Oncology Software
Treatment of a right upper lobe lung tumor using Active Breathing Coordinator™ in a patient with severe pulmonary insufficiency at Centre Régional, Léon-Bérard, Lyon, France –
A 68-year-old male, former smoker, presented with a long history of severe pulmonary insufficiency, which had been managed for several years with oxygen therapy. More recently, as his pulmonary function improved the oxygen therapy was stopped.
Right upper lobe lung tumor
A recent radiograph showed a 4cm diameter tumor in the right upper lobe. CT-scan confirmed a solid mass 48 x 42mm in right upper lobe, with suspicious infra-cranial nodes (between 15 and 20mm in diameter). A PET scan showed a fixed primary tumor but a mobile mediastinum. Cranial CT and abdominal CT were normal. The tumor was considered as stage T2-3 N0-M0.
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How is Cancer Treated?
How Does Radiotherapy Work?
How does a Linear Accelerator Work?
What is Intensity Modulated Radiotherapy?
This guide contains information on frequently asked questions and information on the treatment process. While this information will not necessarily correspond to the exact process adopted by an individual hospital, we hope it will provide general background information and an indication of a typical treatment process.
Who will be looking after me?
A specialist cancer doctor is known as a radiotherapist or radiation oncologist. In this guide we will refer to him/her as an radiation oncologist. The radiation oncologist will plan and oversee your treatment, which will be carried out by radiation therapists. In addition, the team looking after you may include nurses, health care assistants, specialist nurses, counsellors and dietitians, according to your needs during your treatment.
What is radiation therapy?
Radiation Therapy is the treatment of cancer with radiation. This can be done in a variety of ways, depending on the nature of your cancer. The most commonly used method is called external beam therapy (from a machine outside the body), which directs radiation at your tumor.
How does radiation therapy work?
Radiation Therapy Treatment Process
Although the radiation affects both cancer and normal cells, it has a greater effect on the cancer cells. Treatment aimed at cure will give the highest possible dose of radiation to the cancer area (within safe limits) to attempt to kill all the cancer cells. Sometimes smaller doses are used, where the aim is to reduce the size of a tumor and/or relieve symptoms.
How is the treatment planned?
Every course of radiation therapy is designed to suit the particular needs of the person receiving it, so you will usually be asked to make a preliminary visit to the treatment center to have your course of treatment planned. The radiation oncologist and radiation therapists will do this (in conjunction with x-rays and scans, using a machine called a simulator). Your skin will be marked with coloured pens to define where you will have your treatment. In addition, some minute permanent marks will be made using a special dye and a tiny pin prick.
These marks will enable the radiation therapists to identify exactly the right area at every treatment session. If a head shell has been made for you the guidance marks will be put on the shell rather than on your skin.
If you are having radiation therapy to your mouth and/or throat you will need a dental assessment at this stage as you may require some dental treatment before you start your radiation therapy.
How is radiation therapy given?
Radiation therapy is given using either a machine called a linear accelerator or, for some skin tumors, a superficial x-ray unit. To receive the radiation therapy, you will lie on a couch under the machine, and be asked to remain still during the actual treatment.
Will the radiation therapy hurt?
Radiation Therapy Treatment Process
No. The treatment is completely painless. Radiation cannot be seen or felt while it is being given.
Will the treatment make me radioactive?
No. There is no possibility of this whatsoever.
How long will the course of treatment last?
Your radiation oncologist will tell you this once the appropriate treatment for you has been decided. A course can last for anything from a single treatment to five treatments a week for six weeks depending on a number of factors, e.g. the part of your body being treated and the aim of the treatment. Most treatments are carried out daily between Monday and Friday.
How long is each treatment session?
This varies from machine to machine. Some machines operate at a faster rate than others, and it also depends on the plan worked out for you. The length of a treatment session can be anything from five minutes to fifteen minutes. Occasionally a session may take longer, but this will be explained on an individual basis. When you come for your first treatment your radiation therapist will tell you how long each session will take.
Do I have to stay in hospital?
If you are able to travel to the hospital for treatment there is usually no need for you to be admitted during the course. Most people are treated as outpatients, but your radiation oncologist will tell you if it would be better for you to be admitted.
Will I have any tests during treatment?
Radiation Therapy Treatment Process
During your course of treatment, you may need to have occasional blood test and/or urine test, depending on the part of your body being treated. Some people also have X-rays and/or scans during their course of treatment, which is part of the routine and nothing to worry about.
Are there particular things I should or should not do during my course of treatment?
As far as possible throughout your treatment, try to lead a normal life – try to think of the radiation therapy as an interruption to your daily routine rather than as the most important part of your day. However, the following tips might help:
Do
* Drink plenty of fluids every day during treatment, e.g. tea, coffee, milk, fruit juice, water or fizzy drinks (ideally sugar-free).
* Eat regularly and try to keep a balanced diet. If you don’t feel like big meals, try eating little and often. The dietitian can help to plan a diet for you if necessary.
* Wash, shower or bath as normal during treatment using a simple or baby soap taking care to pat dry the area being treated, rather than rubbing it.
Do Not
* Drink spirits, eat spicy food or very hot or very cold food if you are having treatment to your mouth, neck or chest, but ask the radiographers if you would like more information.
* Expose the treated area to the sun during a radiation therapy treatment course, as the treated area will burn more easily and take some time to heal. In the future it is advisable always to apply sunscreen to avoid sunburn.
* Put creams or deodorants on the treated area as these may worsen your skin reaction.
Am I likely to have any side effects?
Radiation therapy is a localized treatment, which means that any side effects will depend on the part of the body being treated. Although many people have few, if any, side effects, everyone reacts differently and during your treatment you may experience one or more of the following:
* Tiredness:
Radiation Therapy Treatment Process
You may feel tired and lethargic during your treatment and especially towards the end of the course and after it has finished. This is very common, and can last a variable length of time. If it happens to you, pace yourself and rest as much as you feel you need to and gradually the tiredness will pass, although it may take a long while.
* Tender skin:
During your treatment and especially towards the end of your course, your skin in the area being treated may turn red, like mild sunburn, and tenderness and redness may even increase for a week or two after your treatment has finished (this is because the tissues continue to be affected by the x-rays for several weeks after treatment.). It will gradually recover, but the nurse or radiation therapist treating you will explain exactly how you should look after your skin, during and after your course of treatment.
* Sickness:
Depending on the part of your body being treated you may feel nauseous or be sick during your course of treatment. This does not happen to everyone. If you do feel sick, please tell your radiation therapist or nurse as it can be controlled by tablets or diet.
* Diarrhoea:
Again, depending on the part of your body being treated, you may experience some diarrhoea. Please tell your radiation therapist or nurse if this happens to you as you may need diarrhoea-relieving medication.The dietitian will also be pleased to advise you and help you with an eating plan if necessary.
