Cancer Information

WHAT IS CANCER?

Cancer is an uncontrolled growth of an abnormal cell in the human body. It can originate from almost any organ. Genetic and environmental factors can contribute to transforming healthy cells into cancerous growths. Cancer is commonly in the form of a centralized tumor; however, if not treated, it can continue to grow and invade adjacent tissue and spread to other parts of the body (metastasize).

Treatment of cancer depends on the type of cancer and its stage. Stage refers to the quantity of cancer in the body. The stage is commonly scored from 1 to 4. The earliest stage is 1. Stage 4 represents distant spread and is generally considered incurable. Most cancers are also given a "grade," which describes the quality or aggressiveness of the malignancy.

Cancer treatments most commonly include surgery, chemotherapy, or radiation. Some cancers require a combination of treatments.

Surgery – Removal of the cancerous growth
Chemotherapy – An oral or intravenous (IV) medication that kills cancers cells
Radiation – Focused X-ray treatment that destroys cancer cells

While doctors can't cure all cancers, researchers have made tremendous strides in cancer treatment in the past 40 years. Treatments have become increasingly effective and targeted. Advances in medicine have also resulted in much more effective management to address the common side effects.

BRAIN TUMORS

Primary brain tumors are tumors that originate in the brain. Brain tumors can be benign (non-cancerous) or malignant (cancerous). Benign brain tumors can grow and compress nearby brain structures but rarely spread into other parts of the body. Malignant brain tumors are likely to grow quickly and spread into other parts of the central nervous system, including the spinal canal. There are several types of brain tumors, including gliomas, meningiomas, pituitary adenomas, and nerve sheath tumors. These cancers are not to be confused with metastatic cancer, which is cancer from another part of the body that has spread to the brain.

Represent roughly 1.5% of all newly diagnosed cancers.
Overall cognitive ability may be affected depending on which brain lobe contains the cancer. For example, Gliomas arise from the glial cells and are the most common brain and CNS (Central Nervous System) tumors. Gliomas make up approximately half of all brain tumors and are classified by the disease's cell type, grade, and location. The most common types of gliomas are oligodendrogliomas, ependymomas, and astrocytomas.
Frontal lobe – Behavioral and cognitive decline
Temporal lobe – Memory or visual field defects, aphasia (inability to speak), seizures, and hemiparesis (partial paralysis).
Parietal lobe – Sensory seizures. Motor dysfunctions that the patient may not recognize
Meningiomas are the second most common of all brain tumors and account for roughly 20% of all brain tumors. Meningiomas are generally slow-growing and produce minimal symptoms throughout a patient's life. Only a tiny percentage of these tumors are malignant.
Pituitary adenomas are benign lesions that originate in the pituitary gland. These tumors make up approximately 15% of all brain tumor patients. They can be hormone-secreting or non-hormone secreting. If they grow, they can compress the optic chiasm leading to visual problems.

Blood-brain barrier (BBB) – The barrier system that hinders the penetration of some substances into the brain and cerebrospinal fluid. The BBB exists between the vascular system and the brain. Its purpose is to protect the brain from potentially toxic compounds.
Cerebellum – Part of the brain that is responsible for the coordination of voluntary muscular movements.
Cerebrospinal fluid (CSF) – The fluid that flows through and protects the brain and spinal canal.
Cerebrum – The largest part of the brain and consists of two hemispheres (left and right). The cerebrum functions include interpretation of sensory impulses and voluntary muscular activities. It is the center for memory, learning, reasoning, judgment, intelligence, and emotions.
Debulking – A surgical procedure used to reduce tumor size, reduce tumor burden, and increase the opportunity to obtain a pathologic diagnosis.
Edema – Excessive accumulation of fluid in a tissue, producing swelling.
Frontal lobe – Front part of the cerebral hemisphere.
Intracranial pressure (ICP) – Increased pressure in the brain resulting in headaches, nausea, and vomiting.

Gliomas

Treatment of choice for most gliomas depends on the location, grade of malignancy, and histology. Treatment often includes a combined approach between surgery, radiation therapy, and sometimes chemotherapy. Surgical removal of the tumor is typically the first line of treatment with postoperative chemotherapy or radiation therapy, depending on the findings from surgery.

Meningiomas

Meningiomas can be initially observed if their growth is very slow. However, for certain tumors that are growing and near critical structures (such as cranial nerves), earlier treatment may help preserve neurologic function. Tumors requiring treatment are typically treated with surgical removal and/or radiation therapy.

Pituitary Adenomas

These tumors are mostly treated with medication but can also be surgically removed. Radiation therapy also can be used to treat these tumors. An endocrinologist must evaluate patients with these tumors to correct any hormone abnormalities.

