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What types of cancer are there?

There are more than a hundred different types of cancer. Each one has its own causes and symptoms and requires its own unique treatment. The cancer is usually named after the body part where it originated, such as breast cancer. In South Africa, the National Cancer Registry (NCR) – which is kept by the National Health Laboratory Service (LHLS) – has collected information on cancer diagnoses since 1986. The 2000–2001 NCR Report indicates that prostate cancer is the most commonly diagnosed cancer amongst males, followed by lung, oesophagus, colon/rectum and bladder cancers. In women, breast cancer is the most prominent, followed by cancers of the cervix, uterus, colon/rectum and oesophagus.

Can I recover from cancer?

Brachytherapy places the radiation source as close as possible to the cancer cells, thus treatment is given over a short distance. Instead of using a large radiation machine, the radioactive material – sealed in a thin wire, catheter, or tube (implant) – is placed directly into the affected tissue. This method of treatment concentrates the radiation on the cancer cells and lessens radiation damage to some of the normal tissues (organs at risk) near the cancer. In remote brachytherapy, a computer sends the radioactive source through a tube to a catheter that has been placed at the required site by the patient’s doctor. The brachytherapy team watches the patient on closed-circuit television and directs the procedure. The radioactivity remains at the treatment site for only a few minutes. In some cases, several remote treatments may be required and the catheter may stay in place between treatments. Because no radioactive material is left in the body, the patient can return home after the treatment. For prostate cancer, the radioactive seeds implanted into the prostate stay in permanently. The patient goes home the following day because of the properties of these radioactive seeds (very low in activity and energy). Remote brachytherapy has been used to treat cancers of the cervix, breast, lung, pancreas, prostate and oesophagus. The side effects of remote brachytherapy depend on the area being treated. You are not likely to have severe pain or feel ill during or after this procedure. A Bebic Gynae Source high dose rate brachytherapy unit and 3D planning is available at our Rondebosch and Port Elizabeth units for the internal treatment of gynaecological cancers. Cancercare is one of the leaders in the field of prostate brachytherapy and has been involved with this procedure since 2003.

What is Brachytherapy?

Brachytherapy places the radiation source as close as possible to the cancer cells, thus treatment is given over a short distance. Instead of using a large radiation machine, the radioactive material – sealed in a thin wire, catheter, or tube (implant) – is placed directly into the affected tissue. This method of treatment concentrates the radiation on the cancer cells and lessens radiation damage to some of the normal tissues (organs at risk) near the cancer. In remote brachytherapy, a computer sends the radioactive source through a tube to a catheter that has been placed at the required site by the patient’s doctor. The brachytherapy team watches the patient on closed-circuit television and directs the procedure. The radioactivity remains at the treatment site for only a few minutes. In some cases, several remote treatments may be required and the catheter may stay in place between treatments. Because no radioactive material is left in the body, the patient can return home after the treatment. For prostate cancer, the radioactive seeds implanted into the prostate stay in permanently. The patient goes home the following day because of the properties of these radioactive seeds (very low in activity and energy). Remote brachytherapy has been used to treat cancers of the cervix, breast, lung, pancreas, prostate and oesophagus. The side effects of remote brachytherapy depend on the area being treated. You are not likely to have severe pain or feel ill during or after this procedure. A Bebic Gynae Source high dose rate brachytherapy unit and 3D planning is available at our Rondebosch and Port Elizabeth units for the internal treatment of gynaecological cancers. Cancercare is one of the leaders in the field of prostate brachytherapy and has been involved with this procedure since 2003.

What happens in the treatment process?

The treatment process involves: A highly-qualified radiation therapist delivers the daily radiation treatment using specialised treatment machines called linear accelerators. The treatment is delivered as prescribed from Monday to Friday and can range from one to 37 treatments, depending on the site and stage of the disease. Computerised record and verify systems are part of the stringent quality assurance systems used in treatment delivery, and ensure that all treatment parameters are met before the beam is switched on. It also keeps a daily record of all treatment delivered for each patient. The routine use of Electronic Portal Imaging allows visual and digital verification of the treatment area. Images are taken in the treatment position prior to the start of treatment and weekly thereafter as part of the quality control procedures. This ensures compliance to the treatment plan and allows for the correction of any treatment variations which may occur due to internal or external movement between treatments. Dose verification is done by means of in-vivo dosimetry at the start of treatment to ensure that the planned dose is delivered for each patient. This is done by placing a small monitor on the centre of the beam to measure the dose output of the linear accelerator. Doses to sensitive structures such as eyes can also be measured in this manner.

When is chemotherapy used as a treatment?

In definitive therapy when the best chance of cure is with chemotherapy. In neo–adjuvant therapy prior to surgery or radiation to reduce tumour burden prior to definitive therapy with either modality. In combination therapy with radiotherapy, either sequentially or concurrently, to enhance the effects of radiation (chemo radiation). In secondary therapy to try to cure metastatic disease. In palliative therapy to improve specific symptoms and enhance the quality of life.

