The Cancer Program at Kent Hospital offers a comprehensive range of services delivered by a dedicated team of professionals using the latest technology, offering patients and their families hope and compassion. A multi-disciplinary team of cancer professionals work with patients to create an individual treatment plan based on the diagnosis. We provide access to radiation oncology through our collaboration with Radiation Oncology Services located across the street from Kent Hospital.
Inpatient care is provided in our 29-bed oncology unit, an 11-station outpatient chemotherapy/infusion unit and a full range of diagnostic imaging and laboratory services. Both oncology units feature an experienced team of physicians and oncology certified nurses.
Our program is accredited with commendation by the American College of Surgeons Commission on Cancer, as a Community Hospital Cancer Program, and the American College of Radiology accredits our Mammography Program.
The Breast Health Center is a truly collaborative team made up of the expert specialty-trained breast health physicians and staff. The center delivers the highest quality services ranging from breast cancer screening, managing benign breast issues, helping with lactation problems and treating cancers. The professional staff includes providers who are leaders in their fields as well as experienced nurses and navigators to guide patients through the program.
This affiliation gives us access to a variety of oncology trials offered through the Cancer Trials Support Unit (CTSU). Through this site, many trials are available to our patients. The CTSU is a project sponsored by the National Cancer Institute (NCI) for the support of a national network of physicians to participate in the NCI sponsored Phase III cancer treatment trials.
Kent Hospital's Cancer Program participates in a number of clinical research trials through the Cancer Registry, offering cutting edge treatments to our patients. The Cancer Registry maintains a database, allowing us to track disease characteristics and treatments. Our program is accredited with commendation by the American College of Surgeons Commission on Cancer, as a Community Hospital Cancer Program. Please visit the COC for further information on accreditation and how it benefits our cancer program.
Cancer that forms in tissues of the breast. The most common type of breast cancer is ductal carcinoma, which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Another type of breast cancer is lobular carcinoma, which begins in the lobules (milk glands) of the breast. Invasive breast cancer is breast cancer that has spread from where it began in the breast ducts or lobules to surrounding normal tissue. Breast cancer occurs in both men and women, although male breast cancer is rare.
Colon cancer forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Rectal cancer forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).
Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.
Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.
Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.
Cancer that forms in tissues of the kidneys. Kidney cancer includes renal cell carcinoma (cancer that forms in the lining of very small tubes in the kidney that filter the blood and remove waste products) and renal pelvis carcinoma (cancer that forms in the center of the kidney where urine collects). It also includes Wilms tumor, which is a type of kidney cancer that usually develops in children under the age of five.
Cancer that starts in blood-forming tissue, such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the bloodstream.
A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include:
Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL
A disease in which malignant (cancer) cells are found in the tissues of the pancreas. Also called exocrine cancer.
Cancer that forms in the thyroid gland (an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight). Four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic thyroid cancer. The four types are based on how the cancer cells look under a microscope.
Having regular Pap smears is the best way to monitor cervical health. Screening should begin at age 21 or within three years of becoming sexually active. For women under 30, the American College of Obstetricians and Gynecologists recommend annual screening. For women aged 30 and over, the screening interval may be increased based on the woman's screening history. For women with a history of three consecutive normal Pap smears within a five-year period, the interval may be increased to every three years. The addition of an HPV test to Pap smears can also be considered for women aged 30 and over. If both tests are negative (that is, the Pap smear is normal and the HPV test is negative), the screening interval may then be increased to three years.
There are a number of infections that can affect the cervix, including:
Some infections cause symptoms, for example, trichomonas can cause a discharge. Others, such as HPV, do not. We do not recommend routinely screening young women for HPV because the infection is common at that age. Some HPV infections result in genital warts and some lead to abnormal Pap smears, usually low-grade changes.
We do suggest screening for more serious abnormalities with Pap smears, however, because some women develop high-grade or potentially precancerous lesions and cervical cancer.
After an abnormal Pap screening result, you may need additional testing, which can be as routine as a repeat Pap or an HPV test. It could also be as detailed as a colposcopy exam. If the follow-up tests show precancerous changes, you may need to have the abnormal cells removed.
Know that cervical cancer screening results may not always be accurate, just like any other lab test. Many factors can cause false results, including:
To avoid false negatives, do not douche, have sex or use vaginal medications or hygiene products for two days before the test. Do not have a screening if you have your menstrual period.
In the U.S., the Centers for Disease Control estimates that approximately 12,109 women were diagnosed with cervical cancer in 2011. Of that number, roughly 4,092 died of cervical cancer. Worldwide, cervical cancer is the second leading cause of cancer-related deaths in women, and in some parts of the world, it is the leading cause of such deaths. Of the 500,000 women diagnosed each year with cervical cancer worldwide, approximately half will die. Most women diagnosed with cervical cancer come from developing nations.
