetrists. Together during the treatment planning phase, they determine in advance the radiation dosage and number of seeds required, as well as the exact location in the prostate where the seeds need to be placed.

This form of treatment is an outpatient surgical procedure. It usually does not require a hospital stay and typically has no long-term side effects. It usually does not alter the patient's lifestyle.

Brachytherapy has a success rate of nearly 85 percent over 15 years. It also is associated with a lower incidence of impotence and incontinence compared to prostate surgery. Even though prostate cancer is the second leading cause of cancer-related death in men after lung cancer, if the cancer is detected early enough, the 5-year survival rate for men approaches 95 percent.

High Dose Rate Brachytherapy (HDR)
HDR Brachytherapy is a form of internal radiation therapy that places the source of the high-energy x-rays as close as possible to the cancer cells so that fewer normal cells are exposed to radiation. By using HDR Brachytherapy, the doctor can give a higher total dose of radiation in a shorter time than is possible with external treatment. Instead of using a large radiation machine, the radioactive material is placed directly into (or as close as possible to) the affected area. HDR Brachytherapy often is used for cancers of the breast, uterus, cervix and lung.

HDR Brachytherapy allows a person to be treated within a few minutes in inpatient or outpatient clinics. With remote HDR Brachytherapy, a very powerful radioactive source travels by remote control through tubes, or catheters, to the tumor location. The radioactivity remains at the tumor for only a few minutes. This procedure is done by the Brachytherapy team, who will watch you on a closed-circuit television. They can also talk to you through an intercom if needed. In some cases, several remote treatments may be required. Sometimes, the catheter stays in place between treatments and sometimes it is removed, depending on your condition.

High dose rate treatments are short (usually a few minutes) and result in less discomfort than other types of radiation therapy. Because radioactive materials are not left in your body, you can return home soon after you recover.

MammoSite
Today, more and more women with early stage breast cancer are able to treat their breast cancer effectively and preserve their breasts through an option called breast conservation therapy (BCT). BCT begins with a lumpectomy, the surgical removal of the cancerous tumor. The lumpectomy is generally followed by seven weeks of External Beam Radiation Therapy (EBRT), during which radiation is directed at the whole breast. This combination of surgery and radiation works well to fight breast cancer. However, some women aren’t comfortable with the idea of radiation going through healthy breast tissue in order to treat the affected area.

One treatment option for patients undergoing breast conservation therapy is partial breast irradiation, also known as limited-field radiation therapy. The most widely practiced method of partial breast irradiation is breast brachytherapy. MammoSite is a form of partial breast irradiation.

Brachytherapy treats the breast using a radiation source that is placed inside the body. This has four important advantages:

Clinical studies of patients treated with Breast Brachytherapy have demonstrated low local recurrence rates. The most recently published study from the Journal of the National Cancer Institute documents a local recurrence rate of one percent at five-year follow-up. This recurrence rate was comparable to that seen in a group of patients treated with external beam radiation.

The MammoSite is a small, soft balloon attached to a thin catheter (tube) that fits inside the lumpectomy cavity (the space left after the tumor is removed). A tiny radioactive source (seed) is placed within the balloon by a computer-controlled machine.

Because the source is inside the balloon, radiation is delivered to the area of your breast where cancer is most likely to recur. When used as a primary therapy - the only form of radiation following a lumpectomy - you would receive treatments twice a day for five days.

If your doctor feels that whole-breast external beam radiation is more appropriate for you, the MammoSite may be used as a boost therapy. This therapy combines the MammoSite with external beam radiation to deliver additional radiation directly to the area of the breast where cancer is most likely to recur. In this case, MammoSite therapy is delivered over one to two days.

Image Guided Radiation Therapy (IGRT)
IGRT is a new technology designed to improve the precision and effectiveness of cancer treatments by giving doctors the ability to target and track tumors more accurately. Designated hardware and software programs enable clinicians to obtain high-resolution three-dimensional images to pinpoint tumor sites, adjust patient positioning when necessary, and complete a treatment, all within the standard treatment time.

Up to now, Radiation Oncologists have had to contend with variations in patient positioning and with the patient's breathing (respiratory) motion by treating a margin of healthy tissue around the tumor. IGRT enables doctors to locate the tumor before each dose is administered while the patient is in the treatment position. This minimizes the volume of healthy tissue exposed to radiation during treatment.

Stereotactic Radiosurgery (SRS)
Stereotactic Radiosurgery is not surgery at all — at least not in the conventional sense, as it does not require an incision.