* Frequency when passing urine:
If you are having treatment to your lower abdomen/pelvis you may find that you pass urine more often and may experience discomfort when doing so. Drinking extra fluids will help, but try to avoid alcohol, tea and coffee as these can irritate your bladder. If this happens to you please tell the staff treating you, so that your urine can be tested for any infection,which could then be treated with appropriate medication.
* Sore mouth and throat:
This only happens if you are having treatment to this part of your body. If it is likely to be a problem your radiation therapist or nurse will explain how to look after your mouth and throat, or give you advice on chewing and swallowing difficulties. This only happens if you are having treatment to this area. If it is likely to be a problem, your radiation therapist or nurse will explain to you how to look after your mouth and throat during treatment.
* Hair loss:
Hair loss only occurs where treatment is given. For example you will only lose the hair on your head if your head is being treated, and if your chest is being treated, then you will only lose your chest hair. Whether or not it grows again will depend on how much radiation you have been given. Your oncologist will explain what this means for you. If your hair is expected to grow again, this should happen within a few months of the end of your treatment.
Can I carry on working?
If you feel you wish to carry on working, as long as your radiation oncologist reason why you should not continue with your normal daily course of treatment. However do ask if you need advice.
What will happen when the treatment is finished?
Radiation Therapy Treatment Process
The immediate side effects of the treatment described above will start to ease off within a week or two of the end of your course. Because of the way radiation therapy works, the full benefit of the course of treatment is not usually reached until some weeks after the last treatment session.
Will I have any check-ups after my treatment?
After your treatment, you will be seen again at the hospital you first attended or be referred back to your Family Doctor. The first follow-up is often about 4 to 6 weeks after the course has finished, and this appointment will be discussed with you before you finish at the treatment center. However, follow-up arrangements can vary from person to person and from centre to centre. Your radiation oncologist will explain to you how and where your follow-up appointments will be arranged.
Can radiation therapy cause permanent damage?
Radiation therapy treatment is planned and delivered with the utmost care, but sometimes sensitive parts of the body are damaged. This is because to treat the cancer effectively, it is sometimes necessary to use high doses of radiation, close to the limits that normal tissues can withstand. The bowel, bladder and nervous system are particularly sensitive, but other parts of the body can suffer long term changes.
If you are having radiation therapy aimed at killing your cancer cells, there is about a 5% possibility of side-effects which may seriously affect your lifestyle. However, it is important to balance this against the much higher potential risks to your life, from the cancer getting worse or recurring without the treatment. On the other hand, if you are having radiation therapy to shrink the tumour and/or relieve symptoms, then the much lower doses of radiation used are unlikely to cause any permanent damage.
If the radiation therapy treatment includes the gonads (ovaries in women, testicles in men) this will affect fertility and hormone function. It is important to discuss this with your oncologist before treatment begins.
If you do have any difficulties at any time in the future which you feel may be connected with your radiation therapy, then do not hesitate to contact your oncologist or GP. If there are any special risks or problems in your case then your oncologist will discuss this with you. Bear in mind that you are being offered radiation therapy because the benefits greatly outweigh the risks.
Acknowledgments
This guide is taken from a booklet produced by the Lynda Jackson Macmillan Centre for Cancer Support and Information in collaboration with Mount Vernon radiation oncologists, other health care professionals, patients and carers. Elekta wish to thank the Lynda Jackson Macmillan Centre for Cancer Support and Information for their kind permission to reproduce this information.
Note:
This website is not intended as a substitute for professional medical advice and does not address specific treatments or conditions specific to any patient. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. The information on this website is subject to change.
WHAT IS THE PANCREAS?
The pancreas is a spongy, tube-shaped organ about 6 inches long. It is located in the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen. It is connected to the duodenum, the upper end of the small intestine. The narrow end of the pancreas, called the tail, extends to the left side of the body.
Pancreatic Cancer
The pancreas makes pancreatic juices and hormones, including insulin. Pancreatic juices, also called enzymes, help digest food in the small intestine. Insulin controls the amount of sugar in the blood. Both enzymes and hormones are needed to keep the body working right.
As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the stomach.
WHAT IS CANCER?
Cancer is a group of diseases. More than 100 different types of cancer are known, and several types of cancer can develop in the pancreas. They all have one thing in common: abnormal cells grow and destroy body tissue.
Healthy cells that make up the body’s tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to control their growth. They grow too rapidly and without any order. Too much tissue is made, and tumors are formed. Tumors can be benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Often, benign tumors can be removed by surgery, and they are not likely to return.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancer cells also can break away from the tumor and spread to other parts of the body. The spread of cancer is called metastasis.
Cancer that starts in the pancreas is called pancreatic cancer. When pancreatic cancer spreads, it usually travels through the lymphatic system. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues all over the body. Cancer cells are carried through these vessels by lymph, a colorless, watery fluid that carries cells that fight infection. Along the network of lymphatic vessels are groups of small, bean-shaped organs called lymph nodes. Surgeons often remove lymph nodes near the pancreas to learn whether they contain cancer cells.
Cancer cells can also be carried through the bloodstream to the liver, lungs, bone, or other organs. Pancreatic cancer that spreads to other organs is called metastatic pancreatic cancer.
WHAT CAUSES CANCER OF THE PANCREAS?
While it can seldom be explained why one person gets pancreatic cancer and another doesn’t, it is clear that the disease is not contagious. No one can “catch” cancer from another person.
Although scientists to not know exactly what causes cancer of the pancreas, they are learning that some things increase a person’s chance of getting this disease. Smoking is a major risk factor. Research shows that cigarette smokers develop cancer of the pancreas two to three times more often than nonsmokers. Quitting smoking reduces the risk of pancreatic cancer, lung cancer and a number of other diseases.
WHAT ARE SYMPTOMS OF CANCER OF THE PANCREAS?
Pancreatic cancer has been called a “silent” disease because early pancreatic cancer usually does not cause symptoms. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow and the urine may become darker. This condition is called jaundice.
As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss and weakness.
A rare type of pancreatic cancer, called islet cell cancer, begins in the cells of the pancreas that produce insulin and other hormones. Islet cells are also called the islets of Langerhans. Islet cell cancer can cause the pancreas to produce too much insulin or hormones. When this happens, the patient may feel weak or dizzy and may have chills, muscle spasms or diarrhea.
These symptoms may be caused by cancer or by other, less serious problems. If an individual is experiencing symptoms, a doctor should be consulted.
HOW IS CANCER OF THE PANCREAS DIAGNOSED?
To diagnose pancreatic cancer, the doctor does a complete physical exam and asks about the patient’s personal and family medical history. In addition to checking general signs of health (temperature, pulse, blood pressure and so on), the doctor usually orders blood, urine, and stool tests. The doctor may also ask for a “barium swallow”, or “upper GI series”. For this test, the patient drinks a barium solution before x-rays of the upper digestive system are taken. The barium shows an outline of the pancreas on the x-rays.