Metastatic Cancers

Metastatic brain cancers are tumors that have spread from another organ system in the body. These patients are considered Stage 4. These tumors are more common than primary brain tumors. Metastatic brain cancer most commonly originates from lung, breast, and melanoma. Most of these patients present with multiple lesions throughout the brain and can be treated with surgery or radiation therapy.

Role of Radiation Therapy in Managing CNS and Brain Tumors

Radiation therapy can help manage both primary brain tumors and secondary brain tumors. Postoperative radiation can be used on tumors requiring additional residual disease treatment. Radiation therapy is commonly used to treat brain tumors in difficult surgical locations or for patients who are medically unfit to undergo surgery.

Metastatic brain tumors often present with multiple small lesions throughout the brain and are often too complex to be removed with surgery. For this reason, radiation to the whole brain is usually performed to treat the multiple lesions throughout the skull.

BREAST CANCER

Breast cancer is the most common cancer affecting women in the United States. Each year, over 200,000 American women are diagnosed with this disease. As a result, thousands of women in Central California will be diagnosed with breast cancer each year. Breast cancer is a type of cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rarer.

At Rio Bravo Cancer Center, our team of oncologists provides only the most innovative and proven cancer-fighting radiation therapies as one part of an overall comprehensive breast cancer treatment program. Indeed, our only objective is the successful treatment of your cancer.

Many breast cancers will require surgery, and nearly all will necessitate cancer-fighting radiation therapy to destroy any remaining cancer cells in the breast and beyond. Yet, older radiation delivery methods fall short when it comes to effective radiation treatment for breast cancer because they can expose nearby, healthy tissue to unwarranted radiation.

However, cutting-edge radiation therapies such as Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) enable Rio Bravo Cancer Center’s team of specialized oncologists to deliver higher doses of radiation with acute precision to cancerous tumors.

Represent roughly 1.5% of all newly diagnosed cancers.
Overall cognitive ability may be affected depending on which brain lobe contains the cancer. For example, Gliomas arise from the glial cells and are the most common brain and CNS (Central Nervous System) tumors. Gliomas make up approximately half of all brain tumors and are classified by the disease's cell type, grade, and location. The most common types of gliomas are oligodendrogliomas, ependymomas, and astrocytomas.
Frontal lobe – Behavioral and cognitive decline
Temporal lobe – Memory or visual field defects, aphasia (inability to speak), seizures, and hemiparesis (partial paralysis).
Parietal lobe – Sensory seizures. Motor dysfunctions that the patient may not recognize
Meningiomas are the second most common of all brain tumors and account for roughly 20% of all brain tumors. Meningiomas are generally slow-growing and produce minimal symptoms throughout a patient's life. Only a tiny percentage of these tumors are malignant.
Pituitary adenomas are benign lesions that originate in the pituitary gland. These tumors make up approximately 15% of all brain tumor patients. They can be hormone-secreting or non-hormone secreting. If they grow, they can compress the optic chiasm leading to visual problems.

A lump or thickening in or near the breast or in the armpit area

nipple tenderness
a change in how the breast or nipple appears
a change in the size or shape of the breast
a difference in the skin of the breast or nipple
nipple discharge (fluid)

Early breast cancer usually does not cause pain. However, a woman should see her health care provider about breast pain or any other symptom that does not go away after a few weeks. Any woman with these symptoms should be evaluated by a physician as soon as possible.

