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Cancers Treated 

We provide personalized, comprehensive and compassionate care for patients with all types of cancer. We offer advanced screening, prevention, diagnostic and treatment services, as well as comprehensive educational and support programs. We offer you and your family the physical, emotional and spiritual support you need during your cancer journey.

Blood & Lymphoma

Blood and lymphoma cancers or hematologic malignancies include leukemia, lymphoma and myeloma. These cancers affect the lymph nodes, blood cells and organs of the immune system.

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Brain

Cancer can develop within the brain or spinal cord or can travel to the brain or spinal cord from another part of the body.

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Digestive

Digestive or gastrointestinal cancers affect the digestive system and are among the most common forms of cancer.

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Head & Neck

Head and neck cancer affects the mouth, throat, sinuses, nasal cavity, larynx and salivary glands.

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Skin CancerCáncer de Piel

Skin Cancer

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the U.S. alone, more than 2 million Americans are expected to be diagnosed in 2013 with nonmelanoma skin cancer, and more than 76,000 are expected to be diagnosed with melanoma, according to the American Cancer Society.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

Name

Description

Basal cell carcinoma

Basal cell carcinoma accounts for approximately 80 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It most commonly occurs among people with light-colored eyes, hair, and complexion.

Squamous cell carcinoma

Squamous cell carcinoma, although more aggressive than basal cell carcinoma, is highly treatable. It accounts for about 20 percent of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on sun-exposed areas such as the face, ears, lips, and mouth. However, if left untreated, squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.

Malignant melanoma

Malignant melanoma accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. Malignant melanoma starts in the melanocytes--cells that produce pigment in the skin. Malignant melanomas sometimes begin as an abnormal mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but people with all skin types may be affected.

Distinguishing benign moles from melanoma

To help find melanoma early, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. Certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth (congenital nevi), and atypical moles (dysplastic nevi), have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal mole / melanoma

Sign

Characteristic

Photo comparing normal and melanoma moles showing asymmetry

Asymmetry

When half of the mole does not match the other half

Photo comparing normal and melanoma moles showing border irregularity

Border

When the border (edges) of the mole are ragged or irregular

Photo comparing normal and melanoma moles showing color

Color

When the color of the mole is not the same all over; you may see shades of brown or black, sometimes with areas of pink, red, white, or blue

Photo comparing normal and melanoma moles showing diameter

Diameter

If the mole's diameter is larger than a pencil's eraser

Photographs Used By Permission: National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may show few or none. Always consult your doctor for a diagnosis.

What are the risk factors for skin cancer?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Other risk factors include:

  • Family history of melanoma

  • Personal history of skin cancer

  • Sun exposure. The amount of time spent unprotected in the sun directly affects your risk of skin cancer.

  • Early childhood sunburns. Research has shown that sunburns early in life increase a person's risk for skin cancer later in life.

  • Many freckles

  • Large or many ordinary moles

  • Dysplastic nevi

  • Male gender

  • An immunosuppressive disorder or weakened immune system (such as in people who have had organ transplants) 

  • Exposure to certain chemicals, like arsenic

  • Radiation exposure

  • Smoking

  • HPV (human papillomavirus)

  • Certain rare inherited conditions, such as basal cell nevus syndrome (Gorlin syndrome), or xeroderma pigmentosum (XP) 

Prevention of skin cancer

The American Academy of Dermatology (AAD) recommends the following steps to help reduce your risk of skin cancer:

  • Wear protective clothing, including a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.

  • Seek the shade when appropriate, especially when the sun's rays are the strongest, from 10 a.m. to 4 p.m.

  • Regularly use a broad-spectrum sunscreen with an SPF (sun protection factor) of 30 or higher on all exposed skin, even on cloudy days. Sunscreen should be reapplied every two hours and after swimming or sweating.

  • Protect children from the sun by using shade, protective clothing, and applying sunscreen.

  • Use extra caution near water, snow, and sand, which can reflect the sun's rays and increase the chances of sunburn.

  • Avoid tanning beds. The UV (ultraviolet) light from tanning beds can cause skin cancer and wrinkling.

  • Check your birthday suit on your birthday. Look at your skin carefully and if you see anything changing, growing, or bleeding on your skin, see your doctor.

  • Get vitamin D safely through a healthy diet (which may include vitamin supplements.) Don't seek out the sun.

The American Academy of Pediatrics approves of the use of sunscreen on infants younger than 6 months old only if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under an umbrella. Snow is a particularly good reflector of UV rays.

How to perform a skin self-examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-exam is usually the first step in detecting skin cancer. The following suggested method of self-examination comes from the AAD:

(You will need a full-length mirror, a hand mirror, and a brightly lit room.)

