Current Clinical Programs – Department of Radiation Oncology

Treating Physicians: Dr. Lara Hathout, Dr. Ronald Ennis, Dr. Malcolm Mattes

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

Treating Physicians: Dr. Lara Hathout, Dr. Ronald Ennis, Dr. Malcom Mattes

The Laurie Proton Therapy Center at Robert Wood Johnson–in partnership with the Rutgers Cancer Institute of New Jersey–is excited to offer the precision of proton therapy, an advanced modality of radiation therapy. Proton therapy is a type of radiation therapy that can target tumor tissues more precisely in certain situations. In contrast to conventional x-ray (or photon) therapy, proton beams have the unique property of stopping at a certain depth in tissue. This property can be put to use and controlled for the treatment of cancer patients. Proton therapy is the latest addition to the wide array of comprehensive radiotherapy services that are available to patients at the Robert Wood Johnson University Hospital and Rutgers Cancer Institute of New Jersey.

Treating Physicians: Dr. Rahul Parikh, Dr. Salma Jabbour, Dr. Sung Kim, Dr. Nisha Ohri, Dr. Bruce Haffty,

Stereotactic Radiosurgery and Radiotherpay are offered and available in the Department of Radiation Oncology at Robert Wood Johnson University Hospital.

Stereotactic Radiosurgery treatment is completed in one day, while stereotactic radiotherapy treatment may require treatments of several days. Advanced technologies are used to deliver radiation precisely to cancer target and radiation dose is usually higher than conventional radiation treatment.

Treating Physicians: Dr. Nisha Ohri

Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.

Each year, nearly 216,000 women and 1,500 men learn they have breast cancer.
Another 59,000 women learn they have in situ or noninvasive breast cancer.
Nearly 40,000 women will die from breast cancer each year.

Risk Factors for Breast Cancer

Most women who develop breast cancer do not have known risk factors, but some factors may increase the chance of developing this disease. One of these risk factors is age — more than 75 percent of women diagnosed with breast cancer are over age 50. Other factors include:

Early onset of menstruation.
Family history of breast cancer in your mother or sister.
Hormone replacement therapy with estrogen and progesterone.
Alcohol consumption.
A personal history of breast cancer or prior breast biopsy for benign disease.

Diagnosing Breast Cancer

Breast tumors are typically, but not always, painless, so it is important to have any breast or underarm lump checked. Swelling, discoloration, thickening of the skin or nipple discharge also should be checked immediately.

In some cases, a biopsy to determine if you have breast cancer will be done in an office setting using a needle to remove cells from the lump.
A stereotactic biopsy uses mammography targeting to pinpoint smaller tumors and permit a small amount of tissue to be removed by a needle for diagnosis.
Your surgeon may suggest removing the lump to see if you have cancer.

Types of Breast Cancer

The breast is made up of ducts and lobules surrounded by fatty tissue.

Cancer confined within a duct is called ductal carcinoma in situ (DCIS). Lobular carcinoma in situ (LCIS) is cells confined to a lobule.
Tumors that break through the wall of the duct or lobule are called infiltrating ductal or infiltrating lobular carcinomas.
Inflammatory breast cancer may involve the entire breast with specific skin changes and swelling.

Breast-conserving Surgery

Studies have shown that women with early-stage breast cancer who have a lumpectomy to remove the cancer followed by radiation live just as long as women who have a mastectomy and may be preferred by many women. The standard of care after breast-conserving surgery is external beam radiation therapy. Often, this follows chemotherapy.

Your surgeon will perform an operation called a lumpectomy, also called a partial mastectomy, excisional biopsy or tylectomy, to remove the tumor. In some cases, a second operation called a re-excision may be needed if microscopic examination finds tumor cells at or near the edge of the tissue that was removed (called a positive or close margin).
To see if your cancer has spread, your doctor may remove several lymph nodes from under your arm (axilla). If any of these nodes contain cancer cells, more nodes may be removed.
Breast-conserving surgery is not suitable for all breast cancer patients. Talk with your surgeon to see if this is the best procedure for you.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Treating Physicians: Dr. Bruce Haffty, Dr. Nisha Ohri, Dr. Malcolm Mattes

Prostate cancer is the most common malignancy in American men.

About 170,000 new cases of prostate cancer each year, making it the number one type of cancer in men.
Nearly 29,000 men died from prostate cancer each year.
More than 75 percent of prostate cancer is diagnosed in men over age 65.

Stereotactic Body Radiotherapy for Prostate Cancer

Robert Wood Johnson University Hospital is advancing the use of an extremely precise, high-dose form of radiation therapy for prostate cancer called stereotactic body radiotherapy (SBRT). SBRT uses innovative imaging technologies combined with a sophisticated computer system (similar to the CyberKnife® system) to deliver intense doses of radiation to prostate tumors with extraordinary accuracy, minimizing damage to healthy tissue. SBRT can deliver your treatment in 10 minutes or less, and the entire treatment may be completed in as few as five sessions. Cyberknife® treatments may take three to five times longer, per treatment, to deliver the same dose of radiation.

RWJ radiation oncologist Rahul R. Parikh, M.D. has found SBRT to be extremely effective for many of his prostate patients. He has successfully treated patients with this approach, with similar side effects to conventional radiation techniques and with excellent immediate and long-term results.

