Our Cancer Treatment Approach in Scottsdale, AZ

At Southwest Oncology Centers, we treat many types of cancers. Dr. Grado and his associates use the most advanced equipment and techniques available to treat patients. Here is a brief description of the types of cancers we specialize in and the most common procedures for each. There may be others, which are more rare, but would be treatable at our facility. If you do not see a cancer listed, please inquire by filling out our quick Information Request Form. We will contact you to discuss any of your questions or concerns.

Prostate Cancer Treatment

Prostate cancer occurs when some cells in the prostate gland grow abnormally. Cancer is a rapid growth of these abnormal cells that may invade and destroy nearby tissues and organs or spread to other parts of the body. Prostate cancer is most commonly found in the posterior or back portion of the prostate gland which is closest to the rectum, but may also arise in other locations or sites in the prostate gland. If prostate cancer can be detected early while it is confined to the prostate gland, proper treatment may result in a complete cure. Early stage prostate cancers can be treated with brachytherapy alone. More advanced prostate cancers may require a type of external beam radiation called IMRT. IMRT stands for intensity modulated radiation therapy and is used to deliver a very precise field so that adjacent structures are not radiated along with the prostate tissue.

Breast Cancer Treatment

Breast cancer is the most common cancer in women, although rarely it can appear in men as well. Early breast cancer can be treated with “breast conservation therapy”, involving limited removal of the tumor, sampling of sentinel lymph nodes and whole breast irradiation (with or without chemotherapy depending upon other factors). Tomotherapy produces a very uniform radiation dose through the breast, avoiding “hot spots” which are associated with bothersome skin reactions. This normally requires about 6 weeks of treatment. It may also permit “partial breast irradiation” without requiring an implant. Partial breast irradiation after conservative surgery appears to be as effective as whole breast irradiation in selected women, and only requires 1 week of treatment. More advanced breast cancer and cancers, which have recurred after surgery, radiation, or both, might be particularly suitable for Tomotherapy since treatment can be delivered with one continuous field. This avoids “hot spots” where adjacent fields may overlap during conventional treatment. Since normal heart and lung tissue can be well protected with this technique, long term side effects may be reduced as well.

Colorectal Cancer Treatment

Cancer of the colon and rectum is very common in the U.S. Early tumors can be treated with surgical removal; however, larger tumors or cancers in the lower rectum frequently require 5 or 6 weeks of radiation, given before or after surgery (with or without chemotherapy depending upon other factors), to prevent recurrence and/or a permanent colostomy. Tomotherapy permits reduction of dosage to the small intestines while permitting successful treatment of the colon or rectum and its draining lymph nodes. This may reduce the likelihood of long term bowel problems as well as the possibility of post-surgical complications. Colorectal cancer can also spread to the liver; frequently, it is the only site of spread. Since the liver is very sensitive to radiation, in the past it has been difficult to treat liver metastases with radiation without damaging the liver. Tomotherapy now allows us to accurately target liver tumors to receive fairly high doses of radiation, while safely sparing the rest of the liver.

Lung Cancer Treatment

Lung cancer is the most common cause of death from cancer in the U.S. When possible, lung cancers are removed by surgery, and, depending on the findings, radiation therapy for 6 or 7 weeks in conjunction with chemotherapy may be required. Some patients have medical problems, particularly lung or heart problems which prevent them from having surgery. Tomotherapy is an excellent technique for treating such tumors to high dose, while minimizing potential injury to lung or heart tissue which is already compromised. The use of positron emission topography or PET scanning in lung cancer has also allowed us to identify cancer which has spread to other parts of the chest or lymph nodes. Tomotherapy allows us to treat such tumors and the sites of spread to high dose, while still minimizing potential injury to lung or heart tissue. Since every Tomotherapy treatment is preceded by a CT scan, the possibility of the treatment missing the targeted tumor because of chest movement during breathing is significantly reduced as well.

Head & Neck Cancer Treatment

Although cancers of the throat, voice box, mouth, and nose can be successfully treated with limited surgery and radiation therapy (with or without chemotherapy depending upon other factors), the side effects of temporary loss of appetite, taste, vocal quality, and saliva production can be severe, resulting in significant weight loss. Long term damage to the teeth and jaw can also occur. Since Tomotherapy can better protect the saliva glands and vocal apparatus than even standard Intensity Modulated Radiation Therapy (IMRT), it is likely that both acute and long term side effects will be reduced by applying this new technique without changing the treatment rates.

Brain Tumors

Brain tumors can be benign or malignant, if they grow into surrounding brain. Neither have a tendency to spread elsewhere in the body, but malignant tumors can never be completely removed by surgery and many benign tumors are found next to critical brain structures, such that surgical removal could result in a permanent disability. Radiation therapy is frequently used in such instances. Treatment may vary from a 6-7 week course to an abbreviated 2-3 week course (fractionated stereotactic radiotherapy) to a single high dose session (stereotactic radiosurgery). Because of its CT-image guidance, Tomotherapy can precisely target benign or malignant brain tumors, while relatively sparing critical structures adjacent to them, which might limit a surgical approach. Sometimes cancer from other organs such as lung or breast can spread through the bloodstream to the brain. These metastases can cause serious disability, seizures, or paralysis. Most often a short (2-3 week) course of radiation to the entire brain is recommended, however in selected situations additional delivery of a single high dose of radiation to the tumor(s) can improve and prolong quality of life. Tomotherapy is an excellent means of accomplishing this because of its ability to limit dosage to the rest of the brain.