Other tests may be ordered, such as:
* An angiogram, a special x-ray of blood vessels
* CT scans, x-rays that give detailed pictures of a cross- section of the pancreas. These pictures are created by a computer
* Transabdominal ultrasound to view the pancreas. In this procedure, an instrument that sends out high-frequency sound waves, which cannot be heard, is passed over the abdomen. The sound waves echo off the pancreas. The echoes form a picture on a screen that looks like a television
* ERCP (endoscopic retrograde cholangiopancreatogram), is a special x-ray of the common bile duct. For this test, a long, flexible tube (endoscope) is passed down the patient’s throat through the stomach and into the small intestine. A dye is injected into the common bile duct, and x-rays are taken. The doctor can also look through the endoscope and take tissue samples
* Endoscopic ultrasound is a relatively new procedure that can be used to diagnose pancreatic cancer. For the procedure, an endoscope is passed in the same way as for ERCP; however, on the end of the endoscope is an ultrasound probe which scans the pancreas for cancers. Because the ultrasound probe is closer to the pancreas than with transabdominal ultrasound, it is possible to identify small cancers within the pancreas. The cancers also can be biopsied through the endoscope
A biopsy is the only sure way for the doctor to know whether cancer is present. In a biopsy, the doctor removes some tissue from the pancreas. It is examined under a microscope by a pathologist, who checks for cancer cells.
One way to remove tissue is with a long needle that is passed through the skin into the pancreas. This is called a needle biopsy. Doctors use x-rays or ultrasound to guide the placement of the needle. Another type of biopsy is a brush biopsy. This is done during the ERCP. The doctor inserts a very small brush through the endoscope into the bile duct to rub off cells to examine under a microscope.
Sometimes an operation called a laparotomy may be needed. During this operation, the doctor can look at organs in the abdomen and can remove tissue. The laparotomy helps the doctor determine the stage, or extent, of the disease. Knowing the stage helps the doctor plan treatment.
Tissue samples that are obtained with one kind of biopsy may not give a clear diagnosis, and the biopsy may need to be repeated using a different method.
HOW IS CANCER OF THE PANCREAS TREATED?
Treatment for pancreatic cancer depends on a number of factors.
Among these are the type, size, and extent of the tumor as well as the patient’s age and general health. A treatment plan is tailored to fit each patient’s needs.
Treatment Methods
Cancer of the pancreas is curable only when it is found in its earliest stages, before it has spread. Otherwise, it is very difficult to cure. However, it can be treated, symptoms can be relieved, and the quality of the patient’s life can be improved.
Pancreatic cancer is treated with surgery, radiation therapy , or chemotherapy . Researchers are also studying biological therapy to see whether it can be helpful in treating this disease. Sometimes several methods are used, and the patient is referred to doctors who specialize in different kinds of cancer treatment.
Surgery may be done to remove all or part of the pancreas. Sometimes it is also necessary to remove a portion of the stomach, the duodenum, and other nearby tissues. This operation is called a Whipple procedure. In cases where the cancer in the pancreas cannot be removed, the surgeon may be able to create a bypass around the common bile duct or the duodenum if either is blocked.
Radiation therapy (also called radiotherapy) uses high-powered rays to damage cancer cells and stop them from growing. Radiation is usually given 5 days a week for 5 to 6 weeks. This schedule helps to protect normal tissue by spreading out the total dose of radiation. The patient doesn’t need to stay in the hospital for radiation therapy.
Radiation is also being studied as a way to kill cancer cells that remain in the area after surgery. In addition, radiation therapy can help relieve pain or digestive problems when the common bile duct or duodenum is blocked.
Chemotherapy uses drugs to kill cancer cells. The doctor may use just one drug or a combination. Chemotherapy may be given by mouth or by injection into a muscle or vein. The drugs enter the bloodstream and travel through the body. Chemotherapy is usually given in cycles; a treatment period followed by a recovery period, then another treatment period and so on.
WHAT ARE THE SIDE EFFECTS OF TREATMENT FOR CANCER OF THE PANCREAS?
The methods used to treat pancreatic cancer are very powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed. Healthy tissue may also be damaged. That is why treatment often causes unpleasant side effects. Side effects depend on the type of treatment used and on the part of the body being treated.
Surgery for cancer of the pancreas is a major operation. While in the hospital, the patient will need special medications and may be fed only liquids. During recovery from surgery, the patient’s diet and weight will be checked carefully.
During radiation therapy, the patient may become very tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the treated area are also common. Good skin care is important at this time, but the patient should not use any lotions or creams on the skin without checking with the doctor. Radiation therapy to the upper abdomen can cause nausea and vomiting. Usually, dietary changes or medications can ease these problems.
The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells, those that line the digestive tract, and those in the skin and hair. As a result, patients can have side effects such as a lowered resistance to infection, less energy, loss of appetite, nausea, vomiting, or mouth sores. Patients may also lose their hair.
Weight loss can be a serious problem for patients being treated for cancer of the pancreas. Researchers are learning that well- nourished patients usually feel better and may be better able to withstand the side effects of their treatment. Therefore, nutrition is an important part of the treatment plan, and doctors may have a number of suggestions to help their patients get enough calories and protein. In many cases, patients feel better if they take food and beverages in very small amounts. Many patients find that eating several small meals and snacks throughout the day is easier than having three large meals.
In addition, treatment for cancer of the pancreas may interfere with production of insulin and pancreatic juices. The patient must take medicines to replace these; otherwise the level of blood sugar may be wrong and digestion may be affected. Even so, taking these medicines can often upset digestion. Careful planning and checkups are important to help the patient avoid weight loss and the weakness and lack of energy caused by poor nutrition.
Patients and family members are often afraid that cancer will cause pain. Cancer patients do not always have pain, but if it does occur, there are many ways to relieve or reduce it. It is important for the patient to let the doctor know about pain, because uncontrolled pain can cause loss of sleep and poor appetite. These problems can make it difficult for the patient to respond to treatment.
The side effects that patients have during cancer therapy vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
HOW DO PATIENTS AND FAMILIES ADJUST TO CANCER OF THE PANCREAS?
The diagnosis of pancreatic cancer can change the lives of cancer patients and the people who care about them. These changes in daily life can be difficult to handle. It is natural for patients and their families and friends to have many different and sometimes confusion emotions.
At times, patients and their loved ones may feel frightened, angry, or depressed. These are normal reactions that people have when dealing with a serious health problem. Others in the same situation have found that they cope with their emotions better if they can talk openly about their illness and their feelings with those who care about them. Sharing feelings with loved ones can help everyone feel more at ease, opening the way for others to show their concern and offer their support. Many patients find that it helps to talk with others who are facing problems like theirs. They can meet other cancer patients through self-help and support groups.
