Cancer Treatments and Procedures
If you have been diagnosed with cancer, you and your oncologist will work closely together to identify the best treatments for your specific health considerations. These may include a surgical intervention, as well as radiation and/or chemotherapy. At Alta Bates Summit, our outstanding physicians provide a wide variety of cancer treatments and procedures to ensure you receive the best possible care. Read below to learn more about the cancer treatments we offer.
Medical Oncology - Systemic Treatment
Medical oncology and hematology focus on treating cancer with drugs and other agents which travel throughout your body’s entire system to destroy cancer cells and help the body defend itself. Medical oncology is considered "systemic treatment" as opposed to radiation oncology which focuses treatment on a specific part of the body.
Chemotherapy
Chemotherapy may be given before or after surgery. Most chemotherapy drugs are administered by intravenous infusion over minutes to several hours. Other types of chemotherapy are administered by injection or in pill form. The duration of treatment depends on the type of the cancer and the treatment regimen. Chemotherapy is given in cycles, allowing a rest period between treatments.
Recently, tremendous strides have been made in the management of side effects associated with chemotherapy. A variety of options now exist to eliminate or minimize chemotherapy-induced side effects such as nausea, vomiting, diarrhea, constipation, temporary hair loss, and/or weight changes. Each person has unique responses to treatment, so Alta Bates Summit doctors and staff will work with you to prevent and minimize your side effects. You will also be taught how to manage side effects using nutritional strategies, complementary therapies and prescribed medications.
Hormone Therapy
Like chemotherapy, hormone therapy – also called "endocrine-based therapy" – is a systemic treatment. But unlike chemotherapy, endocrine-based therapy was developed to interfere with certain natural body chemicals – hormones – which may stimulate cancer growth. Cancer types which characteristically may be sensitive to hormones include breast, prostate, ovarian, and endometrial cancers. To slow or prevent the growth of these sensitive cancer cells, hormone therapy drugs are chemically structured to interfere with the growth of such types of cancer, for example by decreasing the amount of hormone that the body produces or by blocking its action on the cancer cells directly.
Where chemotherapy agents may affect many other general cell types such as white blood cells, hormonal agents are more limited in their effects. They are the first type of systemic treatment directed at a specific target – the hormone-dependent cancer cell – and may be referred to as "targeted therapy." Their benefits and their side effects relate only to the natural effects of the hormone itself and the hormone-cancer cell interaction. For that reason, the typical side effects seen with chemotherapy are not present with hormone or endocrine-based therapies. Hormone therapy may be used alone or in combination with radiation therapy. It is rarely used simultaneously, but is often used following chemotherapy.
Targeted or Molecular Therapies
Normal cell growth and division are mostly under the control of a network of chemical and molecular signals that give instructions to cells. When this signaling process is disrupted, cells no longer grow, divide, or die normally when they should. Scientific discoveries related to these biochemical signals and their targets have resulted in numerous advances in the treatment of cancer. Cancer therapy that is directed to a specific target or signaling pathway is commonly called "targeted therapy" or "molecular therapy."
Targeted cancer therapies use drugs that block the growth and spread of cancer by interfering with cancer cell growth and division in different ways and at various points during the development, growth, and spread of cancer. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies provide effective treatment for cancer while sparing healthy tissues.
The medical oncologists at Alta Bates Summit Medical Center use the most current FDA-approved therapies and are committed to using the most recent discoveries in cancer therapies on behalf of their patients.
Some of the common targeted therapies done at Alta Bates Summit include Colony-stimulating factors (CSFs) which do not directly affect tumor cells, but instead encourage bone marrow stem cells to divide and develop into white blood cells, platelets, and red blood cells. Some examples of CSFs and their use in cancer therapy are as follows:
In addition to CSFs, researchers are evaluating the effectiveness of certain antibodies made in the laboratory called monoclonal antibodies (MOABs or MoABs). These antibodies are specific for a particular target and researchers are examining ways to create MOABs specific to the targets found on the surface of various cancer cells. MOABs may be used in cancer treatment in a number of ways:
Some monoclonal antibodies that are currently in use at Alta Bates Summit Medical Center include:
"Small-molecule" drugs block specific enzymes and growth factors involved in cancer cell growth. These drugs are also called signal-transduction inhibitors. Targeted agents may block a variety of pathways that promote cancer growth, such as: EGFR (epidermal growth factor); TK (tyrosine kinase) and VEGF (vascular endothelial growth factor).
Small molecule drugs that are commonly used by Alta Bates Summit oncologists include:
- Some medical descriptions above are from the National Cancer Institute website
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Radiation Oncology - Focused Treatment
Radiation therapy, or radiation oncology, is a true targeted therapy with treatment directed precisely at the site of the cancer. It may be used as part of a larger treatment strategy that includes a systemic therapy – either chemotherapy or endocrine-based therapy – or it may be administered alone. The science behind radiation oncology continues to make rapid advances in scope and technique, thus reducing side effects and sparing healthy tissues by targeting the disease more precisely.