Risk Factors For Prostate Cancer

Incidence of prostate cancer increases with age.

Median age at diagnosis in Caucasian males is 71.
African-American men have the highest incidence of prostate cancer in the world.
Heredity accounts for 5 to 10 percent of cases.

Screening For Prostate Cancer

According to the American Cancer Society, men aged 50 or older should be offered a digital rectal exam (DRE) and a PSA blood test. However, it is a good idea to visit your doctor earlier to establish a baseline PSA level so you can monitor changes.

Prostate specific antigen (PSA) is a valuable marker for prostate cancer although BPH or infection may also cause a rise in PSA.
Normal range is 0-4, however, a PSA above 3 in men younger than 60 may be considered abnormal.
African-American men and men with a family history of prostate cancer should be examined beginning at an earlier age.

Diagnosing Prostate Cancer

Prostate cancer is most often diagnosed through a blood test measuring the amount of prostate specific antigens (PSA) in the body. However, signs and symptoms of prostate cancer can include:

Changes in urinary flow: Frequency, urgency, hesitancy.
Frequent nighttime urination.
Painful urination.
Blood in urine.

Other conditions that may cause these symptoms include an enlarged prostate (benign prostatic hypertrophy or BPH) or infection.

Radiation Therapy Options for Treating Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options with a radiation oncologist and a urologist. Radiation therapy treatment options to cure prostate cancer include:

External beam radiotherapy.
SBRT – Stereotactic Body Radiotherapy
Prostate brachytherapy.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Prostate Brachytherapy

Prostate brachytherapy, better known as a seed implant, is often done in the operating room.

There are two methods of delivering internal radiation for prostate cancer:

Permanent seed implants.
High-dose rate temporary seed implants.

These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia. Isotopes of iodine or palladium are most commonly used. The seeds are approximately four millimeters long and less than a millimeter in diameter. In certain situations, both prostate brachytherapy and external radiation may be recommended to combat the tumor.

The side effects from seed implants are similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.

Proton Beam Therapy

A Proton Beam Machine will be installed in Robert Wood Johnson University Hospital in near future. In a few parts of the country, proton beam therapy is being used to treat prostate cancer.

Proton therapy is administered much the same way as external beam therapy, but it uses protons rather than x-rays to irradiate cancer cells.

Hormone Therapy

Certain patients may benefit from hormone therapy in addition to radiation. In some patients, hormone therapy works with radiation therapy to improve cure rates.

Treating Physicians: Dr. Rahul Parikh, Dr. Ronald Ennis, Dr. Lara Hathout

Gynecologic cancers include cancer of the uterus, ovaries, cervix, vagina, vulva and Fallopian tubes.

According to the American Cancer Society, nearly 83,000 women per year are diagnosed with some form of gynecologic or GYN cancer.
The most common gynecologic cancer is uterine cancer with more than 40,000 cases diagnosed each year.
Every year, more than 28,000 women die from a type of gynecologic cancer.
Widespread screening with the Pap test has allowed doctors to find pre-cancerous changes in the cervix and vagina. This has helped prevent the development of some invasive cancers.

Risk Factors for Gynecologic Cancers

While all women are at risk for gynecologic cancer, some factors can increase a woman’s chances of developing the disease.

Uterine cancer: Never pregnant, beginning menstruation early, late menopause, diabetes, use of estrogen alone (called unopposed estrogen) for hormone replacement therapy, family history of uterine cancer, high blood pressure and complex atypical hyperplasia. Tamoxifen, a drug frequently used to treat breast cancer, increases the risk of uterine cancer slightly. A genetic syndrome called hereditary nonpolyposis colon cancer (HNPCC) may also increase a woman’s risk.
Cervical cancer: Strongly associated with sexually transmitted diseases, especially several strains of human papilloma virus (HPV), sexual activity at an early age, multiple sexual partners, smoking and obesity.
Ovarian cancer: Obesity, never pregnant, unopposed estrogen, personal or family history of breast or ovarian cancer, genetic mutations in the BRCA1 or BRCA2 gene, HNPCC.
Vaginal cancer: History of genital warts or an abnormal Pap test. There is an increased risk of clear cell carcinoma in women whose mothers took the drug diethylstilbestrol (DES) while pregnant. Women previously treated for carcinoma in-situ or invasive cervical cancer also have a higher risk of developing vaginal cancer.

Signs and Symptoms of Gynecologic Cancers

There are often no outward signs of gynecologic cancers. However, some common symptoms include:

Unusual bleeding, such as postmenopausal bleeding, bleeding after intercourse or bleeding between periods.
A sore in the genital area that doesn’t heal or chronic itching of the vulva.
Pain or pressure in the pelvis.
Persistent vaginal discharge.

Screening for Gynecologic Cancers

Gynecologic cancers are often detected through a series of screening exams.