BB’s – Small markers that are placed on the skin for localization purposes during radiation therapy
Blocks – Used for some patients’ treatments to block out unnecessary structures within the treatment field (heart, lung, etc.)
Dry desquamation – Dryness, itching, scaling, flaking, and peeling of the skin
Ecchymosis – A bruise or contusion
Erythema – Abnormal redness and inflammation of the skin
Fat necrosis – Necrosis of fatty tissue, characterized by the formation of small quantities of calcium soaps when fat is hydrolyzed into glycerol and fatty acids. Also known as steatonecrosis
Gantry – The C-arm part of the machine that rotates around you to deliver radiation from different angles
Induration – Hardening and swelling of a part of the body
Lasers – Red lasers in the treatment room that the therapists will use to align you in the correct treatment position
Linear Accelerator – The machine that delivers the radiation treatment
Lumpectomy – Surgical removal of the breast tumor alone
Lymph node dissection – Surgical removal of the lymph node. In breast cancer, the lymph nodes in the armpit (axilla) are dissected. Often a sentinel lymph node biopsy is done first
Lymphedema – The accumulation of fluid in soft tissues of the body with accompanying swelling, often of the extremities: sometimes caused by inflammation, obstruction, or removal of lymph channels
MammoSite/Savi/Contura – Brand names of breast implants/balloons, which are inserted into the lumpectomy bed for targeted radiation therapy for breast cancer
Mastectomy – Surgical removal of all the breast tissue in the affected breast
Metastasis – The spread of malignant or cancerous cells to other parts of the body by way of blood or lymphatic vessels or membranous surfaces
Moist desquamation – Moist peeling of the skin, which sometimes can be associated with blistering
Port films – X-ray films that confirm the treatment area and patient positioning (taken every week for treatment quality assurance purposes)
Pruritus – Itching
Recurrent Cancer - Recurrent cancer is cancer that has come back (recurred) after being treated. It may recur locally in the breast or chest wall. However, it may also recur distantly in any other part of the body, such as the bone, liver, or lungs
Sentinel Lymph node biopsy – A tracer or dye that is injected into the breast where the tumor originates, it then drains into the axilla (armpit) to help guide the surgeon to which lymph nodes need to be sampled. This procedure reduces the risk of lymphedema in comparison to a lymph node dissection
Seroma – A mass or swelling caused by the localized accumulation of serum (fluid) within a tissue or organ. These typically absorb on their own however it sometimes may require surgical drainage
Stage 0 is carcinoma in situ
Lobular carcinoma in situ: Abnormal cells in the lining of a lobule which is considered a non-invasive disease. However, LCIS does indicate an increased risk of invasive breast cancer
Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct, which is considered a non-invasive disease. The abnormal cells have not spread outside the duct or invaded the nearby breast tissue. DCIS can become invasive cancer if not properly treated.
Stage I is the earliest stage of invasive breast cancer
The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast
Stage II is one of the following:
The tumor is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm
The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm
The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches)
The cancer has spread to the lymph nodes under the arm.
The tumor is larger than 5 centimeters (2 inches)
The cancer has not spread to the lymph nodes under the arm
Stage III is a locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC
Stage IIIA is one of the following:
The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone
The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone
Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or nodules (lumps) in the breast skin.
The cancer may have spread to lymph nodes under the arm
The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone
Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced
Stage IIIC is a tumor of any size. It has spread in one of the following ways:
The cancer has spread to the lymph nodes behind the breastbone and under the arm
The cancer has spread to the lymph nodes above or below the collarbone
Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body

Gliomas

Meningiomas

Pituitary Adenomas

Metastatic Cancers

Role of Radiation Therapy in Managing CNS and Brain Tumors

GASTROINTESTINAL CANCER

Gastrointestinal cancer is a broad term used to describe any cancer originating from the digestive system. This includes cancers of the esophagus, gallbladder, liver, pancreas, stomach, small and large intestine, rectum, and anus.

Presenting symptoms may vary depending on which part of the gastrointestinal system is positive for cancer. A standard diagnostic tool for various gastrointestinal cancers includes an endoscopy or colonoscopy followed by a biopsy. The location and extent of the tumor will dictate the preferred treatment method.

Esophageal cancer is a relatively rare form of cancer that appears in men more than women and has been tied to heavy use of alcohol, smoking, and GERD (gastro-esophageal reflux disease).
Stomach cancers are often asymptomatic because the tumor is growing in a large cavity. This type of cancer is much more prevalent in Asia.
Hepatocellular Carcinoma is the most common type of liver cancer and, fortunately, is rare in the United States. HCC has been associated with alcoholism, toxins, cirrhosis of the liver, and hepatitis.
Gallbladder tumors are also very rare and have a U.S. incidence of approximately 0.00003 % amongst the population.
Like HCC and Gallbladder tumors, pancreatic tumors share similar presenting symptoms such as abdominal pain, lower back pain, and jaundice.
Colorectal cancers are the most common gastrointestinal cancers and are the 4th most common of all cancers. The occurrence of colorectal cancers has been primarily attributed to a diet high in animal fat and low in fiber.
Anal Cancer is often related to HPV (human papillomavirus) infection. This type of cancer is very responsive to chemotherapy and radiation. Surgery is rarely used.

Signs and symptoms depend heavily on the location of the cancer in the GI system. In general, most patients present with nausea, vomiting, and weight loss. Some cancers may cause bleeding and change in the colors of the stool. These symptoms progressively worsen and do not get better without treatment. If you are experiencing these symptoms, a medical doctor should evaluate you as soon as possible.

Abdominoperineal Resection (APR) – Surgical procedure used to treat low-lying rectal cancers and involves the removal of the anus, rectum, and section of the sigmoid colon.
Low Anterior Resection (LAR) – An abdominal incision that removes rectal cancers higher in the rectum.
Dysphagia – Difficulty with swallowing.
Esophagitis – Inflammation of the esophagus.
Familial adenomatous polyposis – Hereditary disease in which the entire large bowel is studded with polyps.
Leukopenia – Deficiency in white blood cell count.
Odynophagia – Painful swallowing.
Tenesmus – Ineffective and painful straining during a bowel movement due to anal sphincter contraction.
Thrombocytopenia – Abnormal decrease in the number of platelets.