  • Examine your body front and back in mirror, then the right and left sides, with your arms raised. Women should look under their breasts. 

  • Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands. Check between your fingers and look at your nail beds.

  • Look at backs of your legs and feet, spaces between your toes, your toenail beds, and the soles of your feet.

  • Examine the back of your neck and scalp with a hand mirror.

  • Check your back, buttocks, and genital area with a hand mirror.

  • Become familiar with your skin and the pattern of your moles, freckles, and other marks.

  • Be alert to changes in the number, size, shape, and color of pigmented areas.

  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your doctor promptly if you notice any changes.

Treatments for skin cancer

Specific treatment for skin cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Type of skin cancer 

  • Extent and location of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

There are several kinds of treatments for skin cancer, including the following:

  • Surgery. Surgery is a common treatment for skin cancer. It is used in most treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure. Surgery may include the following procedures:

    • Cryosurgery. Using liquid nitrogen, cryosurgery uses an instrument that sprays the liquid onto the skin, freezing and destroying the tissue.

    • Curettage and electrodesiccation. This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), followed by cauterizing the wound with an electrosurgical unit.

    • Excision. A scalpel (sharp surgical instrument) may be used to excise (cut away) and remove the growth. The wound is usually stitched or held closed with skin clips.

    • Mohs' microscopically controlled surgery. This type of surgery involves excising a lesion, layer by layer. Each piece of removed tissue is examined under a microscope. Tissue is progressively removed until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors (those that come back after treatment).

  • Laser therapy. Laser surgery uses a narrow beam of light to destroy cancer cells, and is sometimes used with tumors located on the outer layer of skin.

  • Radiation therapy. X-rays are used to kill cancer cells and shrink tumors.

  • Photodynamic therapy. Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells. 

  • Other types of treatment include the following:

    • Chemotherapy. Chemotherapy uses drugs to kill cancer cells.

      • Topical chemotherapy. Chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.

      • Systemic chemotherapy. Chemotherapy administered orally or intravenously (IV) for more advanced cancers. 

    • Immunotherapy. Immunotherapy involves various approaches to boost the body's own immune system, helping it to attack the cancer. Some types of treatment can be applied on tumors or injected directly into them. Other types are used for more advanced cancers and are given as an injection into the vein (IV)

    • Targeted therapy. Some medicines used to treat advanced skin cancers work by targeting specific parts of the cancer cells. These medicines can often be taken as a pill. 

Skin

Skin cancer is one of the most common types of cancer. Although this type of cancer can be treatable, the number of melanoma cases is on the rise in the United States

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Bone & Soft Tissue

Usually caused by cancers that have spread throughout the body, bone and soft tissue cancers are complex and require expertise from many types of specialists available through our Complex Joints & Musculoskeletal Tumors program.

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What Is Breast Cancer?Cáncer de seno

What Is Breast Cancer?

Having breast cancer means that some cells in your breast are growing abnormally. Learning about the different types and stages of breast cancer can help you take an active role in your treatment.

Changes in Your Breast

Your entire body is made of living tissue. This tissue is made up of tiny cells. You can’t see these cells with the naked eye. Normal cells reproduce (divide) in a controlled way. When you have cancer, some cells become abnormal, changing shape. These cells may divide quickly and spread into other parts of the body.

Cutaway view of normal breast

Normal breast tissue is made of healthy cells. They reproduce new cells that look the same.

Cutaway view of breast with tumor

Noninvasive breast cancer (carcinoma in situ) occurs when cancer cells are only in the ducts.

Cutaway view of breast with tumor

Invasive breast cancer occurs when abnormal cells move out of the ducts or lobules into the surrounding breast tissue.

Cutaway view of breast with tumor

Metastasis occurs when cancer cells move into the lymph nodes or bloodstream and travel to another part of the body.

 

Stages of Breast Cancer

Several tests are used to measure the size of a tumor and learn how far it has spread. This is called staging. The stage of your cancer will help determine your treatment. Based on American Cancer Society guidelines, the stages of breast cancer are:

  • Stage 0. The cancer is noninvasive. Cancer cells are found only in the ducts (ductal carcinoma in situ).

  • Stage I. The tumor is 2 cm or less in diameter. It has invaded the surrounding breast tissue, but has not spread to the underarm lymph nodes.

  • Stage II. The tumor is larger than 2 cm or has spread to the lymph nodes under the arm.

  • Stage III. The tumor is larger than 5 cm. Or the tumor has spread to the skin, chest wall, or nearby lymph nodes.

  • Stage IV. The tumor has spread to the bones, lungs, or lymph nodes far away from the breast.

Recurrent breast cancer. When the cancer returns despite treatment.

 

Breast

Breast cancer begins in breast tissues. There are two main types of breast cancer, ductal carcinoma and lobular carcinoma.