What does the planning process for treatment involve?

When radiation treatment is prescribed, the area of interest is usually determined by doing a planning CT scan. This is different from a diagnostic CT scan as it is done in the treatment position. Special immobilisation devices are used to ensure accurate daily set up in the same position. Other imaging modalities such as MRI and PET-CT scans can be done in certain cases, and matched/fused with the planning CT scan, to aid delineation of the tumour volume. Once the planning scans have been done, the tumour volume is delineated by the oncologist and surrounding normal tissue by the radiation therapist. This is done on a specialised treatment planning system capable of planning 3D conformal radiation therapy as well as highly specialised intensity modulated radiation therapy (IMRT). All treatment plans are done with the input of the radiation oncologists, radiation therapists and medical radiation physicists to ensure that the highest quality plan is achieved as prescribed. All planning is done in accordance with international prescribing norms and standards.

What equipment is used in radiotheraphy (radiation therapy)?

Equra Health is the provider of Cancercare’s radiation therapy equipment. Cancercare therefore has access to state-of-the-art digital linear accelerators which are dual energy (photons and electrons) treatment units, giving maximum flexibility in optimal treatment delivery. It generates both low (6MV) and high-energy (15MV) photon beams and a range of electron energies (4 to 18MeV), enabling the delivery of optimal doses of radiation to both superficial and deeper-seated tumours. Multi leaf collimators allow for the delivery of complex shaped 3D and IMRT treatment plans. Cone beam CT and Electronic Portal Imaging provide for fast image acquisition for verification. Due to the highly specialised nature of these treatment machines, routine structured equipment maintenance and replacement is done by in-house service engineers. This, together with routine quality control procedures, ensures that the equipment is in top condition. Cancercare’s record and verify systems are sophisticated computer software programmes used to record all treatments and check the correct set-up of the treatment units prior to each treatment. It ensures patients’ peace of mind as it prohibits treatment unless all set-parameters are correct. Treatment Planning Systems (CMS XiO) are used for 3D treatment planning and inverse planning for IMRT. These planning systems are linked to CT, MRI and PET imaging facilities to provide for accurate delineation of tumour volumes through the highest quality diagnostic imaging available. Cancercare has a well-established centralised planning centre in Cape Town which ensures that throughout the organisation, the highest quality and standard of planning based on international standards is achieved for all patients. Highly specialised stereotactic radiosurgery and radiotherapy is offered at our Rondebosch branch, where the Brainlab planning software is used for the treatment plans. A frameless mask system is used to deliver high doses of radiation to small cranial lesions on the linear accelerator.

What is Cancer?

Cancer is a disease where some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Our bodies are made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die and new cells take their place. When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths, called tumours. Many cancers form solid tumours, which are masses of tissue. Cancers of the blood, such as leukaemias, generally do not form solid tumours. Cancer can affect men, women and children, young and old, rich and poor. You cannot catch cancer from someone else, nor give it to others. With new methods of treatment eminent, many people recover from cancer.

How does the doctor determine if I have cancer?

First the doctor [your general practitioner] will listen to your story and do a physical examination. Should he/she find something, there are several ways to find out if it is cancer or not, namely:

  • Biopsy. A small piece of the tumour is cut out and looked at under a microscope to determine the type of cancer.
  • Endoscopy. This is a medical procedure where a doctor puts a tube-like instrument into the body to look inside. There are many types of endoscopy, each of which is designed for looking at a certain part of the body e.g. gastroscopy for the stomach and cystoscopy for the bladder.
  • CT scan or MRI scan. The machine takes many pictures (x-rays) of the body taken from different angles. These are then combined to give a detailed picture of internal organs. Doctors are then able to look for tumours. The CT and MRI scans are painless.
  • Mammogram. This is a special type of low dose x-ray used to detect breast cancer. The breast is compressed (squeezed by a machine) during the procedure and so it may be slightly uncomfortable.
  • Bloods. Sometimes cancer cells give off substances that can be detected in the blood. This tells the doctor that there is cancer somewhere in the body. They are called blood markers.

How do I know if I may have cancer?

Although some cancer-related symptoms may be caused by another health problem, it is important to remember that should one or more of these symptoms persist, you have to consult your doctor immediately. Warning signs for adult cancer:

  • change in a wart or a mole
  • any continued fever
  • nagging cough or continued hoarseness
  • chronic pain in bones or any other area of the body
  • enduring fatigue, nausea or vomiting
  • repeated infection and/or inflammation
  • change in bowel or bladder habits (pain, difficulty urinating, blood)
  • a sore that does not heal
  • unusual discharge or abnormal bleeding
  • thickening or lump in the breast, testicles or elsewhere
  • indigestion or difficulty in swallowing
  • obvious change in the size, colour, shape or thickness of a wart, mole or mouth sore
  • noticeable weight loss and loss of appetite