Your doctor will first perform a pelvic exam to evaluate your vulva, vagina, cervix, uterus, Fallopian tubes, ovaries and rectum.
During the pelvic exam, your doctor will gently scrape some cells from the cervix and vagina to examine under a microscope. This is called a Pap test.
If the Pap test is abnormal, your doctor may perform a test called a colposcopy to closely examine the cervix. Scraping cells from the cervical canal (endocervical curettage) may also be necessary.
A small sample of tissue may be taken from any suspicious area. This test is called a biopsy.
Occasionally, doctors need to examine a larger sample of cervical tissue. It is obtained during a procedure called conization or cone biopsy.
In some situations, your doctor may recommend an exam under anesthesia to better evaluate the extent of a cancer. Tests requiring anesthesia include examination of the bladder (cystoscopy) and rectum (sigmoidoscopy).
Abnormal uterine bleeding, a common symptom of uterine cancer, is usually evaluated by performing a dilatation and curettage, also called a D and C.
Your doctor may also ask for MRI, CT, PET or ultrasound scans of the abdomen and pelvis to better evaluate areas that cannot be directly viewed, such as the ovaries.

Treatment Options for Gynecologic Cancers

Treatment for gynecologic cancer depends on several factors, including the type of cancer, its extent (stage), its location and your overall health. It is important to talk with several cancer specialists before deciding on the best treatment for you, your cancer and your lifestyle.

A gynecologic oncologist is a doctor who specializes in surgically removing gynecologic cancers.
A radiation oncologist is a doctor specially trained to treat cancer with radiation therapy.
A medical oncologist is a doctor who specializes in treating cancer with drugs (chemotherapy).

Sometimes, your cancer may be cured by using only one type of treatment. In other cases, your cancer may be best cured using a combination of surgery, radiation therapy and chemotherapy.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
Healthy tissues are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Brachytherapy Center of Excellence Program

Treating Physicians: Dr. Lara Hathout, Dr. Dr. Ronald Ennis, Dr. Omar Mahmoud

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

Potential Side Effects

The side effects you may experience will depend on the area being treated, the type of radiation used and whether or not you also received chemotherapy. Before treatment, your doctor will describe what you can expect.

- Some patients experience minor or no side effects and can continue their normal routines.
- Some patients may notice fatigue, skin irritation, vaginal irritation, frequent urination, burning with urination and/or diarrhea. These will all resolve after treatment ends.
- Some patients will have sexual changes, such as changes in the vagina.
- If at any time you develop side effects, tell your doctor or nurse. He or she can give you medicine to help.

Treating Physicians: Dr. Lara Hathout, Dr. Ronald Ennis

The brain is the center of thought, memory, emotion, speech, sensation and motor function. The spinal cord and special nerves in the head called cranial nerves carry and receive messages between the brain and the rest of the body.

There are two types of brain tumors:
- Primary — a tumor that starts in the brain. Primary brain tumors can be benign (noncancerous) or malignant.
- Metastatic — a tumor caused by cancer elsewhere in the body that spreads to the brain. Metastatic brain tumors are always cancerous.
Primary tumors in the brain or spinal cord rarely spread to distant organs.
Brain tumors cause damage because as they grow they can interfere with surrounding cells that serve vital roles in our everyday life.

General Risk Factors for Brain Tumors

Most brain and spinal cord tumors have no known risk factors and occur for no apparent reason. There are no known proven ways to prevent these tumors.

Facts about Brain Tumors

The Central Brain Tumor Registry of the United States estimates that more than 40,000 Americans will be diagnosed with a primary brain tumor this year.
This year, an estimated 170,000 Americans will be diagnosed with a brain or spinal cord tumor that has spread from another part of the body.

Signs of Brain Tumors

No blood test or other screening exam can detect brain tumors, but there are often some outward signs. While tumors in diff

erent parts of the central nervous system disru

pt different functions, some symptoms include:

Headaches.
Nausea/vomiting.
Seizures.
Weakness or numbness on one side of the body.
Changes in vision, hearing or sensation.
Difficulty with speech.
Lack of coordination.
A change in mood or personality.
- Memory loss

Diagnosing Brain Tumors

If you suffer from any of the initial signs of a brain tumor, your doctor will likely conduct some or all of the following tests:

A physical exam to determine your overall health.
A neurologic exam to evaluate brain and spinal cord function.
Imaging studies, such as CT, MRI or PET scans, to look for signs of a brain tumor.
If studies or scans indicate you might have a brain tumor, some tissue may be taken from the tumor to make an exact diagnosis. This test is called a biopsy.
A spinal tap may also be performed to look for tumor cells. During this test, a needle is placed in the lower back to obtain a sample of cerebrospinal fluid. This fluid is then examined to see if tumor cells are present.

Treating Brain Tumors

If doctors determine that you have a tumor, the treatment options and prognosis are based on the following factors:

Tumor type.
Location and size of tumor.
Tumor grade (how abnormal the cells are).
Your age, medical history and general health.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat many different kinds of tumors.

Doctors called radiation oncologists use radiation therapy to try to kill tumors, to control tumor growth or to relieve symptoms.
Radiation therapy works within tumor cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
Healthy cells near the tumor may be affected by radiation, but they are able to repair themselves in a way tumor cells cannot.

Radiation Therapy Options for Brain Tumors

People with brain tumors should discuss treatment options with several cancer specialists, including a radiation oncologist. A radiation oncologist is a doctor who will help you understand the types of radiation therapy available to treat your tumor. Conventional radiation therapy treatment options for brain tumors include:

External beam radiation therapy.
Brachytherapy or internal radiation therapy.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Internal Radiation Therapy

Internal radiation therapy, or brachytherapy, works by placing radioactive sources in or just next to a tumor.