Worries about tests, treatments, hospital stays, and medical bills are common. Talking with doctors, nurses, or other members of the health care team may help to calm fears and ease confusion.
Patients can take an active part in decisions about their medical care by asking questions about pancreatic cancer and their treatment choices. Patients, family, or friends often find it helpful to write down questions to ask the doctor as they think of them. Taking notes during visits to the doctor helps them remember what was said. Patients should ask the doctor to explain anything that is not clear.
Patients have many important questions, and the doctor is the best person to answer them. Most people ask about the extent of their cancer, how it can be treated, and how successful the treatment is likely to be.
Patients are naturally concerned about their future and may try to use statistics they have heard to figure out what the future holds. It is important to remember, however, that statistics are averages. They are based on the experiences of large numbers of patients, and no two cancer patients are alike. The doctor who takes care of the patient and knows his or her case is the best person to discuss the patient’s prognosis.
The doctor can give advice about treatment, working, or limiting activities. Patients also may wish to discuss their concerns about the future, family relationships, and finances. If it is hard to talk to the doctor about feelings and other very personal matters, it may be helpful to speak with a nurse, social worker, counselor, or a member of the clergy.
Learning to live with the changes brought about by cancer is easier for patients and those who care about them when they have helpful information and support services. Often, the social service office at the hospital or clinic can suggest local and national agencies that will help with emotional support, financial aid, transportation, or home care.
WHAT DOES THE FUTURE HOLD FOR PATIENTS WITH CANCER OF THE PANCREAS?
Scientists at hospitals and medical centers all across the country are studying pancreatic cancer. They are trying to learn what causes this disease and how to prevent it. They are also looking for better ways to diagnose and treat it.
The NCI is supporting may studies of new treatments for pancreatic cancer. Researchers are exploring new drugs and drug combinations, new forms of radiation therapy, biological therapy, and combinations of these treatments.
Researchers are also looking at new ways to give radiation. For example, they are studying giving radiation therapy two or more times a day, or during surgery (intraoperative radiation), or with drugs that help protect normal tissue so that higher doses can be given.
Biological therapy is a new type of cancer treatment that uses natural and laboratory-produced substances to stimulate or restore the body’s immune system so it can fight disease more effectively. This kind of treatment is being studied in patients with advanced or recurring cancer of the pancreas.
When laboratory research shows that a new treatment method has promise, it is used to treat cancer patients in clinical trials. These trials are designed to answer scientific questions and to find out whether a new treatment is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods. A person with cancer of the pancreas who is interested in taking part in a trial should discuss this option with his or her doctor.
Note:
This website is not intended as a substitute for professional medical advice and does not address specific treatments or conditions specific to any patient. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. The information on this website is subject to change.
“Your mammogram is suspicious for breast cancer.” “Your biopsy was positive for breast cancer.” These are among the most terrifying words a woman can hear from her doctor. Breast cancer elicits so many fears, including those relating to surgery, death, loss of body image and loss of sexuality. Managing these fears can be facilitated by information and knowledge so that each woman can make the best decisions concerning her care. Optimally, these issues are best discussed with the patient’s doctor on an individual basis. What follows is a review of information on breast cancer intended to aid patients and their families in their navigation through the vast ocean of breast cancer
WHO IS AT RISK FOR BREAST CANCER?
Currently, one in every eight women in the United States develops breast cancer. The exact cause of breast cancer is not known and most likely involves many factors, including genetic, environmental, nutritional and hormonal. Breast cancer is more common in higher socioeconomic groups, unmarried women, urban areas and Jewish women.
The most prominent risk factors for breast cancer are age and gender. Men can develop breast cancer, but women are 200 times more likely to develop breast cancer than men. Breast cancer is four hundred times more common in women who are 50 years old as compared to those who are 20 years old. Seventy-five percent of women who develop breast cancer have no risk factors other than age.
A family history of breast cancer will increase the risk of developing breast cancer in a woman by three to five times. Recently, a breast cancer gene (BR CA 1) has been identified. If a woman has this gene present in her chromosomes, there is an 85% chance of developing breast or ovarian cancer, or both in her lifetime. Fifty percent of these cancers will occur before the age of fifty. This gene is felt to be responsible for only two to four percent of all breast cancer cases. Currently, the test for this gene is available only at certain research centers, and though it is highly predictive of some breast cancers, it is still not clear how best to use this information in treating and counseling patients.
Women who started their menstrual periods before age 12, those who delayed menopause until after age 55, and those who had their first pregnancy after age 30 have a mildly increased risk of developing breast cancer (less than two times the normal risk). Pregnancy and breast feeding have a protective effect in preventing breast cancer. Some studies show that hormone replacement therapy and birth control pills cause a small increased risk of breast cancer, but this has not been confirmed in all studies.
When a breast biopsy demonstrates the development of abnormal cells that are not yet cancerous, called atypical hyperplasia, there is a moderately increased risk of developing breast cancer in the future.
Dietary factors such as high-fat diets and alcohol consumption have been implicated as increased risk factors for breast cancer in some studies. More recent studies have disproven high-fat diets as increasing the risk for breast cancer. Cigarette smoking, caffeine intake, and stress do not appear to increase the risk of breast cancer.
HOW IS BREAST CANCER DIAGNOSED?
Currently, mammography and breast examination serve as the foundation in screening for breast cancer. Mammography is an x-ray examination of the breast. It has the ability to detect a cancer in the breast when it is quite small, long before it may be felt by breast examination. Eighty-five to 90% of all breast cancers are detectable by mammography. Approximately 10 to 15 percent of breast cancers are not visible on mammography, but can be felt on physical examination of the breast.
Since a percentage of breast cancers is not seen on mammography, it is extremely important for a woman to have regular breast examinations as well as mammograms in order to most fully ensure she has no evidence of breast cancer. Breast examination can be performed by the woman’s health professional during the routine physical checkup. It should also be performed monthly by the woman herself using the technique of breast self- examination. It is best to do breast self-examination 3 days after the menstrual period has stopped. Any detected change from the usual appearance or feel is reported to the health professional.
An ultrasound is a test that uses sound waves to visualize structures inside the body. It is often used to distinguish between cysts and solid tumors in the breast. Fluid within cysts can be aspirated (withdrawn with a needle and syringe) for analysis in the laboratory.
If an area of the breast is suspicious for a cancer, a biopsy (removal of a piece of tissue to analyze under the microscope) is usually performed to confirm or deny the diagnosis. Eighty percent of biopsies are not cancerous.
HOW IS THE BREAST DESIGNED?
Breast cancer is not just one disease, but rather is a general term used to describe a number of different types of cancers which occur in the breast. Each different type of breast cancer behaves differently and has a different prognosis. Before describing the different cancers and how they are treated, some background information may be helpful.