Esophageal cancer: Treatment is dependent on the histology of the cancer (squamous cell vs. adenocarcinoma), staging of the disease, and the patient’s medical condition. Surgery along with chemotherapy and radiation are commonly used.
Stomach cancers: Depending on the stage of the disease, treatments may include surgery, chemotherapy, and/or radiation therapy. Surgery generally includes removing part or all the stomach and some of the regional lymph nodes.
Liver cancer: Several treatment methods are used when managing liver cancer. Some procedures include surgical resection, liver transplantation, radiation therapy, chemotherapy, and cryosurgery.
Gall bladder: The most common form of treatment is surgical gall bladder removal. Dissection of parts of the liver and lymph nodes is also performed. Occasionally radiation therapy and chemotherapy are utilized to manage gall bladder tumors.
Pancreatic cancer: The Whipple procedure is the most common surgical treatment used for curative purposes. This is done when the cancer involves the head of the pancreas. The surgery consists of removing the head of the pancreas and parts of the small intestines. Chemotherapy and/or radiation are commonly used after surgery to increase the rate of cure.
Colorectal cancers: Surgery, radiation therapy, and chemotherapy have all been utilized to manage colorectal cancers. The most common form of surgery for rectal cancer patients is Abdominoperineal Resection (APR) or Low Anterior Resection (LAR). A colorectal surgeon will evaluate which surgical procedure is most appropriate. Radiation therapy is commonly used for more advanced rectal cancers. If used before surgery, radiation therapy can aid in the shrinking of the tumor before surgical removal. Furthermore, radiation therapy is used to optimize the treatments by treating lymph nodes and managing the surgical margins for potential microscopic diseases. Chemotherapy drugs are often given along with radiation to enhance the chance for cure.

GYNECOLOGICAL CANCER

Gynecological cancers are cancers of the female reproductive system, including the cervix, vulva, uterus, fallopian tubes, ovaries, and vagina. Over the past two decades, significant improvements have been made in detecting and treating gynecological cancers.

Endometrial (or Uterine) cancer– The most common cancer appearing in the female genital tract in the United States. It includes several types of malignancies originating from the uterus's inner lining, also known as the endometrium. Common risk factors include high estrogen levels, obesity, hypertension, endometrial hyperplasia, and hypertension.
Cervical cancer– The second most common cancer in women, and studies have shown that it is associated with smoking. Early detection of cervical cancer includes Pap smear screening. HPV (human papillomavirus) is the most significant risk factor associated with cervical cancer. Recently, the FDA has approved vaccinations for HPV, which may decrease the incidence of cervical cancer.
Vulvar cancer– The least common of all gynecological cancers, it primarily affects elderly women and accounts for less than 5% of all gynecological cancers. HPV has shown a correlation with the incidence of vulvar cancer.
Ovarian cancer– Disease has correlated with increased incidence in more industrialized nations. Also, the risk of developing ovarian cancer increases with age and decreases with the number of pregnancies.

Endometrial (or Uterine) cancer– Spotting in post-menopausal women, vaginal bleeding, anemia (due to chronic blood loss), and lower abdominal pain.
Cervical cancer– Vaginal discharge and bleeding.
Vulvar cancer– Generally appears as a lump or ulceration in the area. Symptoms include intermittent discharge, local bleeding, and itching.
Ovarian cancer– patients are commonly asymptomatic but occasionally present with pain in the pelvic area, frequent urination, and bloating.
Vaginal cancer – Vaginal bleeding and pain.

Dysuria– Pain with urination, which can be a temporary side effect of radiation treatments.
HDR (High Dose Rate) brachytherapy– A form of internal radiation where a radioactive source is temporarily implanted for gynecological cancer treatment.
Linear Accelerator – The machine that delivers the radiation treatment.
Lymph node dissection – Surgical removal of lymph nodes. In gynecological cancer, the lymph nodes in the pelvis are dissected.
TAH/BSO – Total abdominal hysterectomy with bilateral salpingo-oophorectomy – surgical procedure for uterine cancer.

Endometrial (or Uterine) cancer
- The primary treatment of early-stage disease is surgery. Women with higher-risk disease may need additional radiation therapy to improve their chance of cure. Chemotherapy may be necessary for patients with more advanced-stage uterine cancer.
Cervical cancer
- Treatment of early stages requires a hysterectomy (surgical removal of whole uterus/cervix and a portion of the vagina) and sampling of lymph nodes. A fertility-sparing surgery known as a trachelectomy may also be performed in very early-stage cervical cancers. This involves the removal of the cervix, preserving the uterus and ovaries. Early-stage disease may also be treated with external beam radiation therapy (EBRT) and internal radiation (brachytherapy). Larger, more advanced stages are usually treated with radiation therapy and chemotherapy.
Vulvar cancer
- Surgery is the primary treatment of choice and usually involves a radical vulvectomy (complete removal of the vulva). Chemotherapy and radiation therapy can be utilized in more advanced stages.
Ovarian cancer
- Often treated with a combination of chemotherapy and surgery, but sometimes radiation therapy can improve outlook. Depending on the stage and grade of the tumor when diagnosed, surgery can include removing all or some gynecological organs. Partial surgeries can include the ovaries, fallopian tubes, and the uterus. A complete resection of all structures is known as the TAHBSO surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy).
Vaginal cancer
- Treatment varies depending on your specific case. It often involves surgery, radiation, and chemotherapy. Your oncology team determines the optimal treatment.