It has been proven that oncogenic (cancer-causing) HPV infection is needed for cervical cancer to develop. That said, many women have oncogenic HPV infections, and the majority do not get cervical cancer. This shows us that other factors clearly play a role. One such factor would be immunosuppression, which means the body becomes incapable of controlling HPV infection.
Yes. Two HPV vaccines are available to protect males and females against the types of HPV that cause most cervical, vaginal, and vulvar cancers. These are given in three doses and are recommended for girls age 11 and 12. Females age 13 through 26 who did not get any or all of the shots when they were younger should make an appointment to get the vaccine. Doctors recommend that females get the same vaccine brand for all three doses when possible. Even after having the HPV vaccine, women should still have regular Pap tests to screen for cervical cancer.
Other ways to reduce your chance of contracting cervical cancer include:
Clinical trials show the vaccines provide close to 100 percent protection against precancers. Since the vaccine was first recommended in 2006, there has been a 56-percent reduction in HPV infections among teen girls in the US.
Pediatricians, family practitioners, internists, and gynecologists can give the vaccine.
The most common side effects are:
The vaccine does not contain live virus and, as such, is not infectious nor can it cause cancer.
CRC is a common and lethal disease. In the United States, CRC is the third most commonly diagnosed cancer and the second leading cause of cancer death. Approximately 148,610 new cases of CRC are diagnosed each year in the United States, of which 106,680 are colon and the remainder rectal cancers. Globally, the incidence of CRC varies ten-fold, with the highest incidence rates in North America, Australia and northern and western Europe.
Environmental and genetic factors can increase the likelihood of developing CRC. Consider the following, all of which elevate an individual's risk of developing CRC:
Screenings can detect CRC when it can be treated. In the meantime, certain practices have been identified as protecting the body against CRC, including:
Symptoms vary depending on the location of the cancer within the colon or rectum, though there may be no symptoms at all. The most common presenting symptom is rectal bleeding. Cancers arising from the left side of the colon generally cause bleeding, and in their late stages may cause constipation, abdominal pain and obstructive symptoms. On the other hand, right-sided colon cancer may produce vague abdominal aching or weakness, weight loss and anemia from chronic blood loss.
Men tend to get colorectal cancer at an earlier age than women, but women live longer so they 'catch up' with men and, thus, the total number of cases in men and women is equal. In the United States, incidence rates of colon cancer declined by 3 percent between 1998 and 2000. During the period from 1996 to 2000, the average annual incidence rates per 100,000 population were 64.2 from men and 46.7 for women. Despite such data, during the same time period, the incidence rates for right-sided cancer increased, particularly in women. In addition, while tobacco and alcohol increase the risk of colorectal cancer, women who smoke are a higher risk. Among women, CRC screening rates are still relatively low (30-40%) and are comparable to mammography rates 20 years ago. African Americans are at a much higher risk for colon cancer than other races. They have a significantly lower age at diagnosis and experience a larger number of polyps and cancer in the proximal colon. Their survival is reduced compared to Caucasians.
Age is a major risk factor for sporadic CRC. The lifetime incidence of CRC in patients at average risk is about 5 percent, with 90 percent of cases occurring after the age of 50.
Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps. Not all polyps have the potential to transform into cancer. Those that do are called adenomas. It takes more than 10 years in most cases for an adenoma to develop into cancer. Screening identifies cancers earlier, before symptoms develop, which dramatically improves the chance of survival. Identifying and removing polyps before they become cancerous actually prevents the development of colorectal cancer. The pathologic stage at diagnosis remains the best indicator of long-term prognosis. The most important characteristics are the presence of distant metastases, local tumor extent, nodal positivity and residual disease. Five-year survival rates vary from 93 percent for stage I to 8 percent for stage IV colon cancer. Five-year survival rates for rectal cancer tend to be somewhat lower.
The American College of Gastroenterology considers colonoscopy the preferred screening test, but the following tests are available:
Screenings can detect CRC when it can be treated. For individuals at normal risk, screening tests should begin at age 50. The preferred approach is a screening colonoscopy conducted every 10 years. In addition, consider the following recommendations for screening:
Screening colonoscopy is done under conscious sedation using a combination of painkiller and sedative given intravenously. Patients are usually comfortable during and after the colonoscopy. The day before the procedure, the patients need to take a bowel preparation, which is available in different forms and well tolerated. Complications including perforation and major bleeding are unusual, about one to two per 1,000 procedures.
Gynecologic cancer largely applies to the malignancies of the female reproductive system which includes the:
Malignancies of the breast have received more awareness - and rightfully so - but there is a similar need to heighten the awareness of gynecologic cancers.
In general, malignancies are more common as people age, but gynecologic pelvic malignancies can affect women - and young girls - of all ages. All cases of gynecologic cancer should be looked at individually.
Pelvic gynecologic cancers are relatively less frequent, but still a very significant health problem for women. Cancers of the endometrium (uterus), ovary, cervix, and other areas constitute approximately 70,000 cases each year in the United States, compared to 180,000 women who develop breast cancer. In many countries, however, cervical cancer is the most common, and an even bigger health care problem. Pap smear screenings, which diagnosis precancerous changes on the cervix, are a major factor in limiting this problem in the US.
