Medical Oncology

med.i..cal on.col.o.gy: \'med-i-kel än-'kal-e-je\ The medical management of patients with the diagnosis of cancer. The treatment of of cancer with specialized drugs (chemotherapy).

During your first trip to the Medical Oncology Department you will meet with a specially trained cancer nurse who will gather information about you for the physician. You will be asked about your medical history and your current medical diagnosis. A physical exam, or assessment will be performed.

After the interview has been completed, you will meet with a medical oncologist who is a physician extensively trained in the treatment of cancer.

The medical oncologist will use the information gathered by the nurse and his own assessment to determine a treatment plan for you. It is possible that the physician may decide that more tests are needed before a plan can be finalized. In that case our office staff will schedule any necessary x-rays, blood work or other tests. They will also schedule any subsequent office visits.

If it's determined that chemotherapy is necessary, you will receive information about any drug or drugs that may be used.. Your nurse will give you a detailed explanation about the way your chemotherapy will be given and any possible side effects that may occur.

A pharmacist is on staff at the Cancer Center to prepare chemotherapy and other drugs relating to your treatment. He is another resource available to you should you have any questions concerning the medications your Cancer Center physicians has prescribed for you.

Most chemotherapy is given at the FitzPatrick Cancer although some patients may have to be admitted to the hospital to receive their treatments.

At each follow-up visit with your physician, you will be evaluated by a nurse who will assess you for side effects or any other symptoms.

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Radiation Oncology

ra.di.a.tion on.col.o.gy: \rad-e-'a-shen än-'kal-e-je\ The treatment of patients with the diagnosis of cancer utilizing high energy radiation to destroy the cancer cells' ability to grow and multiply.

Unlike medical oncology, where a variety of drugs are used to battle cancer, radiation oncology relies on high energy radiation to kill cancer cells. This radiaiton is usually delivered to the cancer site by a machine called a linear accelorator. There are some cases where the radiation will be delivered surgicallyimplanting a radioactive source near or in the tumor. This procedure requires a short hospital stay.

Radiation therapy is the brief, intense use of high-energy penetrating rays or subatomic particles to destroy or halt the rapid growth of cancer cells by damaging the cells' DNA. The radiation dose is measured in Grays (Gy) or Centigrays (CGy). Carefully controlled doses of radiation are used on over 50% of all cancer patients:

•as the curative therapy in some cases •in combination with surgery and/or chemotherapy in others •to palliate (reduce pain or intensity) advanced stages of cancer or painful areas of metastasis.



Two forms of radiation therapy exist:

1.External radiation is given from outside the body to treat cancers that are near the skin surface. Three ranges are used to treat cancers: superficial, orthovoltage, and supervoltage.

2.Internal radiation is implanted near or directly into the tumor via a thin tube, and is suitable only for deeply located tumors.





The Linear accelerator (Linac) is a supervoltage machine that delivers about 6 million to 18 million volts of x-rays by turning electricity into high-energy beams. The Linac can be programmed to deliver electrons rather than x-rays for certain situations. The Cobalt 60 is a supervoltage machine that uses a radioactive isotope to produce gamma rays.

Both machines can be used to deliver radiation to a specific, carefully mapped area of the body. The radiation oncologist, a physician specially trained in the use of radiation to treat cancer, uses diagnostic studies such as Ct scan, MRI, bone scan, ultrasound, and/or x-rays to localize (precisely define) the area to be treated.

The radiation oncologist and the radiation therapist (specially trained technologist) then simulate the treatment by using a machine that shows exactly where the radiation beam will be directed.

The therapist marks the patient's skin with tiny tatoo dots (permanent) and a brightly-colored marker (temporary) to show the treatment area. Using precise measurements and non-diagnostic, diagrammed x-ray films taken during the simulation, a physicist and a dosimetrist utilize sophisticated computer programs to complete the calculations involved in the treatment planning. Special lead blocks that fit into the treatment machine may also be customized to shield normal tissue from the radiation beam.

Radiation can be delivered to several different fields, or portals, which may require repositioning the patient during the treatment time, or repositioning the treatment machine. Treatment is given daily, five days a week. While the consultation and the simulation may take several hours, the actual treatment time takes only several minutes.

The duration of radiation therapy varies according to the type and location of the cancer. Breast cancer patients usually undergo about 25 to 30 treatments over 5 to 6 weeks on a Linac, then may receive a 1 or 2 week boost with electrons. The side effects of radiation therapy to the breast or chest wall may include reddening and irritation of the skin, a slight cough or shortness of breath if part of the lung lies in the treatment field, and a general fatigue. Within 2 to 3 weeks of the last treatment, these effects should dissipate.

Lung cancer patients receiving treatment to the site of the primary tumor usually undergo 25 to 30 treatments over 5 to 6 weeks for a total of 5,000 to 6,000 Gy or rads. The short-term side effects of radiation therapy to the chest may include reddening and irritation of the skin, coughing, fatigue, and loss of appetite. The radiation oncology team can advise patients on the best ways to treat short-term side effects.

Early stage prostate cancer is usually treated with a 7 to 8 week course of therapy to the pelvic area. Temporary side effects may include reddening or tanning of the skin, nausea, diarrhea, and general fatigue. The radiation oncology team can advise the patient on the appropriate diet to follow during the course of therapy, as well as prescribe certain medications to alleviate the abdominal discomforts.

Patients who receive radiation therapy to a site of metastasis for relief of symptoms usually undergo a shorter, simpler course from between 1 to 4 weeks.

Regardless of the number of treatments a patient receives, a complete blood count will be performed once a week to monitor white blood cell (WBC) and platelet count. Radiation therapy can cause a decrease in the WBC, which may make the patient less resistant to infection. A decrease in the platelet count may cause a decrease in the blood's ability to clot. Treatment may be halted for several days to allow the WBC and platelets to increase.