SRS is a one-day outpatient procedure. It uses a computer-guided radiation therapy system to aim highly focused beams of radiation directly into a tumor or abnormality. This non-surgical approach relies on the Pinnacle treatment planning computer system to develop a plan to deliver high doses of radiation precisely to specific areas within the brain or other areas of the body. With this technique, all the radiation is focused directly on the area of the tumor or abnormality with a limited amount of radiation reaching the surrounding normal tissues.

Chemotherapy uses drugs to kill cancer cells, control their growth, or relieve pain symptoms. Chemotherapy may involve one drug, or a combination of two or more drugs, depending on the type of cancer and its rate of progression. Chemotherapy can be used in combination with other treatments such as Surgery or Radiation Therapy.

Intravenous (IV) - A needle is inserted into a vein and attached with tubing to a plastic bag holding the chemotherapy drugs.

Injections - Administered into the muscle, under the skin, or directly into a cancer lesion, depending on the type or location of the cancer.

Preventive surgery is used to keep cancer from occurring. Many colon cancers can be prevented by removing precancerous polyps before they become malignant. A woman at very high risk for breast cancer may decide to have her breasts removed rather than worry about getting breast cancer later in life. Click here for more information on the da Vinci S Surgical System, the second generation of robotic surgical systems.

Diagnostic surgery is also known as a biopsy. In this procedure, the surgeon removes some or all of a tumor for examination to determine if the growth is cancerous. A biopsy can be done in several ways, such as:

Fine Needle Aspiration (FNA): a needle is inserted into the tumor and tissue is drawn out for examination under a microscope.

Incisional or Excisional Biopsy: A small incision is made in the skin. The surgeon either removes a piece of a large tumor (incisional), or the entire mass (excisional), for further examination.

Staging surgery is used to determine the extent of a cancer. This procedure can sometimes be done without an incision by using tiny cameras (scopes) attached to a flexible tube, which are inserted into natural body openings. Besides allowing surgeons to view the suspicious area, these devices can take a tissue sample.

Curative surgery simply involves removal of a cancerous tumor. It works best on localized cancers that haven't yet spread to other parts of the body.

Supportive surgery is used to help with other cancer treatments. For example, some chemotherapy devices require a port (connecting device) to be inserted under the skin.

Restorative surgery returns the body to normal or near normal appearance or function following cancer treatment. The most common restorative surgery is reconstruction of a breast after a mastectomy. Facial reconstruction and testicular implants are also examples of restorative surgery.

Palliative surgery is only used to ease pain, disability or other complications that come with advanced cancer. Palliative surgery may improve quality of life, but is not a cure or anticancer treatment.

There are so many factors to consider before launching your personal fight against cancer, from finances to the emotional strain on loved ones. The Mercy team of cancer specialists has the expertise to recommend the best course of action for your particular type of cancer, but you must take an active role in your care.

Second Opinion
If you have been diagnosed with cancer by your primary care physician, it is wise to get a second opinion from a cancer specialist. In fact, many health insurance plans require a second opinion before covering some treatment costs. If the specialist agrees with the first diagnosis, he or she can let you know what treatment options exist for your type of cancer, depending on how advanced it is.

Prognosis
A prognosis is a cancer specialist's best estimate of how your disease will respond to treatment, and what your life expectancy may be. Some patients, especially if their cancer was discovered in the early stages, may only need minor treatment. At the other end of the spectrum, patients with advanced cancer may not have any treatment options, or they have an aggressive form of cancer with a very low survival rate.

Patients who receive the worst news may go ahead with treatment anyway in the hope of a cure, or to live long enough to take care of personal affairs. Others may refuse treatment. Whatever decision you make, consider the wishes of loved ones, and talk it over with your cancer care team.

Cost/Insurance Coverage
Because cancer treatment involves sophisticated techniques, machinery and medicine, it can be very expensive. Some treatments require a hospital stay of one night or more, which adds on to the overall cost. Health insurance and managed care plans rarely cover all the costs of cancer treatment, so it’s important to find out what is and is not covered by your policy. Uncovered expenses are the patient’s responsibility.

Caregivers
Cancer treatment is difficult to get through without help from family or friends. In addition to emotional support, caregivers can provide transportation to and from treatment sessions, help with housework, grocery shopping and other personal affairs, and help the patient take an active role in the treatment process. You don’t have to fight cancer alone!

Legal Issues
No matter what your prognosis may be, it is wise to prepare legal documents that spell out how your cancer treatments and personal affairs should be handled, if you become unable to make decisions. Advance directives include documents such as living wills, medical power of attorney and do-not-resuscitate orders.


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