Cancer Care Associates

Click on a question to see the answer.

Surgery most commonly is used to remove a cancer before it spreads. It can be performed using a scalpel (a surgical knife), electrocautery (a hot knife), or a laser. In most cancers the goal of surgery is to remove the cancer completely to attempt a cure. In the majority of cancers a partial operation (debulking) to remove only part of the cancer is not helpful and therefore in most cancers, surgery is used only for cancers of limited stage when the cancer can be removed completely. For example if a patient has lung cancer that has spread into the liver, removal of the lung will not result in a cure or even be helpful since the cancer has already spread to other areas. Learn more >

This is a surgical technique using a scope placed through a small incision into the abdomen. Similarly the operation of using a scope placed into the chest is called a thoroscopy. The benefit of operating through a scope is that the extent of surgical incision is much less and therefore the recovery time for the patient is much shorter. Not all surgeries can be accomplished with a scope.

This is a technique of using a probe which is inserted into a cancer to destroy the cancer by freezing it. Liquid nitrogen, which is extremely cold, is used to create an iceball. When initially developed the technique generated great interest but subsequent studies have raised concerns that it may be a suboptimal cancer operation because the heat from blood vessels protects parts of the cancer, thereby preventing complete destruction.

This is a new and promising technique where a probe is used to deliver microwaves into a cancer to destroy it with heat. Initially, the placement of the probe required a surgery. Now, the probe can often be placed by a radiologist using ultrasound or CT guidance and surgery can be avoided. The most frequent use of radiofrequency ablation (referred to as RFA) is for cancers within the liver. At this time those cancers are technically the easiest to treat with this technique although the technique is sometimes used in cancers within the bone or lungs. There is limit to the size of cancer that can be treated effectively and at this time that is about 5 cm.

Radiation therapy is the use of high energy Xrays in the form of photons to destroy cancer. The energy source is a linear accelerator and the treatment is administered by a radiation oncologist (radiation therapist). The radiation beam targets a specific area of the body. Because of toxicity, it is not possible to irradiate safely either entire organs or the entire body. The way in which radiation treatments are effective is by damaging DNA within the cancer and causing the cells to die as they divide. Therefore radiation is most effective in fast-growing cancers and much less effective in cancers with very slow growth rates. Modern advances in radiation technique permit more accurate focusing of the beam to permit high doses to the cancer and lower doses to surrounding tissues making the treatments more effective and limiting side effects. Radiation therapy is typically given 5 days a week for a number of weeks which vary depending upon dose necessary to treat a particular cancer. Once treatment planning is complete, which may take 2 hours, the daily treatment visits generally take 10-15 minutes. Learn more >

The technical name for this is brachytherapy or interstitial radiation. This is a technique of delivering high doses of radiation to a small area by inserting a small radioactive device. Some surgery, usually minor, is required to place either radioactive seeds or thin rods into the targeted area. The duration of radiation exposure is relatively short and radioactive implants can then be removed as when treating the cervix or left in place indefinitely as when treating the prostate.

This is a way of giving high doses of external radiation to a limited area and is most commonly used to treat cancers within the brain. Using a device to stabilize the head, a very high dose of radiation is delivered to a part of the brain using very sophisticated physics and computer assistance. The entire treatment is accomplished in a single session. The amount of brain tissue receiving this type of radiation needs to be limited in size to minimized damage to surrounding normal brain. The decision to use this type of radiation is determined by the radiation oncologist and is not appropriate in all cases.

Proton therapy is a form of external radiation using particles which can be bent and shaped to try to focus the treatment more specifically and reduce toxicity to nearby tissue. The treatment process is very complicated and the advantage of using this technique of radiation delivery is limited to only a few relatively uncommon circumstances such as attempting to repeat radiation treatments to the spinal cord area. Proton therapy has been available for over 20 years but still only a very small number of centers exist in the United States with proton machines, which reinforces the general lack of advantage of this type of radiation compared to the more standard radiation.

Chemotherapy refers to the use of medicines to treat cancer. There are many different chemotherapy drugs and different types of cancers are treated with different chemotherapy combinations. The drugs work by interfering with DNA production as cancers try to grow. Therefore, much like radiation therapy, chemotherapy has greater activity in faster growing cancers and is often inactive in slowly growing cancers. The advantage of chemotherapy is the ability of the treatment to have an effect throughout the entire body, with the exception of the brain, which has limited chemotherapy penetration due to the properties of its blood vessels. Learn more >

Most chemotherapy is given intravenously as an outpatient, usually in an infusion center. The treatment is given under the supervision of a medical oncologist by a registered nurse. At Cancer Care Associates all nurses are experienced and chemotherapy certified RNs.

Chemotherapy treatment is empiric. That means that the drug selection for each individual patient is determined scientifically by clinical trials that report the success rate of the drug combinations based upon cancer type and stage. The results of these trials are reviewed at national meetings and reported in peer review journals so that the same treatments are given by cancer specialists throughout the United States and much of the rest of the world. At one time, about 20 years ago, it was thought that oncologists would individualize treatments for each cancer patient based upon chemotherapy assays of a patient’s cancer, very much like antibiotic sensitivity testing in patients with infection. Unfortunately that approach has not been proven helpful due to the inaccuracy and unreliability of the chemotherapy assay which is now rarely used nor recommended by university cancer leaders or the National Cancer Institute. Instead, the national leaders in oncology have emphasized the use of scientific evidence-based medicine and reliance on well conducted clinical trials to select appropriate chemotherapy. It may be that genetic and protein tests in the future will be valuable in helping pick the right chemotherapy and many studies are currently underway to look at this. At Cancer Care Associates, we only use chemotherapies that are approved for the specific cancer being treated by the FDA (with the exception for patients on clinical trials). This is a significant issue because use of chemotherapy in non-approved situations can lead to insurance denial of reimbursement which can be a huge problem given the large cost associated with some of the drugs.