The breast is an organ of the body designed to produce milk. The breast contains glands called lobules which produce breast milk. There are also tubes or channels called ducts which transport the milk from the glands to the nipple. The majority of breast cancers begins in either the ducts or the lobules and cancer names are based on their site of origin (i.e., ductal carcinoma of the breast or lobular carcinoma of the breast). The lobules and ducts are supported in the breast by surrounding fatty tissue and ligaments.
There are also blood vessels and lymphatics present in the breast. Lymphatics are small thin channels similar to blood vessels. They do not carry blood, but collect and carry tissue fluid. This fluid ultimately re-enters the blood stream. Breast tissue fluid drains through the lymphatics into the axillary lymph nodes, located in the underarm. Lymph nodes are small glands through which lymphatic channels enter. They filter the lymph fluid and can serve as a barrier to the further spread of bacteria or cancer cells that may have entered the lymph fluid. Lymph nodes are not completely effective in filtering out cancer cells and may spread to other parts of the body despite their presence. Once cancer cells have gained access to either the lymph channels or the blood stream, they have the potential to spread to any area of the body. In breast cancer, these areas are typically the bone, the lungs, the liver and the brain.
Breast cancer is also categorized as invasive (infiltrating) or non-invasive (in-situ). Invasiveness, as it relates to cancer, refers to the cancer’s ability to spread to other parts of the body (metastasize). If a cancer is invasive, it has the capability of growing directly into other parts of the body, or traveling in the blood or lymph fluid to these areas. Non-invasive cancers (in situ cancers) are those cancers which are defined by microscopic criteria as lacking the ability to spread to other parts of the body.
WHAT ARE THE TYPES OF BREAST CANCERS?
The majority of breast cancers can be classified into one of the following categories; infiltrating ductal carcinoma, infiltrating lobular carcinoma, ductal carcinoma in situ, lobular carcinoma in situ, inflammatory carcinoma, Paget’s disease, and cystosarcoma phyllodes. There are other tumors of the breast, such as angiosarcoma, squamous cell cancer and lymphoma, but they are quite rare. These categories are based on the microscopic appearance of the breast tissue obtained with a biopsy sample.
* INFILTRATING DUCTAL CARCINOMA
* INFILATRATING LOBULAR CARCINOMA
* DUCTAL CARCINOMA IN SITU (DCIS)
* LOBULAR CARCINOMA IN SITU (LCIS)
* INFLAMMATORY CARCINOMA
* PAGET’S DISEASE
* CYSTOSARCOMA PHYLLODES
INFILTRATING DUCTAL CARCINOMA
Infiltrating Ductal Carcinoma begins in the cells forming the ducts of the breast. It is the most common form of breast cancer, comprising about 65-85% of all cases. On a mammogram, invasive ductal carcinoma is usually found as an irregular mass, or as a group of small white irregular dots called microcalcifications, or a combination of both. It may also appear as a lump in the breast. On physical examination, this lump usually feels much harder or firmer than other benign causes of lumps in the breast.
INFILATRATING LOBULAR CARCINOMA
Infiltrating Lobular Carcinoma comprises 5 to 10 percent of breast cancers. This type of breast cancer can appear similar to infiltrating ductal carcinoma on mammography, but on examination of the breast there is usually not a hard mass, but rather a vague thickening of the breast tissue. Lobular carcinoma can occur in more than one site in the breast (multicentric) or in both breasts simultaneously (bilateral).
DUCTAL CARCINOMA IN SITU (DCIS)
Ductal Carcinoma In Situ (DCIS) is a pre-invasive form of breast cancer. It is commonly seen in association with an invasive breast cancer. If it occurs without an invasive cancer there is usually no lump associated with it. On mammography, there may be fine microcalcifications which can signal its presence. DCIS is frequently multifocal, meaning it is located in more than one area of the breast. Approximately one-third of DCIS cases are multifocal. If DCIS is treated with biopsy alone, about 40% of women will ultimately develop an invasive cancer of that breast in the future.
LOBULAR CARCINOMA IN SITU (LCIS)
Lobular Carcinoma In Situ (LCIS) is usually encountered as an incidental finding in a breast biopsy. It has no symptoms, and has no characteristic pattern on mammography. It has been found to occur in multiple sites in the same breast in 40 to 90% of cases. In 50% of the cases, it may also occur in the opposite breast. The risk of developing an invasive cancer of the breast with LCIS is approximately 1% per year. The invasive cancer that develops has about an equal chance of being in either breast regardless as to which breast the LCIS was initially found. A large percentage (38%) of women with LCIS may not develop an invasive cancer until more than 20 years after the initial diagnosis.
INFLAMMATORY CARCINOMA
Inflammatory carcinoma of the breast is a subtype of infiltrating ductal carcinoma, but is named for its typical clinical presentation. The breast becomes red, swollen, and warm, and the skin becomes quite thickened. The breast appears as if it were infected. This appearance is due to the rapid growth of the cancer which blocks the lymphatics in the breast, causing it to swell and appear infected. The cancer has already spread to the lymph nodes in 90% of the cases at the time of diagnosis. The prognosis for this cancer is very poor, and is fortunately relatively uncommon.
PAGET’S DISEASE
Paget’s disease of the breast accounts for about one to four percent of all breast cancers. It occurs typically as a crusting and scaling of the nipple. It can be mistaken for a benign skin condition unless there is a high index of suspicion.
CYSTOSARCOMA PHYLLODES
Cystosarcoma Phyllodes is a firm tumor that resembles a benign fibroedenoma. This cancer is very different than other cancers of the breast. It seldom spreads to the lymph nodes, but can metastasize to other parts of the body by way of the bloodstream.
WHAT TREATMENTS ARE USED FOR INVASIVE BREAST CANCER?
Currently, when breast cancer is detected it is already an invasive cancer in the majority of cases. The treatment of invasive breast cancer is similar, whether it be invasive ductal or invasive lobular carcinoma.
The treatment plans are divided into local therapy and systemic therapy. Local therapy is designed to remove or kill the cancer cells in the breast and adjacent lymph nodes. If the cancer has not spread outside these areas, the patient can be cured by local therapy alone. Unfortunately, breast cancer can metastasize or spread to other areas of the body even though the primary cancer is quite small and there is no evidence of cancer spread to the lymph nodes. Breast cancer does not always follow a predictable pattern of growth. From many studies, estimates of the risk of metastasis and recurrence of the cancer are given based on factors, such as tumor size, cell type, lymph node status, and hormone receptors. But in any individual woman, an outcome (or prognosis) cannot be predicted with certainty. Due to this uncertainty, a systemic therapy is incorporated to treat the potential and actual risk of cancer cells spreading elsewhere. This systemic therapy is called chemotherapy, and utilizes drugs to kill cancer cells.