HEAD & NECK CANCER

Head and neck cancer spans a broad field of oncology and includes cancerous tumors in areas of the head and neck and is different from brain cancer. Head and neck cancer generally develops from smoking and drinking. However, certain viruses have been implicated in its development. Head and neck cancers originate from the nasopharynx, nasal cavity, oropharynx, oral cavity, salivary glands, larynx, hypopharynx, and thyroid.

Since surgery presents a significant risk to critical structures in this area afflicted with cancer, radiation therapy is often the first choice for treatment, in conjunction with chemotherapy. Most head and neck cancers are very responsive to chemotherapy along with radiation.

The oncologists at Rio Bravo Cancer Center are committed to delivering radiation that minimizes damage to the healthy surrounding tissue when it comes to radiation therapy. We utilize only the newest, most precise, cancer-fighting radiation therapies to help our patients fight their head and neck cancer.

Cutting-edge therapies such as Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) enable our team of cancer specialists to deliver higher doses of accurately targeted radiation to the cancerous head and neck tumors while sparing nearby healthy tissue.

Nasopharyngeal cancer is prevalent in Asian countries and is caused by EBV (Epstein-Barr Virus)
Oropharyngeal cancers are now commonly caused by HPV (Human Papilloma Virus), the prognosis of these cancers is much better than cancers caused by smoking and drinking
HPV associated oropharyngeal cancers commonly affect younger patients
Most cancers are of the squamous cell carcinoma histology – these are very responsive to chemotherapy and radiation

Dyspnea – Difficulty in breathing
Dysphagia – Difficulty with swallowing
Hemoptysis – The process of coughing up blood
Neck Dissection – Surgical removal of the lymph nodes in the neck
Concurrent Chemoradiation – Treatment with chemotherapy and radiation at the same time
Post-Operative (adjuvant) Radiation – Radiation given after surgery to address any remaining gross or microscopic disease

Treatment of head and neck cancer depends heavily on the site and stage of the disease. Below is a general outline of treatment options. Depending on the site, most patients will need a dental evaluation by a dentist trained in managing patients undergoing radiation. Unhealthy teeth may need to be extracted.
Nasopharynx
Treatment commonly involves radiation. Advanced stage patients may need concurrent chemoradiation. Surgery is rarely used in this disease site.
Nasal Cavity
Surgery is the mainstay of treatment. Some patients may need post-operative radiation if high-risk features are found. Radiation can also be used before surgery to help shrink the tumor to make the surgery easier.
Oropharynx
In general, this includes the tonsils, base of the tongue, soft palate, and other structures. Radiation along with chemotherapy can result in excellent outcomes.
Oral Cavity
Surgery is the mainstay of treatment. If high-risk features are found after the surgery, adjuvant radiation and possibly concurrent chemotherapy may be recommended.
Salivary Glands
Surgery is the mainstay of treatment. If high-risk features are found, adjuvant radiation may be recommended.
Larynx /Hypopharynx
Historically patients were treated with surgery. However, in an attempt to preserve the voice box, definitive chemoradiation has been used with good results. Surgery is now reserved for persistent of recurrent disease. Some patients with very advanced disease may also be treated directly with surgical resection.
Thyroid
Surgery is the mainstay of treatment. Depending on the type of thyroid cancer, additional radiation may be required. Some forms of thyroid cancer require ingesting a radioactive molecule that targets residual microscopic cancer.

LUNG CANCER

Abnormal proliferation of the cells is the basic definition of cancer. When this primary incidence occurs in the lung, this is known as primary lung cancer, as opposed to metastasis (spread from another cancer in the body to the lung). The majority of lung cancers are carcinomas that arise from epithelial cells. The two main types of lung cancer are NSCLC (Non-Small Cell Lung Carcinomas) and SCLC (Small Cell Lung Carcinomas).