During brachytherapy, a tube or balloon called a catheter will be inserted into the brain. The radiation will then be carried to the tumor using this catheter.
The radioactive source will then be left in place from several hours to several days to kill the tumor cells.
In some cases, the radiation is permanently placed directly into the tumor or the area where the tumor was before surgery.

Newer Techniques

Doctors are constantly exploring new and better ways to treat primary brain tumors.

Drugs that make tumor cells more sens itive to radiation are called radiosensitizers. Combining radiation with radiosensitizers may allow doctors to kill more tumor cells.
Chemotherapy is used with radiation to treat some brain tumors. Your doctor may recommend that you consult with a medical oncologist (chemotherapy doctor) before starting radiation.

Potential Side Effects

The effects of brain radiation can vary depending on your tumor and the technique used to treat it.

Before treatment, your radiation oncologist will discuss any side effects — however rare — you may experience.
Possible side effects can include fatigue, change in appetite, headaches, visual changes, hair loss, skin irritation, nausea, vomiting and/or unsteadiness.

Some side effects can be treated with steroids or other medications. Talk to your doctor about any problems you experience.

Treating Physicians: Dr. Rahul Parikh

Colorectal cancer includes malignant or cancerous tumors of the colon and/or the rectum.

The colon extends from the end of the small intestine to the rectum. It consists of ascending, transverse and descending segments.
The sigmoid colon is roughly S-shaped and is the lower portion of the descending colon, leading into the rectum.
The rectum is part of the digestive system. It makes up the final five inches of the colon.
Colorectal cancer can affect any of these areas.

Facts About Colorectal Cancer

This year, about 147,000 Americans will be diagnosed with colorectal cancer.
The disease affects men and women equally.

General Risk Factors for Colorectal Cancer

The majority of colorectal tumors are found in patients over age 50. However, the disease can happen at any age so it is important to know your family history and the following risk factors.

Diet high in fat and red meat and low in fruits and vegetables.
Personal history of colon cancer.
History of polyps in the colon, ulcerative colitis or Crohn’s Disease.

Screening for Colorectal Cancer

The American Cancer Society recommends that, beginning at age 50, both men and women be screened for colorectal cancer according to one of the following schedules:

A yearly fecal occult blood test where your stool will be checked for blood.
A double-contrast barium enema every five years. During this test, your colon is filled with a fluid containing barium. The barium is then drained out and air is put into the intestine. X-rays of the area are then taken to look for abnormalities.
Every 10 years, a colonoscopy where the doctor uses a long, lighted tube to look inside the rectum and the entire colon for polyps or other abnormal areas that may be cancerous.

People who have any of the colorectal cancer risk factors should consult with their doctor about earlier, more frequent screening.

Signs of Colorectal Cancer

Often there are no obvious signs of colorectal cancer, but some symptoms can include:

Change in bowel frequency, such as alternating episodes of diarrhea and constipation.
Bloody bowel movements or rectal bleeding.
General abdominal discomfort.
Unexplained weight loss.
Chronic fatigue.
Bloating.
Unexplained anemia.

Diagnosing Colorectal Cancer

Special tests to evaluate the colon and rectum are used to detect and diagnose colorectal cancer.

A physical exam to assess your overall health, including a digital rectal exam (DRE) to evaluate the rectum for abnormal masses.
Fecal occult blood test.
A sigmoidoscopy to look inside the rectum and sigmoid colon for polyps or other abnormal areas that may be cancerous using a thin, lighted tube.
A double-contrast barium enema.
A colonoscopy.

To determine for sure if you have cancer, some tissue will be removed during sigmoidoscopy or colonoscopy and examined under a microscope. This test is called a biopsy. Your doctor may also request a CT or PET scan to see if other body parts are affected.

Treating Colorectal Cancer

The primary treatment for cancers of the colon and rectum is surgery. For cancers that have not spread, surgery alone may cure your cancer.

Depending on the location and stage of your cancer, your doctor may recommend chemotherapy and/or radiation therapy either before or after surgery.
For rectal cancer, radiation is usually given with chemotherapy. It can be given before surgery (called preoperative or neoadjuvant therapy) or after surgery (called postoperative or adjuvant therapy). Depending on the location and stage of your tumor, preoperative therapy may allow the surgeon to spare your anal sphincter. This would avoid the need for a permanent colostomy and may reduce the chance of the cancer coming back.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

After a diagnosis of colorectal cancer has been established, it’s important to talk about your treatment options with a radiation oncologist.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Possible Side Effects

People with colorectal cancer often get chemotherapy while they are receiving radiation. Side effects during treatment result from both the local effects of radiation to the pelvic area and the systemic effects of chemotherapy throughout the body.

Possible side effects from radiation include more frequent bowel movements, diarrhea, abdominal cramping, pressure or discomfort in the rectal area, urinating more often, burning with urination, skin irritation, nausea and fatigue. These are usually temporary and resolve after your treatment ends.
Chemotherapy side effects will depend on the specific drug you receive.
Side effects are not the same for all patients. Ask your doctor what you can expect from your specific treatment.
Many of these side effects can be well controlled with medications and changes to your diet. Tell your doctor or nurse if you experience any discomfort so it can be treated.

Treating Physicians: Dr. Salma Jabbour

This year, about 62,000 Americans will be diagnosed with cancer of the oral cavity, pharynx, larynx and thyroid.