It depends on the specific chemotherapy drugs administered. Each drug has a unique way of working and unique specific common side effects. One of the major advances in chemotherapy is the use of new and effective anti-nausea medication. Many patients will have minimal nausea so it wouldn't be unusual if you notice some nausea for a day or so. Depending on the specific chemotherapy, you might also have vomiting but usually limited to the evening of treatment and part of the following day. Contrary to popular belief, many patients receiving modern-day chemotherapy feel well enough to maintain a near normal level of activity and employment.

That depends on the specific drugs used. Some cause hair loss and others don’t. When chemotherapy is finished hair regrowth occurs. Sometimes the new hair is thicker and curlier, but eventually hair returns to near normal in texture.

Yes, but contrary to popular perception, the infections are not typically viral but bacterial and you don't catch them from others. Chemotherapy lowers the type of white blood cells called neutrophils which fight bacterial infection. Generally the lowest levels occur 10-14 days after a chemotherapy treatment and remain low for 3-7 days. During this time, you may develop a bacterial infection of your blood due to bacteria that can enter the bloodstream from the skin and intestines. The risk generally doesn’t occur until the absolute neutrophil count (abbreviated ANC) is less than 500. This type of infection usually occurs less than 10% of the time for the entire treatment period (for some chemotherapies less than 2%) but is very important as this can lead to severe illness and very rarely death. Therefore chemotherapy is not given when the ANC is very low except when using specific drugs that don’t lower the ANC. You are advised to take your temperature whenever you are feeling ill. If you have a fever greater than 100.5 should begin an antibiotic and to notify our office within a day so that the blood count can be checked. Usual treatment is as an outpatient but severely ill patients are hospitalized for intravenous antibiotics. It should be noted this these infections are not colds so that your activities and diet are not typically altered while on most chemotherapies.

There is no denying that chemotherapy is a significant and serious form of treatment. When given under the guidance of expert oncologists and experienced chemotherapy nurses the risks of a catastrophic event, although never entirely eliminated, is very rare.

You are encouraged to do as much as you can to lead a near normal life. Some patients feel well enough to work and are encouraged to do so. Exercise is also permitted. Diet is not restricted. For most chemotherapies alcohol in moderation is permitted. One restriction is requested. Women should use birth control (non-hormonal for breast cancer patients) to avoid pregnancy while undergoing any form of cancer treatment including chemotherapy, oral medications, and radiation.

No. Vitamins should not be taken with chemotherapy unless specifically prescribed by your doctor. There is data to indicate that even a daily multi-vitamin can lower the effectiveness of chemotherapy. Large doses of vitamins and antioxidant type doses are especially not permitted because there is a potential to partially negate the effect of chemotherapy against cancer. Chemotherapy leads to cancer destruction by processes leading to oxidation.

No. The act of fighting cancer in and of itself is very stressful emotionally and sometimes physiologically. There are no scientific studies indicating that higher stress levels affect survival and cure. Many studies however show that reduced stress levels improve a patient’s experience while undergoing treatment. All people have different levels of stress tolerance and reasonable common sense is recommended. Stress isn't good because it will effect how you feel, but it won't make the cancer grow or lower your cure rate.

This is a form of immunotherapy. Antibodies are proteins normally made by the immune system to combat infections and other extraneous substances which may be harmful to the body. The term monoclonal refers to multiple copies of the exact same antibody which in the case of cancer treatment is bioengineered to react against some unique part of the cancer to permit the immune system to take action against the cancer.

This term usually refers to therapies that are not traditional or given under the supervision of established cancer experts. Surveys indicate that 60% or more of all cancer patients try alternative therapies at some time during their illness. Proponents of alternative care sometimes claim that these treatments are effective but are suppressed by the medical establishment and pharmaceutical companies to protect profits. While it is true that chemotherapy, radiation, and surgery are very expensive, it is also well known that insurance companies control what is permitted and paid for (everything must be pre-authorized). If there were any evidence that alternative treatments provide effective cancer therapy, your insurance company would insist that you receive those treatments as they are certainly much less expensive than chemotherapy drugs. Cancer Care Associates sometimes permits patients to take some alternative treatments while NOT receiving chemotherapy but cautions that the ingredients of these compounds are often unknown and they are not manufactured under any guideline of purity or sterility. Rare severe organ damage has occurred with a number of popular compounds. A certain degree of scientific thought and skepticism is suggested in evaluating the possible choices. The treatment of cancer is complex and difficult. Many hundreds of millions of dollars is spent yearly on cancer treatment research. Beware of simple solutions. Learn more >

This is a program paid for by medical insurance and Medicare which permits patients to remain at home at a time when treatment is not effective, nor appropriate. Unfortunately, there are cancer situations where treatments become ineffective and/or patients are too ill from their cancers to permit treatment. For these patients, hospice promotes quality of life at home in the care of family and loved ones. Experienced nurses make home visits. Social services are offered. When needed, a part-time attendant will assist in bathing and dressing. Basic equipment such as a hospital bed and oxygen is provided to help comfort and cleanliness. Unnecessary medical tests and intervention is avoided to reduce patient discomfort and inconvenience. Hospice care focuses on increasing quality of life and on controlling symptoms in a loving and caring environment, the home, in the company of family and friends. Learn more >