Possible symptoms of lung cancer include dyspnea (shortness of breath), hemoptysis (blood in cough), and loss of weight.
Most common cause of lung cancer is due to extensive use of tobacco smoke (including second-hand smoke)
Other common causes may include exposure to asbestos, polluted environments, radon gas, and several genetic factors
Treatment usually involves a combination of surgery, radiation therapy, and chemotherapy

Respiratory difficulties such as shortness of breath, severe coughing, hemoptysis (coughing up blood), and/or wheezing
Pain in bronchial airways due to compression may lead to general pain in the chest, dysphagia (trouble with swallowing), and Superior Vena Cava (SVC) obstructions.
General fatigue, fever (usually due to a compromised immune system), and weight loss (due to obstructions) are also common side effects.

Dyspnea– Difficulty in breathing
Dysphagia– Difficulty with swallowing
Hemoptysis– Coughing up blood
Adenocarcinoma– Malignant tumor of gland-like structure that originates from the epithelium.
Primary and secondary bronchi– The two main branches of the trachea.
Trachea– Recognized as the windpipe and serves as the principal passage for conveying air to and from the lungs.
Superior Vena Cava– One of the two large veins that are responsible for returning blood into the right atrium of the heart.

Surgery
- Depending on the location, staging, and extent of the disease, surgery can be the first part of a treatment regimen to remove the bulk of the tumor. CT and PET scans are used to determine the possibility of whether surgery can be used. Pulmonary function assessment and blood tests are also used to dictate the eligibility of a surgical candidate.
- A majority of NSCLC cases are often managed with lobectomy, a surgical procedure that involves the removal of an affected lobe of the lung. Pneumonectomy is another surgical procedure that involves the removal of a whole side of the lung but is used much less often than a lobectomy.
- SCLC is rarely managed with surgery except in very early stages. Treatment is usually a combination of chemotherapy and radiotherapy.
Radiation Therapy
- NSCLC patients who are not surgical candidates are often given radiation therapy combined with chemotherapy for curative intent. NSCLC with more advanced cancers may also benefit from radiation therapy after surgery. Sometimes chemotherapy and radiation are used before surgery to help shrink the tumor, allowing for a more complete resection.
- SCLC cases are also often treated with a combination of radiation therapy and chemotherapy. Prophylactic Cranial Irradiation (PCI) is another radiotherapy technique that involves the treatment of the brain to help reduce the risk of metastasis to the brain. When patients are treated with external beam radiation, a complex blocking system known as multi-leaf collimators (MLC) is used during the treatment. This helps treat only the volume of interest while protecting the surrounding healthy tissue, resulting in fewer side effects. MLC usage allows us to shape and manipulate the exposures for each radiation beam angle, allowing for the optimal dose to the area of interest.
Chemotherapy
- Chemotherapy is sometimes used in more advanced cancers after surgery. Advanced staged NSCLC may also be treated with radiation therapy and chemotherapy. Although chemotherapy is widely used in managing lung cancer, the general use depends upon the tumor type.

Non-Small-Cell Lung Carcinoma (NSCLC): The three most common subtypes of NSCLC include adenocarcinoma, squamous-cell lung carcinoma, and large-cell carcinoma. Adenocarcinoma commonly originates in the periphery of the lung and comprises approximately 40% of all lung cancers. Squamous-cell carcinoma usually occurs near larger airways and makes up roughly 30% of all lung cancers. Large-cell carcinomas are the least common NSCLC and are described as large cells due to the microscopic structure of the cancer cell containing excess cytoplasm and large nuclei.
Small-cell Lung Carcinoma: Small-cell lung carcinoma (SCLC) commonly arises in the primary and secondary bronchi. This type of lung cancer is heavily associated with smoking and tends to be advanced when diagnosed. Spread or metastasis to the brain is quite common.

PROSTATE CANCER

Prostate cancer is the most common cancer among American men, and it is the second leading cause of death from cancer in men. It occurs when cells in the prostate gland mutate and multiply very rapidly. Prostate cancer often stays confined to the area for several years, but it may metastasize or spread to other body areas such as the bone.

Treating prostate cancer with traditional radiation therapy can be difficult. Older means of radiation delivery exposed nearby healthy organs to damage. At Rio Bravo Cancer Center, we are proud to offer only the most cutting-edge radiation treatments available to treat your prostate cancer specifically.

At Rio Bravo Cancer Center, we proudly provide Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT). These technologically advanced radiation treatments allow our team of expert radiation oncologists to deliver higher doses of precisely focused radiation to cancerous tumors within the prostate while sparing nearby healthy tissue. Numerous studies have shown clinically similar cure rates with radiation therapy versus traditional surgery for prostate cancer treatment. Radiation therapy also has fewer side effects than surgery, such as urinary incontinence and sexual dysfunction.

Rio Bravo Cancer Center also offers the SpaceOAR rectal spacer. This technology dramatically reduces the chance of injury to the rectum from radiation. Now patients can benefit by having their prostate cancer cured with minimal side effects to the body.