More than 25 percent of oral cancers occur in people who do not smoke or have other risk factors.
Rates of head and neck cancer are nearly twice as high in men and are greatest in men over age 50.

Risk Factors for Head and Neck Cancer

The use of tobacco and alcohol greatly increases your chances of developing head and neck cancer. Risk factors include:

Alcohol consumption.
Smoking or use of smokeless tobacco, such as chew or dip.
Exposure to wood or nickel dust or asbestos.
Plummer-Vinson syndrome (disorder from nutritional deficiencies).
Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr.

Quitting Smoking

If you quit smoking, the health benefits begin immediately.

For patients with head and neck cancer, quitting smoking reduces the risks of infections and developing other cancers.
To learn how to quit, ask your doctor or visit http://www.smokefree.gov/.

Symptoms of Head and Neck Cancer

Although there are sometimes no symptoms of head and neck cancer, common complaints include:

Lump or sore that does not heal.
Sore throat that does not go away.
Difficulty or pain with swallowing.
Change in your voice or hoarseness.
Blood in your saliva or from your nose.
Ear pain or loss of hearing.
Lump in the neck.
Nasal stuffiness that does not resolve.

Diagnosing Head and Neck Cancer

To look for cancer, your doctor will examine all the areas of your head and neck.

Your doctor will first feel for lumps on the neck, mouth and throat. He or she may also use a flexible endoscope, a thin, lighted tube that is passed through the nose, to obtain a more comprehensive assessment of the head and neck area.
X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.
To confirm if you have cancer, some tissue will be removed and analyzed. This test is called a biopsy.

Types of Head and Neck Cancers

Head and neck cancers arise from the cells that make up the face, mouth and throat. Because cancers in different locations behave differently, treatment depends on the cancer type and extent. Some common locations include:

Nasal cavity/paranasal sinuses.
Nasopharynx.
Oral cavity (lips, gums, floor of mouth, oral tongue, cheek mucosa, hard palate, retromolar trigone).
Oropharynx (base of tongue, tonsils, soft palate, oropharyngeal wall).
Larynx (vocal cords and supraglottic larynx).
Hypopharynx (pyriform sinuses, post-cricoid area, posterior pharyngeal wall).
Salivary glands (parotid, submandibular, sublingual and minor salivary glands).
Thyroid.

Cancers arising in the brain or eyes are considered different from head and neck cancers. However, your doctor will check the areas to make sure the cancer has not spread.

Treatment for Head and Neck Cancer

Treatment for head and neck cancer depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

Surgery, radiation therapy and chemotherapy are the mainstays of treating head and neck cancer.
For many head and neck cancers, combining two or three types of treatments may be most effective. That’s why it is important to talk with several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.
An important concept in treating head and neck cancer is organ preservation. Rather than relying on major surgery, an organ preservation approach first uses radiation and chemotherapy to shrink the tumor. This allows for a less extensive surgery and may even allow some patients to avoid surgery altogether.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast.

Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks.
The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of the radiation beams. It is currently being studied for treating breast cancer.
Side effects might include skin irritation, like a mild to moderate sunburn, mild to moderate breast swelling and fatigue.

Brachytherapy Center of Excellence Program

Treating Physicians: Dr. Lara Hathout, Dr. Dr. Ronald Ennis, Dr. Omar Mahmoud

Brachytherapy, also called internal radiation or seed implants, is the placement of radioactive sources in or just next to a tumor. The radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used. Because the radiation sources are placed so close to the tumor, your doctors can deliver a large dose of radiation directly to the cancer cells with minimal exposure to normal tissue.

The radioactive sources used in brachytherapy, such as thin wires, ribbons, capsules or seeds, come in small sealed containers. Some sources are placed permanently and are referred to as implants. These radioactive sources remain in the body after their radiation has been expended and the source is no longer radioactive. Other sources are placed temporarily inside the body, and the radioactive sources are removed after the prescribed dose of radiation has been delivered.

There are two main types of brachytherapy: intracavity treatment and interstitial treatment. With intracavity treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.

Often these procedures require anesthesia and brief hospitalization. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will need to take special precautions to limit their exposure to radiation.

Devices called high dose rate (HDR) remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.

Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can help this. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.

Possible Side Effects

Side effects of radiation therapy are limited to the area that is receiving treatment.

Side effects can include redness of the skin, sore throat, dry mouth, alteration of taste, pain on swallowing and possible hair loss in the treated area. Fatigue is also very common.
Side effects are different for each patient. Medications and nutritional supplements may be prescribed to make you as comfortable as possible.
If at any time during your treatment you feel discomfort, tell your doctor or nurse. They may be able to alter the treatment or prescribe a drug to help you feel better.

Mouth Care

It is important to take care of your mouth, teeth and gums during radiation.

Careful brushing of your teeth can help prevent tooth decay, gum disease, mouth sores and jaw infections.
Be sure to tell your dentist that you received radiation to the head and neck area.
Talk to your doctor or dentist about any problems you are having.

Treating Physicians: Dr. Sung Kim

The lymphatic system is a network of thin tubular vessels that branches out to almost all parts of the body. Scattered in between these vessels are lymph nodes. The job of the lymphatic system is to fight infection and disease. Cancer of the lymphatic system is called lymphoma. Hodgkins is one of two main types of lymphoma with non-Hodgkins being the other.