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Gynecologic

Gynecologic cancers can include endometrial, ovarian and cervical among others. Some of these cancers are difficult to detect.

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Lung CancerCáncer del Pulmón

Lung Cancer

Illustration of the human respiratory system
Respiratory System - Click to Enlarge

What is lung cancer?

Lung cancer is cancer that usually starts in the lining of the bronchi (the main airways of the lungs), but can also begin in other areas of the lungs, including the bronchioles, or alveoli. It is the leading cause of cancer death in both men and women. In 2013, about 228,000 new cases of lung cancer are expected, according to the American Cancer Society.

Lung cancers are believed to develop over a period of many years.

Nearly all lung cancers are carcinomas, a cancer that begins in the lining or covering tissues of an organ. The tumor cells of each type of lung cancer grow and spread differently, and each type requires different treatment.

Lung cancers are generally divided into 2 types:

  • Non-small cell lung cancer. This type is much more common than small cell lung cancer, accounting for about 85% to 90% of lung cancers. The 3 main kinds of non-small cell lung cancer are named for the type of cells in the tumor:

    • Squamous cell carcinoma (also called epidermoid carcinoma). It often begins in the bronchi near the middle of the lungs.

    • Adenocarcinoma. This type usually begins along the outer edges of the lungs. It is the most common type of lung cancer in people who have never smoked.

    • Large cell carcinomas. These are a group of cancers with large, abnormal-looking cells. These tumors may begin anywhere in the lungs and tend to grow quickly.

  • Small cell lung cancer. This type is sometimes called oat cell cancer because the cancer cells may look like oats when viewed under a microscope, grows rapidly and quickly spreads to other organs. There are two stages of small cell lung cancer:

    • Limited. In this stage, cancer is generally found in only 1 lung. There may also be cancer in nearby lymph nodes on the same side of the chest.

    • Extensive. In this stage, cancer has spread beyond the primary tumor in the lung into other parts of the body.

It is important to find out what kind of lung cancer a person has. The different types of carcinomas, involving different regions of the lung, may cause different symptoms and are treated differently.

What are the symptoms of lung cancer?

The following are the most common symptoms for lung cancer. However, each individual may experience symptoms differently.

Lung cancer usually does not cause symptoms when it first develops, but symptoms often become present after the tumor begins growing. A cough is the most common symptom of lung cancer. Other symptoms include:

  • Constant chest pain

  • Shortness of breath

  • Wheezing

  • Recurring lung infections, such as pneumonia or bronchitis

  • Bloody or rust-colored sputum

  • Hoarseness

  • A tumor that presses on large blood vessels near the lung can cause swelling of the neck and face

  • A tumor that presses on certain nerves near the lung can cause pain and weakness in the shoulder, arm, or hand

  • Fever for unknown reason

Like many other cancers, lung cancer can cause:

  • Fatigue

  • Loss of appetite

  • Loss of weight

  • Headache

  • Pain in other parts of the body not affected by the cancer

  • Bone fractures

Other symptoms can be caused by substances made by lung cancer cells, which is referred to as a paraneoplastic syndrome. For example, certain lung cancer cells produce a substance that causes a sharp drop in the level of sodium in the blood, which can cause many symptoms, including confusion and sometimes even coma.

None of these symptoms is a sure sign of lung cancer. Only a doctor can tell whether a patient's symptoms are caused by cancer or by another problem. Consult your doctor for a diagnosis.

What are the risk factors for lung cancer?

A risk factor is anything that increases a person's chance of getting a disease, such as cancer. Different cancers have different risk factors. Several risk factors make a person more likely to develop lung cancer:

  • Smoking is the leading cause of lung cancer, with about 80% of lung cancer deaths thought to be a result of smoking.

Additional risk factors include:

  • Secondhand smoke. This refers to breathing in the smoke of others.

  • Radon. A radioactive gas that cannot been seen, tasted, or smelled. It is produced by the natural breakdown of uranium. High levels of radon may be found in some homes or other buildings, especially basements.  

  • Asbestos exposure

  • Talc. While no increased risk of lung cancer has been found from the use of cosmetic talcum powder, some studies of talc miners and millers suggest a higher risk of lung cancer and other respiratory diseases from their exposure to industrial-grade talc. Talcum powder is made from talc, a mineral which, in its natural form, may contain asbestos; however, by law, all home-use talcum products (baby, body, and facial powders) have been asbestos-free since 1973.

  • Cancer-causing agents in the workplace, including:

    • Radioactive ores, such as uranium

    • Arsenic

    • Vinyl chloride

    • Nickel chromates

    • Coal products

    • Mustard gas

    • Chloromethyl ethers

    • Diesel exhaust

  • Personal or family history of lung cancer

  • Air pollution. In some cities, air pollution may slightly increase the risk of lung cancer.