Gastrointestinal Cancer Treatment

Cancers arising in the upper abdomen or gastrointestinal tract, such as esophageal, stomach, gall bladder, biliary and pancreatic cancers, are very serious since they may be fairly advanced at the time of detection, making curative surgery difficult or impossible. Larger tumors or cancers in the biliary region frequently require 5 or 6 weeks of radiation (with or without chemotherapy depending upon other factors), usually given after an attempt at surgery. The presence of radiation sensitive organs such as the liver, kidneys, spinal cord, and small intestines in this region can make it difficult to deliver an optimal radiation therapy program. Tomotherapy can allow treatment of most areas at risk for tumor recurrence to a high dose, while keeping the exposure of sensitive organs within their tolerance limits. Most of these cancers also have a tendency to spread to the liver and occasionally to the lung. Since both the liver and lung are very sensitive to radiation, in the past it has been difficult to treat liver or lung metastases with radiation without damaging these organs. Tomotherapy now allows us to accurately target liver or lung tumors to receive fairly high doses of radiation, while safely sparing the rest of the organ.

Gynecological Cancers Treatment

A woman may develop cancer in any of the reproductive organs, including the vagina, ovary, and uterus (cervix or endometrial). Very early cervical cancer and early endometrial cancer are usually highly curable with surgery alone. More advanced cancers of the vagina and uterus have a greater tendency to involve lymph nodes in the pelvic area and sometimes in the lower abdomen along the spine. These malignancies are treated with radiation portals that encompass the primary disease and the lymph nodes at risk for 5-6 weeks. Frequently radioactive sources are temporarily placed in the vagina, the cervix, the uterus, or tissues around the uterus either during or after external beam irradiation (brachytherapy) to increase the dose to the primary tumor. External beam irradiation using Tomotherapy allows delivery of full radiation doses to suspicious or involved lymph nodes, while simultaneously limiting the dose to the small intestine. This reduces acute side effects during treatment and should result in a lower incidence of long-term bowel complications. Ovarian cancer is frequently advanced when diagnosed and is treated with surgery and chemotherapy. If the cancer is not treated by this approach it can involve multiple areas within the abdomen and pelvis. With conventional radiation treatment, it is difficult to deliver a high enough dose of radiation to control bulky abdominal disease because of the sensitivity of the adjacent small intestine, kidneys, and liver. Tomotherapy can permit escalation of radiation dose in these bulky areas while still limiting the dosage to small intestine within the tolerance of these tissues.

Connective Tissues Cancer Treatment

Cancers which arise in bone, muscle, cartilage, or tendon are usually sarcomas. Surgery is the treatment of choice, however, it is often difficult for sarcomas of the trunk to be removed, and sarcomas of the limbs sometimes cannot be removed without amputation. In these situations, 5 or 6 weeks of radiation treatment given before or after a “wide excision” or “limb sparing” procedure can achieve good local control rates. Unfortunately with conventional radiation, bones, or large blood vessels adjacent to the tumor can receive enough radiation to potentially damage the limb or bone. Since Tomotherapy can precisely target these tumors, while relatively sparing adjacent structures, it is possible to limit the dosage to bones and blood vessels while treating sarcomas to effective doses. This can be particularly beneficial if long segments of bone or vessels are at risk.

Lymphomas

Cancer of the lymph nodes, such as Hodgkin’s Disease or Non-Hodgkin’s Lymphoma, can often involve multiple lymph node regions and occasionally other (extra nodal) sites. Optimal treatment often involves chemotherapy, and radiation therapy is frequently used to treat involved or bulky sites, often using large fields of treatment to cover multiple lymph node bearing regions. Although the effective doses are low and can usually be given in 3-4 weeks, sometimes large volumes of lung or small intestine can be at risk for damage. Tomotherapy can do a good job of limiting dosage to these normal structures, and by using CT image guidance, the uncertainty of reproducing treatment positioning for large fields of treatment can be reduced.

Childhood Malignancies

Fortunately cancer is rare in children, however solid tumors (not leukemia) can often grow rapidly and to a large size before they are detected. If possible, surgical removal is recommended unless the danger or disability to the child prohibits this. Many childhood cancers also respond to chemotherapy, but a number of tumors will also require radiation therapy. Radiation delivery is especially challenging in children because the bones and hormone producing glands are still growing and are sensitive to the effects of radiation. Since Tomotherapy can precisely target such tumors, while relatively sparing adjacent structures, it is possible to limit the dosage to growing bones and glands while treating inoperable cancers to effective doses. It is even possible to treat the entire brain and spinal cord to effective doses, while protecting the bones of the spine and head enough to permit relatively normal growth. Some institutions are even treating the entire bone marrow instead of the entire body in preparation for bone marrow transplantation. With conventional radiation, even with IMRT, children must sometimes be positioned lying on their stomach or even standing (for total body treatment). Since the Tomotherapy beam rotates around the child like a CT scanner, all children can be treated comfortably lying on their back.

Genitourinary

The other cancer besides prostate cancer which is exclusive to men is testis cancer. The most common variety, seminoma, is very sensitive to radiation and can be treated 95% of the time with about 3 weeks of treatment. The fields of treatment, however, include a fairly large volume of lymph nodes within the abdominal and pelvic cavities. This can sometimes result in nausea or diarrhea because of the small intestine within the treated volume. Tomotherapy is an excellent way to treat such tumors, while relatively sparing adjacent small bowel. Both men and women can develop bladder cancer. If this only involves the inside surface of the bladder, surgical removal and/or instillation of chemotherapy within the bladder is very successful. Tumors which have grown into the bladder muscle are much more difficult to control. Sometimes the only potentially curative procedure requires surgical removal of the entire bladder (radical cystectomy). In selected patients, high doses of localized radiation with or without chemotherapy can also result in treatment rates comparable to radical cystectomy. With Tomotherapy, it is possible to achieve these high doses, while limiting the side effects from adjacent bowel.

Southwest Oncology Centers

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