Hodgkins lymphoma (Hodgkins disease) commonly affects lymph nodes in the neck or in the area between the lungs behind the breastbone. It can also begin in groups of lymph nodes under the arms, in the abdomen or in the groin.
It’s named after the British doctor Thomas Hodgkin who first described the disease in 1832.
According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year. This includes 7,350 cases of Hodgkins lymphoma.
Hodgkins lymphoma is very treatable and often curable. Eighty-five percent of patients with Hodgkins live longer than five years after diagnosis.
Non-Hodgkins lymphoma (or NHL) refers to a variety of cancers involving the lymph system. Non-Hodgkins lymphoma can begin in any part of the body, not just the lymph nodes.
According to the American Cancer Society, nearly 64,000 new cases of lymphoma will be diagnosed this year.
Survival rates vary widely by cell type and stage of disease. More than 75 percent of patients with NHL live longer than a year after diagnosis; nearly 60 percent of patients live longer than five years.

Risk Factors for Hodgkins and Non-Hodgkins Lymphoma

The cause of Hodgkins lymphoma is unknown. However, doctors believe immune system problems as well as age may increase a person’s chance of developing this disease.

Hodgkins lymphoma has two peak time frames: between the ages of 15 and 40 and in people over age 55. However, the disease can affect anyone.
Males are typically more at risk of developing Hodgkins lymphoma.
Those who have been infected with the Epstein-Barr virus are more likely to develop Hodgkins lymphoma.
Having a parent or sibling with Hodgkins lymphoma also increases risk of the disease.
Non-Hodgkins is most commonly found in people in their 60s and 70s. However, the disease can affect anyone.
People with auto-immune disorders, including HIV and AIDS, are more likely to develop non-Hodgkins lymphoma.
People who have received an organ transplant have a high risk of developing non-Hodgkins. This is because they must take drugs that suppress the immune system.

Signs and Symptoms of Hodgkins and Non-Hodgkins Lymphoma

The signs and symptoms of lymphoma are not specific and may also be associated with other, noncancerous conditions. Talk to your doctor if you have any of these problems.

Signs and Symptoms of Hodgkins Lymphoma

Swollen lymph nodes in the neck, underarm or groin.
Unexplained fevers.
Drenching night sweats.
Unexplained weight loss.
Constant fatigue.
Skin rash or itchy skin.

Signs and Symptoms of Non-Hodgkins Lymphoma

Swollen lymph nodes in your neck, underarm or groin.
Unexplained fevers.
Unexplained weight loss.
Constant fatigue.
Skin rash or itchy skin.
Unexplained pain in the chest, abdomen, pelvis or bones.
Drenching night sweats.

Unexplained fevers, night sweats and weight loss are known as “B” symptoms. Ask your doctor about their significance in your case.

Diagnosing Hodgkins and Non-Hodgkins Lymphoma

Lymphoma is not just one disease. Rather, it is more than 30 types of cancer that act differently and may need special treatment. To see if you have lymphoma and what kind it is, your doctor may order some or all of the following tests.

To see if you have Hodgkins lymphoma, your doctor will first examine you to assess your overall health and look for anything unusual. He or she may also perform some or all of the following tests.

The doctor will order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
Several imaging tests will be performed to see if lymphoma has spread to other organs. These tests may include CT, PET or gallium scans.

To see if you have Non-Hodgkins lymphoma, your doctor will first examine you to assess your overall health and look for anything unusual. He or she may also perform some or all of the following tests.

The doctor may order blood tests to evaluate a variety of factors, including the number of blood cells in your blood and how well your liver and kidneys are working.
During a lymph node biopsy, your doctor will perform surgery to take out a lymph node. It will then be examined under a microscope to look for cancer.
A bone marrow biopsy may help determine if lymphoma has spread to that part of the body.
Your doctor may order imaging tests to see if lymphoma has spread to other organs. These tests may include X-rays or CT, PET or MRI scans.

Staging of Hodgkins and Non-Hodgkins Lymphoma

The stage of cancer is a term used to describe its size and whether it has spread.

Knowing this helps doctors plan the best treatment.

Staging of Hodgkins Lymphoma

Stage I: Single lymph node or non-lymph node region is affected.
Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumors in distant lymph nodes. Staging of Non-Hodgkins Lymphoma

The stage of cancer is a term used to describe its size and whether it has spread. Knowing this helps doctors plan the best treatment.

Stage I: Single lymph node or non-lymph node region is affected.
Stage II: Two or more lymph node or non-lymph node regions are affected on the same side of the diaphragm (the muscle under the lungs).
Stage III: Lymph node or non-lymph node regions above and below the diaphragm are affected.
Stage IV: The cancer has spread outside the lymph nodes to organs such as the liver, bones or lungs. Stage IV can also refer to a tumor in another organ and/or tumor in distant lymph nodes.