When you’re fighting prostate cancer, Rio Bravo Cancer Center will be your strongest ally, standing beside you with the only objective of helping you to defeat your prostate cancer safely.

Measurement of the prostate gland by a transrectal ultrasound exam may be helpful to determine the extent of the disease. On the other hand, this exam may not give any valuable information to the physician if the patient has a known metastatic disease. Therefore, it is not always performed.
If a transrectal ultrasound exam is done, it is performed by the physician. The prostate gland is measured for size and shape. This information is recorded. The radiation oncologist and medical radiation physicist will use this information to plan your radiation treatment.
If the prostate gland measured is large or if you have more aggressive prostate cancer, the urologist or radiation oncologist may give a medication to block testosterone production. This will stop the tumor growth and decrease the size of the prostate gland. The medicine may be given for either a short-term or long-term basis.
A smaller gland will lead to a safer (fewer complications) treatment course, and we now feel that a course of anti-testosterone therapy enhances the overall cure rate. Unfortunately, there are some side effects to this medication. This can include hot flashes, lack of sexual drive, fatigue, and muscle weakness. They are temporary and resolve after the medication wears off.

Patients with prostate cancer typically do not have any symptoms. However, some patients may have pain, difficult or frequent urination, a weakened urinary stream, and sexual dysfunction. Diagnosis often begins with a PSA (Prostate-Specific Antigen) blood test and digital rectal exam (DRE). Elevated levels of PSA signify an abnormality in the function of the prostate, which could be the result of an infection, benign hypertrophy (growth of the gland or tissue), or cancer. Depending on the outcome of the PSA test, a biopsy may be performed to establish the diagnosis.

BPH – Benign Prostatic Hypertrophy (Hyperplasia) – Noncancerous growth that is common in the prostates of men over the age of 40. These growths compress the urethra, causing difficulty with urination.
Brachytherapy – Surgical implantation of radioactive sources into a tumor.
Cryosurgery – treatment that freezes the prostate with liquid nitrogen.
DRE – Digital Rectal Exam (finger exam)
EBRT (External Beam Radiation Therapy) – A form of external radiation delivered by a linear accelerator machine. The most commonly used photon (X-ray) treatment for prostate cancer.
Hormonal Therapy – Medication prescribed by your urologist to block testosterone production. Hormonal therapy may be used in conjunction with primary radiation or for palliation.
HDR (High Dose Rate Brachytherapy) – A form of internal radiation. This involves the surgical implant of temporary plastic needles into the prostate. Computers then perform treatment under remote control. This treatment serves as a radiation boost to the prostate.
LDR (Low Dose Rate Brachytherapy) – Another form of internal radiation. This involves the surgical implantation of permanent seeds into the prostate.
Orchiectomy – Surgical removal of the testes to block the production of testosterone.
Palliation – Course of treatment for patients whose cancer is considered incurable. The goal of palliation is to control pain and improve the quality of life.
Proton Beam – A radiation technique that uses positively charged protons to treat prostate cancer.
Salvage Treatment – Treatment for a failed initial course of treatment.
Seed, Pellet – Used to describe the radioactive pellet(s) used in brachytherapy. HDR uses one high-dose seed, whereas LDR uses multiple low-dose seeds.
SpaceOar - A system designed to reduce rectal injury in men receiving radiation therapy for prostate cancer.

A Gleason Score is given about the grade or aggressiveness of the prostate cancer, ranging from 2 to 10. The Gleason Score is the sum of two numbers- the grade of the primary tumor grade and the secondary tumor grade. These grades depend on the cancer cell’s deviation from normal healthy prostate cells, with 1 being the mildest change and five being the most severe. A score may look like a Gleason’s grade of (4+3) = 7. This means the primary tumor pattern was a 4, but secondary type 3 cancer cells were found in the specimen reviewed.

Full Course External Beam Radiation
- External beam radiation delivers radiation via a source outside or external the body, in this case through a linear accelerator. This complex machine uses electricity to produce high-energy x-rays targeted and delivered to the tumor site. These x-rays deposit the prescribed radiation dose deep within the body while sparing surrounding structures.
- Radiation is invisible, tasteless, odorless, and painless. External beam radiation is a completely non-invasive technique. It works by damaging cancer cells and slowing their growth and division. Healthy cells can repair the effects of radiation reasonably quickly, while cancer cells have a difficult time repairing. By delivering radiation over a pre-determined amount of time (approximately eight weeks), we allow the healthy tissues to repair while repeatedly damaging the cancer cells.
Image-guided Intensity Modulated Radiation Therapy (IMRT) / Dynamic Arc MLC-IMRT Radiation
- In conformal radiation, a computer simulation produces a highly accurate image of the tumor and surrounding area to aim the radiation beams directly at the tumor. The precise focus spares nearby healthy tissue from the beams.
- Intensity-Modulated Radiation Therapy (IMRT), a type of conformal radiation, aims tiny beams of radiation at a tumor from different angles while varying the intensity of the radiation. Careful control of the shape and position of the beam bends the radiation dose around healthy tissue to hit cancerous cells. Our high-tech PET/CT scanner provides an extremely accurate 3-dimensional map of the tumorous area, allowing this method to be effective and precise. This form of treatment requires sophisticated planning by the doctor, physicist, and dosimetrist. It also requires thorough QA (quality assurance) to ensure the treatment delivered is safe for the patient.
- Full course external beam irradiation treatment allows the radiation oncologist to deliver a dose beyond the prostate gland to the seminal vesicles and/or surrounding lymph nodes in the pelvis.