At Alta Bates Summit, we offer the following current radiation therapies:
3D Conformal Treatment Planning
3D conformal treatment planning uses computer generated, three-dimensional images of the patient’s tumor, surrounding tissue, and the tumor’s exact position in the body, to make radiation therapy more accurate. Using the computer, the radiation oncologist develops a precise plan to deliver radiation to the tumor from a number of angles. Radiation physicists with expertise in medical radiation issues are an important part of this planning team.
Because of the degree of accuracy and precision that 3D conformal treatment planning allows, higher doses of radiation can be delivered to the tumor. Treatment is more effective, treatment time is shortened, and healthy tissue is spared. This approach is especially valuable to treat complex tumors such as cancers of the brain, lung and prostate or to treat children with cancer.
Brachytherapy
Unlike external beam radiation, which treats the tumor from the outside in, brachytherapy treats cancer from the inside out by using radioactive implants placed into or a short distance from the tumor. Brachytherapy, though, is often combined with external radiation, surgery, or other treatments as part of an integrated care strategy.
High Dose Rate (HDR) Brachytherapy
Traditionally, low dose rate brachytherapy techniques have required two to five days of hospitalization for certain disease sites, such as gynecologic malignancies. Now, high dose rate techniques can deliver a therapeutic dose in minutes rather than days. High dose rate (HDR) brachytherapy delivers radiation directly into tumors through fine needles that are deployed from computer controlled "afterloaders" that move the radiation source on a wire within the needle accordingly to a carefully customized treatment plan developed by your doctor, a physicist, and a radiation therapist.
External Beam Radiation
Radiation therapy uses either beams of radiation delivered from outside the body, called external beam radiation, or radiation emitted from "seeds" planted inside the body, either temporarily or permanently, called brachytherapy. New radioisotopes are in use that can be administered in liquid format for certain diseases as well (radioimmunotherapy). Radiation oncologists use the state-of-the-art tools to improve accuracy, reduce treatment time and side effects, and produce better overall results, as described below.
Image Guided Radiation Therapy (IGRT)
To maximize the effectiveness of IMRT treatments, the tumor, or target, must be accurately located each day. Even a slight change in a patient’s position from day to day can affect the delivery of the treatment. New image-guided techniques are being used to verify the location of the tumor before the treatment session begins.
Alta Bates Summit Medical Center is proud to be the first medical center in the Bay Area to provide TomoTherapy, IMRT / IGRT technology for the treatment of many different types of cancer. The TomoTherapy cancer treatment system combines an advanced form of IMRT, the accuracy of CT scanning technology, and advanced tools for planning and delivering radiation therapy in one machine.
Intensity Modulated Radiation Therapy (IMRT)
Used after 3D conformal treatment planning, Intensity Modulated Radiation Therapy (IMRT) delivers pencil thin beams of radiation to target tumors while it spares healthy tissue. Very simply, IMRT gives the radiation oncologist more control over where and how much radiation is delivered. Importantly, IMRT allows the doctor to “paint” or conform the dose to a tumor’s irregular shape, while “sculpting” the dose to avoid critical structures such as nerves or glands.
Alta Bates Summit Medical Center is proud to be the first medical center in the Bay Area to provide TomoTherapy, IMRT / IGRT technology for the treatment of many different types of cancer. The TomoTherapy cancer treatment system combines an advanced form of IMRT, the accuracy of CT scanning technology, and advanced tools for planning and delivering radiation therapy in one machine.
MammoSite® Radiation Therapy System
The MammoSite® Radiation Therapy System (RTS) offered at Alta Bates Summit is a minimally invasive, short-duration form of brachytherapy used in breast cancer after lumpectomy procedures. By internally delivering radiation directly to the tissue surrounding the original tumor, exposure to the rest of the breast, skin, ribs, lungs, and heart is limited.
The MammoSite RTS consists of a balloon catheter that is inserted into the space where the tumor was removed, either during the lumpectomy or shortly thereafter. An applicator shaft, which is a tube connected to the balloon, remains outside the breast. A radioactive “seed” is inserted into the balloon, through the applicator shaft over a one to five-day series of treatments. When the therapy is complete, the balloon is deflated and the catheter is easily removed. No source of radiation remains in the patient’s body.
The MammoSite RTS makes it easier for women to consider lumpectomies rather than mastectomies, promoting the practice of breast conservation therapy. However, this type of treatment is not for everyone. Talk to your doctor to see if you are a candidate.
On-Board Imager (OBI)
An On-Board Imager™ produces both excellent quality kilovoltage images as well as high quality Cone-Beam Computed Tomography (CBCT) images in less than a minute. Tumors are located quickly and precisely at the beginning of each session, allowing treatments to be completed quickly. The ability to target the tumor and avoid the normal tissues is extremely important in certain disease sites, and the ability to use the linear accelerator as a CT scanner allows for excellent refinement.