Treatment Options for Hodgkins and Non-Hodgkins Lymphoma

Treatment options depend on the type of lymphoma, its stage and your overall health. Treatment may include chemotherapy or radiation therapy, either alone or in combination. It may help to talk to several cancer specialists before deciding on the best course of treatment for you, your cancer and your lifestyle

A radiation oncologist is a doctor who specializes in destroying cancer cells with high energy X-rays or other types of radiation.
A medical oncologist is a doctor who is an expert at prescribing special drugs (chemotherapy) to treat cancer. Some medical oncologists are also hematologists, meaning they have experience treating blood problems.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

Radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
Healthy tissues are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

External Beam Radiation Therapy

External beam radiation therapy is a series of outpatient treatments to accurately deliver radiation to the cancer cells. Radiation therapy has been proven to be very successful at treating and curing Hodgkins lymphoma.

External Beam Radiation Therapy of Hodgkins lymphoma

Radiation oncologists deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each, every day except for Saturday and Sunday, for three to four weeks.
Involved field radiation is when your doctor delivers radiation only to the parts of your body known to have cancer. It is often combined with chemotherapy. Radiation above the diaphragm to the neck, chest and/or underarms is called mantle field radiation. Treatment below the diaphragm to the abdomen, spleen and/or pelvis is called inverted-Y field radiation.
Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to eliminate any remaining cancer cells and create space for the new stem cells.

External Beam Radiation Therapy of Non-Hodgkins lymphoma

Radiation oncologists usually deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator.
Each treatment is painless and is similar to getting an X-ray. Treatments last less than 30 minutes each and are every day, except for Saturday and Sunday for three to four weeks.
Involved field radiation is when your doctor delivers radiation only to the parts of the body known to have cancer. It is often combined with chemotherapy.
Your radiation oncologist may deliver radiation to all the lymph nodes in the body to destroy cancer cells that may have spread to other lymph nodes. This is called total nodal irradiation.
Your radiation oncologist may also deliver radiation to the entire body. This is called total body irradiation. It is often done before chemotherapy and a stem cell or bone marrow transplant to destroy any remaining cancer cells and create a space for the new stem cells.

Potential Side Effects

Potential Side Effects of Hodgkins lymphoma Treatment

The side effects you may experience will depend on the part of the body being treated, the dose of radiation given and if you also receive chemotherapy. Ask your doctor before treatment begins about possible side effects, and how best to manage them.

You may experience very few or no side effects and can continue your normal routine during treatment.
You may experience mild skin irritation, hair loss, sore throat, upset stomach, loose bowel movements, nausea and/or fatigue. Most side effects will go away after treatment ends.
Tell your doctor or nurse if you experience any discomfort. They may be able to prescribe medication or change your diet to help.
Hodgkins lymphoma is often curable, allowing many people with the disease to live long lives after treatment. In some very rare cases, the treatments that cured the cancer may lead to significant after effects. Talk to your doctor about the risks of your treatment.

Potential Side Effects of Non-Hodgkins lymphoma Treatment

The side effects you may experience will depend on the part of the body being treated, the amount of radiation you are given, and whether or not you have received chemotherapy. Ask your doctor before treatment begins about possible side effects and how best to manage them. Most side effects go away once you finish treatment.

You may experience very few or no side effects and can continue your normal routine during treatment.
You may notice mild skin irritation, upset stomach, hair loss, sore throat, loose bowel movements, nausea and fatigue.

Tell your doctor or nurse if you experience any discomfort during treatment. They may be able to prescribe medication or change your diet to help.

Biologic Therapy of Non-Hodgkins Lymphoma

Also called immunotherapy, biologic therapy works with your immune system to fight cancer. Biologic therapy is like chemotherapy. The difference is that chemotherapy attacks the cancer directly and biologic therapy helps your immune system better fight the disease

Monoclonal antibodies work by targeting certain molecules in the body and attaching themselves to those molecules. This causes some lymphoma cells to die and makes others more likely to be destroyed by radiation and chemotherapy.
Radiolabeled antibodies are monoclonal antibodies with radioactive particles attached. These antibodies are designed to attach themselves directly to the cancer cell and damage it with small amounts of radiation without injuring nearby healthy tissue. Presently, radiolabeled antibodies are being used to treat non-Hodgkins lymphoma that has come back after treatment.

Treating Physician: Dr. Rahul Parikh

Pediatric Hematology/Oncology Program

The skin is the body’s largest organ. Its job is to protect internal organs against damage, heat and infection. The skin is also the most exposed organ to sunlight and other forms of harmful ultraviolet rays. There are three major types of skin cancer.

Basal cell carcinoma: The most common form of skin cancer. These cancers begin in the outer layer of skin (epidermis).
Squamous cell carcinoma: The second most common type of skin cancer. These cancers also begin in the epidermis.
Melanoma: The most serious skin cancer, it begins in skin cells called melanocytes that produce skin color (melanin).

If caught and treated early, most skin cancers can be cured. Be sure to talk to your doctor about anything unusual on your skin.

General Risk Factors For Skin Cancer

There are many risk factors for developing skin cancer ranging from sun exposure to moles to family history:

Exposure to ultraviolet rays and sunburn: People who have experienced prolonged exposure to sunlight and tanning booths are at an increased risk to develop skin cancer. The amount of exposure depends on the intensity of the light, length of time the skin was exposed, and whether the skin was protected with either clothing or sunscreen. In addition, severe sunburn in childhood or teenage years can increase the risk of skin cancer.
Skin coloring/pigmentation: People with fair skin are 20 times more likely to develop skin cancer than people with darker skin. Caucasian people with red or blonde hair and fair skin that freckles or burns easily are at the highest risk. People with darker pigmentation can also develop skin cancer, more likely on the palms of the hands, soles of the feet, under the nails or inside the mouth.
Moles: Individuals with moles may be at increased risk of developing melanoma, especially if the moles are unusual, large or multiple.
Family history: Risk of developing melanoma is higher if one or more members of a person’s immediate family have been diagnosed.
Immune suppression: People who have illnesses affecting their immune system (such as HIV) or who are taking medicines to suppress their immune system (such as after an organ transplant) are at an increased risk of skin cancer.
Occupational exposure: Individuals exposed to coal tar, pitch, creosote, arsenic compounds or radium are at increased risk to develop skin cancer.