Nerve-sparing Prostatectomy
This is the most common operation for prostate cancer. The cancerous prostate is removed without removing the nerve bundles responsible for erections on either side of the prostate gland. This procedure may not be suitable for patients with cancer involvement of the nerve. This procedure can be either done through laparoscopy or with robotic assistance.
Cryosurgery (Endocare Freezing)
While the patient is under anesthesia, a needle is carefully inserted into his prostate gland through the perineum. The needle is guided by ultrasound to ensure accurate placement and monitor the process; the needle produces sub-zero temperatures to freeze the prostate and tumor. This procedure has high complication rates and is normally used if the patient’s cancer recurs after radiation.

Since prostate cells are stimulated by testosterone, a drop in this hormone can slow down the proliferation of cancerous cells and shrink the prostate. Hormonal therapy is often with other treatment methods.
Review with you your prostate anatomy and cancer
Review and discuss your treatment options
All your test and laboratory results are essential for your doctor to make the best decision in outlining your treatment options for you. If you were not able to obtain all your information before the consultation, it is vital to make sure that the results of your tests are forwarded to the doctor.

COLORECTAL CANCER

Approximately 5% of Americans will be affected by colorectal cancer in their lifetime. Fortunately, when colorectal cancer is diagnosed early, the chance of curing the cancer through a comprehensive cancer treatment program -which includes radiation therapy-is as high as 90%.

The successful treatment of colorectal cancer will generally require surgery, followed by a comprehensive radiation therapy program to ensure any remaining cancer cells are destroyed. However, in successfully treating colorectal cancer via radiation therapy, damage to healthy surrounding tissue must be minimized.

The radiation oncologists at Rio Bravo Cancer Center rely on only the most advanced radiation therapies available to treat colorectal cancer. Utilizing Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT), our cancer specialists can deliver the higher doses necessary to kill colorectal cancer cells with astonishing precision. That means that our expert team of oncologists, dosimetrists, and physicists will customize a personal radiation treatment plan which will target your cancer only while minimizing damage to surrounding tissue.

SKIN CANCER

Skin cancer occurs when the cells in the skin are damaged and grow uncontrollably. The epidermis (the top layer of the skin) goes through a general cell cycle, which involves the division, maturation, death, and eventual sloughing of the cells. A normal healthy skin cell cycle involves eventual repairs to damaged cells that promote skin growth and healthy division. If the body cannot successfully repair damaged skin cells, the normal process is interrupted, and cells will uncontrollably divide and grow. This damage is usually due to long-term sun exposure. Skin cancers can spread to other parts of the body.

Skin cancer is the most common cancer in the United States.
Approximately one million Americans get diagnosed with skin cancer every year.
It has been known that 1 in 5 Americans and roughly 1 in 3 Caucasians will develop skin cancer throughout their life.
The leading cause of skin cancer is overexposure to the sun, and anyone who has experienced more than five sunburns is twice as likely to develop skin cancer.

Basal Cell Carcinoma – The most common form of skin cancer and is very curable. Arises from epithelial cells and rarely metastasizes: often associated with overexposure to sunlight.
Melanoma – A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may start as a mole (skin melanoma) but can also start in other pigmented tissues, like the eye or the intestines.
Merkel Cell Carcinoma – A rare and highly aggressive form of skin cancer. It is most common in older people and people with weakened immune systems. This type of cancer has a high propensity to spread to other body parts.
Squamous Cell Carcinoma – Cancer that arises from the squamous epithelium (tissue that forms the skin's surface) and sometimes in the mucous membranes.

Treatment for skin cancer can be based on several factors, including the type, location, size, and stage of the cancer.

Basal and Squamous Cell Carcinomas
- Radiation Therapy
- Surgical excision
- Removed with scraping tool (often referred to as Moh's surgery)
- Liquid nitrogen used to freeze skin cancer
- Topical chemotherapeutic agent
Melanoma
- Surgical excision
- Radiation therapy
- Chemotherapy
- Immunotherapy

TO SCHEDULE A CANCER CONSULTATION, PLEASE CALL US AT 661-491-5060