How is lung cancer diagnosed?

In addition to a complete medical history to check for risk factors and symptoms, and a physical examination to provide other information about signs of lung cancer and other health problems, procedures used to diagnose lung cancer (or to help determine if it has spread) may include:

  • Chest X-ray.  This procedure looks for any mass or spot on the lungs.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs such as the lungs. CT scans are more detailed than general X-rays.

  • Sputum cytology. A study of phlegm (mucus) cells under a microscope.

  • Thoracentesis. A hollow needle is inserted through the skin in the chest wall to remove fluid, which is then sent to the lab to be checked for cancer cells. 

  • Needle biopsy. A thin, hollow needle is guided into the mass while the lungs are being viewed on a fluoroscopy or CT scan, and a sample of the mass is removed and evaluated in the pathology laboratory under a microscope.

  • Bronchoscopy. The examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope) passed down the mouth or nose. Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or to help remove a foreign body.

  • Endobronchial ultrasound. An exam in which a bronchoscope with a small ultrasound transducer on its tip is passed down the windpipe to look at lymph nodes in the mediastinum (the space between the lungs). If enlarged lymph nodes are seen, a small needle can be passed down the bronchoscope and through the wall of the airway to get samples of the nodes for testing. 

  • Mediastinoscopy. A process in which a small cut is made in the neck so that a tissue sample can be taken from the lymph nodes (mediastinal nodes) along the windpipe and the major bronchial tube areas to evaluate under a microscope.

  • Thoracoscopy. A procedure in which a small cut is made in the side of the chest wall through which a small tube with a video camera on the end is inserted. This allows the doctor to look at the outer part of the lungs and chest wall and to sample any abnormal areas for viewing under a microscope.

  • MRI, PET, or bone scans. These procedures are done to determine if the cancer has spread from where it started into other areas of the body.

Other tests and procedures may be used as well.

Treatment for lung cancer

Specific treatment for lung cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • The type of lung cancer

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Depending on its type and stage, lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, local treatments such as laser therapy, or a combination of treatments. Combination treatment or multimodality treatment refers to having more than 1 type of treatment.

Treatment for lung cancer includes 1 or more of the following:

  • Surgery. Surgery is part of the treatment for early stage lung cancers. The type of surgery depends on the size and location of the tumor in the lung, the extent of the cancer, the general health of the patient, and other factors. Many surgeries are done with a long incision in the side of the chest, known as a thoracotomy. Some early stage tumors may be treated with video assisted thoracic surgery (VATS), which uses several small incisions (instead of 1 large one) and special long surgical tools. Types of surgery include:

    • Segmental or wedge resection. Removal of only a small part of the lung.

    • Lobectomy. Removal of an entire lobe of the lung.

    • Pneumonectomy. Removal of an entire lung.

    • Sleeve resection. Removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus.

  • Radiation therapy. Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. Radiation may also be used with chemotherapy to treat lung cancer. There are 2 ways to deliver radiation therapy:

    • External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.

    • Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected, or implanted directly into the tumor. Some of the radioactive implants are called seeds or capsules. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.

  • Chemotherapy. The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given before other treatments, after other treatments, or alone for lung cancer.

  • Photodynamic therapy (PDT). A type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. For lung cancer, the light is delivered through a bronchoscope (a small, flexible tube with a light on the end) that is inserted through the mouth or nose.

  • Targeted therapy. These are drugs that target specific parts of cancer cells or nearby cells that help them grow. So far, these drugs have only been found to be useful for some non-small cell lung cancers. For example, as cancers grow, they form new blood vessels which nourish them. Research aimed at blocking the growth of these blood vessels has led to the development of medications called antiangiogenesis medications. Bevacizumab is 1 of these medications. It has been found to be helpful in prolonging the survival of some patients with advanced lung cancer. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as crizotinib, erlotinib, and cetuximab, may also be useful.

There are specific names for the order in which treatment is given. Neoadjuvant treatment refers to having radiation or chemotherapy before surgery. Having one or both of these before surgery may help shrink the tumor, as a smaller tumor is easier to take out in surgery.

Chemotherapy or radiation soon after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may be left after the surgery. Even if there is no sign of cancer cells, your doctor may suggest adjuvant treatment, as it may lower the risk that the cancer will come back or spread.

Clinical trials are being conducted on prevention and treatment options for lung cancer, including photodynamic therapy and chemoprevention.

Lung

There are two types of lung cancer, small cell and non-small cell. Smoking is the leading cause of lung cancer.

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Urologic

Urologic cancers can occur in any organ of the urologic system, including the kidneys, testicles and prostate. Each type of cancer has different symptoms and treatments.

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