Facts About Skin Cancer

More than 1 million cases of basal and squamous cell skin cancers will be diagnosed in the United States this year. These cancers can usually be cured.
Nearly 60,000 cases of melanoma are diagnosed annually. Nearly 5,000 men and 2,900 women will die from the disease this year.
Skin cancer usually occurs in adults but can sometimes affect children and teenagers.

Signs Of Skin Cancer

Skin cancer can be detected early and it is important to check your own skin on a monthly basis. You should take note of new marks or moles on your skin and whether or not they have changed in size or appearance.

The American Cancer Society’s “ABCD rule” can help distinguish a normal mole from melanoma:

Asymmetry: The two halves of a mole do not match.
Border irregularity: The edges of the mole are ragged and uneven.
Color: Differing shades of tan, brown or black and sometimes patches of red, blue or white.
Diameter: The mole is wider than a quarter inch in size.

The American Cancer Society recommends a skin examination by a doctor every three years for people between 20 and 40 years of age and every year for anyone over the age of 40.

Diagnosing Skin Cancer

If initial test results show abnormal skin cells, your doctor may refer you to a skin specialist called a dermatologist. If the dermatologist thinks that skin cancer may be present, a biopsy, or sample of skin from the suspicious area, will be checked for cancer. There are three types of biopsies to test for skin cancer.

Shave biopsy: The doctor “shaves” or scrapes off the top layers of the skin with a surgical blade.
Punch biopsy: This type removes a deeper skin sample with a tool that resembles a tiny cookie cutter.
Incisional and excisional biopsies: For an incisional biopsy, a surgeon cuts through the full thickness of skin and removes a wedge for further examination. An excisional biopsy is when the entire tumor is removed.

Other tests such as a chest X-ray, CT scan or MRI may be used to see if the cancer has spread to other parts of the body.

Treating Skin Cancer

The treatment you receive depends on several factors including your overall health, stage of the disease and whether the cancer has spread to other parts of your body. Treatments are often combined and can include:

Radiation therapy where the cancer cells are killed by X-rays.
Surgery where the cancer cells are cut out and removed.
Electrodessication where the cancer is dried with an electric current and removed.
Cryosurgery where the cancer is frozen and removed.
Laser surgery where the cancer cells are killed by laser beams.
Chemotherapy where the cancer cells are attacked by a drug that is either taken internally or applied on the skin.
Photodynamic therapy where the cancer is covered with a drug that becomes active when exposed to light.
Biologic therapy where doctors help your immune system better fight the cancer.

Understanding Radiation Therapy

Radiation therapy, also called radiotherapy, is the careful use of radiation to treat many different kinds of cancer.

Cancer doctors, called radiation oncologists, use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms such as pain.
Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
Healthy cells that grow and divide quickly are also harmed by radiation, but they are able to repair themselves in a way cancer cells cannot.

Potential Side Effects

You may have little or no side effects from radiation therapy and be able to keep up your normal activities.

Side effects are usually limited to the part of your body that receives radiation.
Skin changes such as redness, dryness or itching are common side effects.
You will also likely lose your hair in the area treated.
Side effects should go away when the treatment ends.

Talk to your doctor or nurse about any discomfort you feel. He or she may be able to provide drugs or other treatments to help.

Treating Physician: Dr. Rahul Parikh

Soft Tissue Oncology Program

Total Skin Electron Irradiation Therapy (TSET) is offered and available in the Department of Radiation Oncology at Robert Wood Johnson University Hospital ( http://www.rwjuh.edu/rwjuh/total-skin-electron-beam-therapy-tsebt-for-treatme.aspx ).

The Total Skin Electron Therapy (TSET) program is utilized in the management of patients with cutaneous lymphoma as well as several other disorders. This service is offered in the Department of Radiation Oncology. Quality assurance is a critical feature in the delivery of such technically complicated therapy, and the departmental radiation physics and dosimetry staff members will be an integral part of the program. Patients will be seen in consultation by Dr. Parikh, who will be leading the program at the Department of Radiation Oncology. The clinical visit will be organized in such a manner that patients will become familiar with our cutaneous lymphoma program. Additional clinical support may be required, based on specific treatment recommendations. A nursing educational session will provide patients with information describing the TSET program and what they may expect from treatment; this will be provided during the initial consultation visit. Patients will receive detailed written information, references and concepts that are presented and reviewed during their first consultation visit. Our treatment facility is state of the art with multiple radiotherapeutic modalities, which will incorporate (TSET) into the management of patients with cutaneous lymphoma. The standard course of TSET is provided over 9 weeks or less, 4 days or less per week, approximately 1 hour per day. For more information please contact Dr. Parikh at 732.253.3939.