Local therapy involves surgery, radiation, or both. There are many terms used in connection with breast cancer surgery. Mastectomy is a general term for removal of the breast. A modified radical mastectomy involves removal of the breast and the axillary lymph nodes. A simple mastectomy removes the breast, but not the lymph nodes. Lumpectomy, partial mastectomy, and quadrentectomy refer to removing only a portion of the breast. An axillary dissection means removal of a portion of the lymph nodes under the arm.
Radiation therapy is the use of special high energy x-ray beams to kill rapidly growing cells, such as cancer cells. It is a generally a painless treatment and is given in an outpatient setting without the need for hospitalization.
A woman who has developed an invasive breast cancer usually has several surgical options for treatment. A modified radical mastectomy or removal of the entire breast, nipple complex and lymph nodes, is one well established option. This is inherently quite a physically deforming operation and less disfiguring treatments for breast cancer now exist. Breast conservation treatment for invasive breast cancer consists of lumpectomy (removal of the breast cancer and a surrounding rim of normal tissue), axillary dissection (removal of a portion of the lymph nodes under the arm), and radiation therapy to the remaining breast tissue. This maintains the majority of a woman’s breast and often the shape is not altered significantly. Many studies have compared these two techniques of therapy and both are equally effective in the treatment of invasive breast cancer. The survival rates at 5 and 10 years for both these therapies are the same. Neither therapy can guarantee a cure of the breast cancer as approximately 25-30% of women will ultimately die from their disease.
The choice of breast conservation therapy or modified radical mastectomy is usually an option available to most women with breast cancer. There are some conditions which pose relatively higher risks with breast conservation therapy. These include multiple sites of invasive breast cancer in the same breast, multiple sites of associated ductal carcinoma in situ, a primary breast cancer that was not detected on mammography, a breast that is difficult to evaluate on physical examination or by mammography, the inability to obtain margins that are clear of cancer at the time of lumpectomy, and cancers that are large in comparison to the breast size, which when removed, would lead to severe breast deformity. These conditions tend to have either a higher risk of local recurrence or make the early detection of a local recurrence in the conserved breast difficult if treated with breast conservation therapy. The risk of local recurrence with breast conservation therapy is about 5-7%. The local recurrence rate following modified radical mastectomy is 1-2%.
If modified radical mastectomy is chosen by a woman as the treatment of her breast cancer, then reconstructive surgery to recreate the breast mound can be done either at the time of mastectomy or at a later time. There are several operations that can be performed to reconstruct the breast. Reconstruction can be done with a woman’s own tissue (autologous reconstruction) or a prosthetic implant can be placed.
A prosthetic implant is usually inserted beneath the pectoralis muscle of the chest. There is usually not enough skin left after a mastectomy to place an adequately sized implant. Therefore, a tissue expander is commonly used. This is a balloon- shaped silicone implant which when initially inserted is flat. The tissue expander can be then filled with fluid externally by means of a small valve under the skin. The implant is filled over a period of several months after the operation. This enlarges the tissue expander and stretches the skin until an appropriately sized permanent implant can be placed which simulates the size of the opposite breast.
In autologous reconstruction, the woman’s own tissue is used to reconstruct the breast. A transverse rectus abdominis myocutaneous flap (TRAM flap) or a latissimus dorsi myocutaneous flap are currently the most used. The TRAM flap uses a portion of the abdominal muscles, fat and skin to reconstruct the breast. The latissimus dorsi myocutaneous flap uses a muscle of the upper back along with its overlying skin to reform the breast.
Nipple reconstruction can also be done in conjunction with any of the reconstructive breast procedures.
WHAT HAPPENS AFTER THE SURGICAL PROCEDURE?
Once the surgical procedure has been completed, whether it has been a breast conservation technique or a modified radical mastectomy, the status of the lymph nodes will be known. The presence or absence of cancer in the lymph nodes plays an important role in determining further treatment. If the cancer has spread to the lymph nodes, the risk of the cancer recurring is much higher and the addition of chemotherapy and/or hormonal therapy is usually indicated.
Chemotherapy and hormonal therapy, used in addition to surgery, is known as adjuvant systemic therapy. The purpose of this therapy is to eradicate microscopic deposits of breast cancer cells which still may be present in other areas of the body. The risk of these metastatic cancer cells roughly increases with the size of the original tumor, whether or not there is spread to the lymph nodes, the number of lymph nodes involved, and the microscopic characteristics of the cancer. There are no tests currently available which can tell doctors precisely whether there is microscopic spread of breast cancer. This is important because even when the cancerous tumor is small and there is no evidence of spread to the lymph nodes, there may be reasons to use adjuvant systemic therapy, since approximately 10%-15% of women in this group will still develop metastatic breast cancer.
Chemotherapy in adjuvant breast cancer treatment usually involves using a combination of drugs, typically, cyclophosphamide (CYTOXAN or NEOSAR), methotrexate, and 5-flourouracil (CMF), or cyclophosphamide, doxorubicin (ADRIAMYCIN, RUBEX) and 5-flourouracil. Currently, six cycles of chemotherapy which encompasses about six months of therapy is standard.
Breast cancer tissue is also tested for estrogen and progesterone receptors, or the so-called hormone receptors. A certain percentage of breast cancers will have molecular sites in their cells to which these hormones will attach. The hormones have a role in promoting the growth of cancerous cells. If these hormone receptors are present, the use of an anti-estrogenic agent called tamoxifen can be used. In older, post-menopausal women it can decrease the risk of recurrent breast cancer similar to the decrease seen with the use of chemotherapy. This avoids many of the side effects of chemotherapy which may include nausea, vomiting, hair loss, loss of energy, susceptibility to infection, and heart toxicity. Tamoxifen, however, can increase the risk of uterine cancer. Tamoxifen can also be given following the completion of chemotherapy because in certain women it can decrease the risk of cancer recurrence even further than with just chemotherapy alone. The optimal duration of treatment with tamoxifen is not known and most regimens range from two to five years. There are ongoing studies to help answer this question.
Inflammatory cancer of the breast is a rapidly growing cancer which has often metastasized at the time of diagnosis. A combination of surgery, radiation therapy and chemotherapy is currently now used. Mastectomy is not performed first as is typically the case in breast cancer. Rather, chemotherapy is started immediately. Radiation therapy to the breast follows and surgery is performed subsequently. This sequencing of treatment has shown to provide the best survival statistics compared to other regimens.
Paget’s disease of the breast is treated similarly to other forms of invasive breast cancer. A modified radical mastectomy is the usual treatment of choice. Lumpectomy which includes removing the nipple complex, followed by radiation therapy is sometimes used.