Pediatric Radiation Therapy Program
In conjunction with the pediatric oncology team at Children’s Hospital and Research Center in Oakland (CHO), Alta Bates Summit radiation oncologists provide radiation services for all children with malignancies who require radiation as part of their curative treatment. This includes treatment for a wide array of leukemias, lymphomas, soft tissue tumors and brain tumors in children from birth to age 18. The recent addition of an active pediatric anesthesia program allows the safe and highly focused delivery of radiation to infants who must be sedated for each daily treatment. These pediatric patients are treated based on active, national, Children’s Oncology Group (COG) protocols, and our pediatric radiation therapy program has received accreditation through the national Quality Assurance Review Center.
Permanent Prostate Seed Implants
Implanting "seeds" of radioactive iodine or palladium directly into the cancerous area of the prostate gland is a treatment that offers a cost-effective alternative to surgery. This technique allows a much shorter treatment time than external beam radiation.
The seeds are inserted into the prostate through hollow needles, which are removed after the procedure is complete. The patient is typically discharged after several hours, or the next day at the latest. The seeds release their energy for a period of time after the procedure and before their radioactive properties decay. After a carefully planned interval, the radioactivity contained within the seeds is delivered to the site and they become inactive. The treatment is then complete. Talk to your doctor to see if you are a candidate for permanent prostate seed implants.
Radiolabeled Antibody Therapy
Although radiation therapy itself is a targeted therapy, there is an even newer type of treatment which combines radiation with a systemic agent, enabling the radiation to be delivered in the body directly to the cancer cells through bloodstream. In this instance, the systemic therapy is an antibody with a radioactive medication attached to it, directed against certain lymphomas. An antibody is a protein which the body makes to fight against a target, usually a bacteria or another infectious agent. In this circumstance, however, the target is the surface of the lymphoma cell itself. One of these combination drugs is called “Zevalin” and consists of an antibody with an attached radioactive agent called “Yttrium” which is delivered to the lymphoma cells, thus sparing healthy tissues.
Although Zevalin treats only certain types of lymphomas, it is likely that the use of this type of therapy will become more widespread as more agents and combinations are developed.
Respiratory Gating
Respiratory gating is a technology that matches the delivery of radiation to a patient’s breathing pattern. When you breathe, your chest wall moves in and out, and your organs and tissue in the chest and upper abdomen move as well. With respiratory gating, the radiation beam is only on at certain times to ensure that the beam is delivered to the proper target. This allows your doctor to treat a smaller area, with improved accuracy.
Respiratory gating is useful in treating tumors that may move with respiration during the radiation treatment, such as cancers in the liver and tumors in the outer regions of the lung. This technique also protects the heart during treatments for some types of breast cancer. The ability to localize dosage and protect healthy tissues in this manner allows treatment of lesions in the liver that could not previously be treated with radiation.
Respiratory gating is not for everyone. It requires the patient’s cooperation and ability to follow specific breathing instructions. Talk to your doctor to determine if respiratory gating is appropriate for you.
Stereotactic Body Radiotherapy (SBRT)
For certain disease sites, such as small lesions in the liver, lung or along the spine, treatment plans can be designed that will treat the tumor in three to five periods over the course of a week as an outpatient. This can only be accomplished with highly conformal radiation beams that minimize risk to nearby structures. The advent of the cone beam CT, on board imagers, and respiratory gating now make this possible for certain individuals. This is an effective alternative to surgical resection under the appropriate circumstances. Talk to your oncologist to ask if Stereotactic Body Irradiation is right for you.
TomoTherapy
One new and very effective method of delivering radiation is through TomoTherapy - a linear accelerator that's able to focus an external beam of radiation at a specific part of the body with outstanding accuracy. Alta Bates Summit is proud to be the first medical center in the Bay Area to offer TomoTherapy to its patients. Click here to learn more about the TomoTherapy Hi-Art (linear accelerator) system.
Total Body Irradiation Program
As part of the adult/pediatric stem cell transplant programs, the Radiation Department has been performing total body irradiation for over 15 years. A variety of radiation protocols are available for different disease sites, with the availability of anesthesia for the young children as well.
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Cancer Surgery
Surgical therapy is the most frequently used and most successful cancer therapy available today. In fact, more patients are cured of cancer by surgery than any other single therapeutic method, however, it can be curative only for patients with localized tumors. Surgery for cancer can be used to prevent, diagnose, treat, ease symptoms or improve function for individuals living with cancer.
Cancer surgery refers to the surgical removal of any tissue that contains cancerous cells to prevent the spread and growth of the cancer, and it may include everything from a relatively simple outpatient procedure, such as the removal of a cancerous mole, to more complex procedures that are individually tailored to the needs of each patient. Surgeons who perform cancer surgery continue to develop new surgical techniques that are less invasive, cause less pain and have decreased recovery time. Leading approaches to surgical cancer care can involve the use of newer anesthetic agents, laser technology, endoscopes and laparoscopic approaches.
For more complex cancer conditions, surgery is typically accompanied by medical and/or radiation oncology treatments. Post-surgery care is also very specific to each individual's treatment needs and cannot be generalized.
To select a surgeon who treats cancer, visit our Find A Doctor search tool.
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