Cystosarcoma phyllodes cancer of the breast spreads somewhat differently than other breast cancers. It is rare for this cancer to ever spread to the lymph nodes, but it does spread through the blood stream. Since it does not involve the lymph nodes, treatment does not involve removing the lymph nodes, even if the tumor is quite large. Treatment consists of removing the tumor with a rim of normal breast tissue or simple mastectomy (removal of the entire breast, but without removing the axillary lymph nodes).
WHAT TREATMENTS ARE USED FOR NON-INVASIVE BREAST CANCER?
The management of non-invasive breast cancer, ductal carcinoma in situ and lobular carcinoma in situ, is much different than with invasive cancer of the breast. Treatment options are less clear cut in non- invasive cancer of the breast.
Ductal carcinoma in situ is a pre-invasive cancer. Its treatment is based on the risk of this disease evolving into an invasive cancer which is then life- threatening. Treatment options for ductal carcinoma in situ include lumpectomy, lumpectomy combined with radiation therapy, and simple mastectomy. A simple mastectomy is an operation which removes the entire breast, but does not remove the axillary lymph nodes as is done in a modified radical mastectomy.
If the area involved with ductal carcinoma is quite small (one centimeter or less) then simply removing this area alone may suffice. If the area of breast involved is larger, then further therapy is usually indicated, because the risk of the breast cancer recurring is reasonably high over the ensuing years. When the cancer recurs, 50% of the time the cancer is invasive. If a simple mastectomy is used to treat carcinoma in situ, the cure rate is 98-99%. Since all the remaining breast tissue is removed, there is no further breast tissue that remains in which a breast cancer can form. Why isn’t the cure rate 100%? This is due to the fact that a microscopic analysis of the cancer can miss a small area of invasive cancer. Therefore, there is a chance that the cancer can metastasize. Secondly, even with the best surgical technique, some breast tissue may remain after a mastectomy.
If a woman wishes to pursue breast conservation therapy and not mastectomy, then lumpectomy and radiation therapy to the remaining breast tissue is used. Data does not yet exist which confirms that this form of therapy is as effective as a simple mastectomy. The results of clinical trials which compare these two forms of therapy should be available within the next several years. Most doctors expect lumpectomy and radiation to compare quite favorably to mastectomy as it does with invasive cancer. There are some forms of ductal carcinoma in situ that are resistant to radiation therapy. The treatment for carcinoma in situ must be individualized in each woman’s case and she should be made aware of the relative risks and benefits of each treatment modality.
Lobular carcinoma in situ is not a pre-invasive cancer as is ductal carcinoma in situ. Rather, it represents a high risk potential for the development of invasive breast cancer. This risk is estimated to be approximately one percent per year. This risk is for both breasts because 50% of the time the invasive cancer will occur in the opposite breast in which the lobular carcinoma in situ was found. Additionally, lobular carcinoma in situ is multifocal (it occurs in many places or throughout the breast).
Since the risk of developing an invasive cancer is acceptably low to most women and their doctors, the usual recommendation is to perform yearly mammograms and to have a breast examination every six months for life. If a more aggressive approach is taken, the only logical choice that exists at this time is the removal of both breasts (bilateral simple mastectomy). This approach is sometimes justified in a woman with a strong family history of breast cancer, and/or the woman who is young at the time of the diagnosis. This is because the cumulative 1% per year risk of developing invasive cancer can be substantial after many years.
Lumpectomy with or without radiation does not significantly decrease the risk of developing an invasive breast cancer with lobular carcinoma in situ. A single mastectomy does not seem to be the answer either, since the invasive cancer can occur in either breast. This is yet another area of breast disease that requires more research and knowledge to optimize management and offer treatment options.
CAN WOMEN HELP THEMSELVES ADDRESS BREAST CANCER ISSUES?
As can be seen, the management of breast cancer is quite varied and complex. The subtleties of each case make it most important for each woman to discuss her options with the health professionals involved in her care.
The best chance of eliminating breast cancer is prevention. However, we currently do not have the knowledge to prevent breast cancer. The capability of diagnosing breast cancer in a much earlier stage than in previous years does exist. Early diagnosis of breast cancer can be achieved with routine mammography and early biopsy of suspicious lesions. The earlier a breast cancer is found, the better the chances of a cure.
Current American Cancer Society guidelines for mammography recommend that a woman should have a baseline mammogram between the ages of 35 and 40. She should have a mammogram every other year between the ages of 40 and 50. Beyond the age of 50, a woman should have a yearly mammogram.
The more the community is educated about breast cancer issues, the greater the likelihood of controlling this deadly disease.
BREAST CANCER AT A GLANCE
* One in every eight women in the United States develops breast cancer.
* The causes of breast cancer are not yet fully known although a number of risk factors have been identified.
* Breast cancer is diagnosed with self- and physician- examination of the breasts, mammography, ultrasound testing, and biopsy.
* There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
* Treatment of breast cancer depends on the type and location of the breast cancer, as well as the age and health of the patient.
* The American Cancer Society recommends that a woman should have a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended.
Breast Cancer Case Studies: –
Where Brain Metastases Occur
A brain tumor is an abnormal mass of tissue in which cells grow and multiply uncontrollably. Primary brain tumors originate in the brain and rarely spread to other parts of the body.
Metastatic (or secondary) brain tumors come from cancer cells in another part of the body and develop as a tumor in the brain. The site where the cancerous cells originated is referred to as the primary cancer.
The diseased cells spread to the brain by moving through the bloodstream and continue growing in their new location. This spread of a tumor to a new part of the body is called metastasis, and the primary cancer is said to have metastasized.
There has been an increase in metastatic brain tumors, as people are surviving primary cancers for longer periods of time.
Roll over areas of the brain to see risk of metastases.
This website is not intended as a substitute for professional medical advice and does not address specific treatments or conditions specific to any patient. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. The information on this website is subject to change.
CMS Software, part of the Elekta Group and leader in radiation treatment planning and workflow management solutions, today announced that Oregon Health & Science University (OHSU) Knight Cancer Institute has purchased Monaco, the next-generation Intensity Modulated Radiotherapy (IMRT) treatment planning system.
Monaco - next Generation IMRT
Featuring biological modeling, constrained optimization, sensitivity analysis and Monte Carlo dose calculation algorithms, Monaco represents a new approach to IMRT planning, including a sophisticated set of tools to make the radiotherapy planning process easier, more straightforward and more clinically reliable.
“The OHSU Department of Radiation Medicine is excited to offer its patients new technology that comes with the purchase of Monaco,”
says Wolfram Laub, Ph.D., and Associate-Director of Medical Physics at OHSU.
“The department has acquired multiple new technologies within the past few years and is a state-of-the-art facility. This recent purchase underlines OHSUs commitment to providing patients access to cutting-edge radiation therapy treatment.”
As the clinic continues to adopt advanced treatment planning technologies, they intend to review the soon-to-be-released Volumetric Modulated Arc Therapy (VMAT)* planning functionality in Monaco. With the addition of VMAT to Monaco, clinicians will have additional benefits including:
• Simultaneous optimization of multiple non-coplanar arcs, which allows flexibility when planning with one or more arcs.
• Monte Carlo dose engine allows continuous arc calculation rather than being limited to dosing approximations with discrete gantry positions.
• Biologically based constrained optimization, which enables better target dose conformity and normal tissue sparing.
Developed in collaboration with leading academic healthcare institutions, Elekta’s comprehensive VMAT solution, with 3D volumetric imaging and advanced treatment planning algorithms, allows more precise dose distribution and faster treatment delivery. Future developments include creating more efficacious and efficient approaches for clinicians to deliver patient care.
*Monaco VMAT functionality is a works-in-progress.
Elekta Synergy at New York Queens Hospital
View More Elekta Videos on our YouTube Channel
The creation of Elekta Synergy was driven by the need to visualize internal structures, including soft tissues, in three dimensions within the reference frame of the treatment system and at the time of treatment. This will allow the clinician to minimize geometric uncertainties resulting from both organ motion/deformation and slight differences in patient set-up.
Elekta Synergy has therefore been designed to inspire clinical confidence via IGRT to practice advanced radiation therapy techniques. This combination of high resolution imaging, taken in 3D and at the time (the 4th dimension) of treatment – combined with workflow solutions developed to be applicable on a routine basis – is described as ‘4D Adaptive’ and is the Elekta® IGRT solution…..Read more about Elekta Synergy
Twitter is a social networking and micro-blogging service that allows its users to send and read other users’ updates (known as tweets), which are text-based posts of up to 140 characters in length.
Twitters from Elekta – News and Twitters from the Oncology and Neuroscience World
As Energy consumption is fast becoming an issue with many clinics, clinic administrators are seeking to cut costs and minimize power consumption, or alternatively are increasingly coming under pressure from regulatory bodies to reduce carbon emissions.
The good news is that all Elekta dual energy linear accelerators use approximately 30% less energy than typical klystron-based dual energy machines.
Elekta linear accelerators minimize energy consumption and are designed to be careful with resources
This graph shows total energy usage for a duty cycle of five days per week, running eight hours per day in the ready state and 400 beam hours per year (figures calculated from published power consumption data – does not include the use of any imaging devices or networking systems).It is the design of the Elekta digital accelerator which helps to optimize power consumption and minimize cost of ownership over the lifetime of the linear accelerator.
Elekta linear accelerators use a magnetron to create the RF pulse at all energies. Magnetrons, due to their simpler modulator requirements, have lower energy consumption than the klystrons used to generate high energy RF in typical high energy machines. In addition, the Elekta linear accelerator is designed to run at lower temperatures. Other commercially available linear accelerators need to run at high standby power 24/7 levels to maintain their stability, thereby continuing to consume high levels of power. The consequence of running at higher temperatures is that you pay twice; firstly for the high power consumption of the linear accelerator and secondly for the air conditioning required to cool the excess heat generated by power-hungry machines.
- Leksell Gamma Knife Perfexion Advanced Program for Stereotactic Radiosurgery September 8, 2015Objective To further enhance the participant’s knowledge of Leksell Gamma Knife Perfexion and its advanced applications in the field of stereotactic radiosurgery. Specific focus will be placed on Gamma Knife surgery with or without the Extend System for several different indications. Patient selection, radiosurgical techniques and complication avoidance as […]
- Leksell Gamma Knife Perfexion - Upgrade Program December 10, 2013Objective To receive aspects of clinical and technical training for handling new features of Leksell Gamma Knife Perfexion, when upgrading from previous models. Training on the dynamic workflow of Leksell GammaPlan includes instruction on using the pre-planning and follow-up features of the program as well as on developing treatment plans using composite sho […]
- Leksell Gamma Knife Perfexion - Introductory Program December 8, 2013Objective To identify the basic principles and biophysics of Gamma Knife surgery and how they apply to day-to-day patient treatment. Review the clinical indications, parameters of treatment and outcomes of Gamma Knife surgery. Recognize radiation safety issues and principles, as well as become familiar with emergency procedures that pertain to Leksell Gamma […]
- Leksell Gamma Knife Perfexion - Applications Introductory Program November 17, 2013Objective To make users confident in the operation, care and maintenance of Leksell Gamma Knife Perfexion. The course focuses on radiation physics, dosimetry, stereotaxy for Gamma Knife surgery, quality assurance (QA), technical information and treatment planning using Leksell GammaPlan®. Content ■ Principles of stereotaxy and radiosurgery ■ Prin […]
- Leksell Gamma Knife Perfexion / 4C - Introductory Program November 10, 2013Objective To obtain knowledge about the practical aspects of stereotactic radiosurgery using Leksell Gamma Knife. Principles of radiation physics and radiobiology, that apply to single-session, focused, small volume irradiation will be covered. Registrants should be able to create radiosurgery dose plans for various indications. Content ■ Principles a […]
- Leksell Gamma Knife Perfexion Clinical Introductory Program October 6, 2013Objective To introduce clinicians to Gamma Knife® surgery with Leksell Gamma Knife Perfexion and Extend™ System. The course focuses on clinical information, combined with hands-on sessions using Leksell GammaPlan®. Experts with years of experience from Gamma Knife surgery are selected to lecture on this course. Training center and duration 4-day course at Un […]
- XiO - Application December 16, 2012OBJECTIVE To provide applications training in the use of XiO for treatment planning. The course provides an understanding of the software enabling the user to efficiently create effective treatment plans using our product. COURSE CONTENT Structure Contouring Digitized Contour-based Planning 2D Irregular Field Planning 3D External Beam Planning Special Plann […]
- XiO IMRT December 9, 2012Objective To provide applications training in IMRT treatment planning utilizing the Xio Treatment Planning System. The course provides an understanding of the IMRT software enabling the user to efficiently create effective IMRT treatment plans using our product. Course Content Contouring for IMRT Planning Beam Placement IMRT Prescription Optimization Segme […]
- SRT December 9, 2012OBJECTIVE This advanced clinical training program is designed to present the processes required to implement SRT for routine treatment on Elekta Axesse™ and other Elekta linear accelerators sterotactic capabilities. COURSE CONTENT • Recognize indications for and outcomes of SRT/Radiosurgery • Understand dose selection, fractionation and planning techniqu […]
- Monaco December 9, 2012OBJECTIVE To provide applications training in advanced radiobiology-based IMRT treatment planning. The course provides an understanding of the IMRT software enabling the user to efficiently create effective IMRT treatment plans using our product. COURSE CONTENT Contouring / Image Fusion for IMRT Planning Beam Template Creation The IMRT Prescription IMRT Co […]