The survival rate with all cancers depends on the type of malignancy, the stage, and its unique biology. Many gynecologic pelvic malignancies - endometrial/uterine cancer, for example - are cured completely. Surgery alone is curative for most women with endometrial cancer, but radiation and occasionally chemotherapy can be called for. Likewise, cervical cancer is usually cured by surgery and/or radiation. It may be surprising to learn there are many types of ovarian cancer. Some are entirely curable by surgery and chemotherapy while others are not, though treatments for all types of ovarian cancers can greatly extend life, and the quality of life, for years.
Having regular gynecologic examinations is not something anyone looks forward to, but its benefits are substantial in terms of diagnosing cancer at a time when it is early and curable. It is often said that ovarian cancer is the “silent killer” of women because there are no early signs, though there are ongoing efforts to diagnose ovarian cancer earlier. As far as “screening tests” for other gynecologic malignancies, mammography, pap smears and endometrial biopsies (to evaluate any type of abnormal uterine bleeding) are readily available and highly useful.
Genetics plays a significant role in the development of malignancy. One of the cruder assessments of genetic risk is the family history. Long before DNA was understood, it was clear that malignancies of certain types seem to occur more frequently in certain families. Today, a combination of better genetic understanding coupled with family history analysis can be very important. It is well known, for example, that certain breast, ovarian and other gynecologic cancers are associated with both genetic defects and family history, even when those defects are not understood. Women who do have a family history of any of these malignancies should tell their physicians.
There are literally hundreds of treatment possibilities depending on the specific medical circumstances. There are dozens of types of ovarian cancers, each with its own biologic behavior and susceptibility to various treatments. Multiple treatments apply to all cancers and patients need to seek guidance from a multidisciplinary cancer team to understand their choices. As for treatments in general, surgery, increasingly done through the laparoscope, along with chemotherapy and radiation continue to represent the main therapies against gynecologic cancers. Improved therapies coupled with new medications can lessen and even prevent side effects, in turn drastically improving the quality of life for women undergoing chemotherapy.
Cancer research is ongoing and from all directions, though it is an incredibly complex and diabolical set of diseases. Cancer cells change in ways that often make them resistant to treatments, despite the best efforts. That said, treatments are increasingly effective at managing even the most difficult malignancies, so even if a cure is not possible, an increased quality of life is almost always possible. The most typical gynecologic pelvic malignancies remain curable through increasingly less invasive means and the use of minimally invasive procedures such as laparoscopy, allow patients to have curative surgery, making recovery easier. Radiation therapy is increasingly more precise, minimizing side effects without reducing overall effectiveness. There also is great optimism about better therapies through both biological agents and new genetic approaches, which may well be standards of care in the next five years.
The World Cancer Research Fund, together with the American Institute for Cancer Research (AICR) issued the report “Food, Nutrition and the Prevention of Cancer” describing the impact of nutrition and exercise on the prevention of cancer. We asked Lauren Talbert, RD, CSO, LDN, of the Program in Women’s Oncology at Women & Infants to talk about the report.
In the report, more than 7,000 studies related to food, nutrition and cancer were reviewed by 21 world-renowned experts including world-famous scientists, researchers, and physicians. The goal was to review all the relevant research, using the most thorough methods, in order to generate a comprehensive series of recommendations on food, nutrition, and physical activity.
One of the 10 recommendations is to limit energy-dense foods and avoid sugary beverages. Energy density measures the amount of energy (calories) per weight of food. Processed foods such as cookies, chips, fried foods, and desserts are examples of energy-dense foods. These foods often contain large amounts of fat or added sugar and tend to be more “energy-dense” than fresh foods such as fruits or vegetables. For example, half a cup of Ben and Jerry’s Coffee Health Bar Crunch ice cream contains 290 calories, 27 grams of sugar and 18 grams of fat. This is clearly an example of an energy-dense food when compared to half a cup of sliced fresh strawberries that contains 27 calories, 4 grams of sugar and 0.2 grams of fat. The best way to limit energy-dense foods is to increase the proportions of plant foods (fruits, vegetables, whole grains and beans) in your diet. You should also avoid sugary drinks. Because of their water content, drinks are less energy-dense than foods. Sugary drinks provide “extra” calories to the diet and consuming more calories than required causes weight gain.
Dietary supplements are also known as vitamins. Evidence from the reviewed studies showed that high-dose nutrient supplements, for example taking a Vitamin C pill daily, can be either protective against cancer or cause cancer. The problem is that the studies are conflicting and the balance of risks and benefits cannot confidently be predicted in the general population. It’s always best to consume nutrients from their natural state, in fresh foods, rather than in a processed form. Instead of taking a Vitamin C pill, eat an orange.
AICR’s recommendations for cancer prevention have been simplified into three guidelines. These guidelines explain how the choices we make about food, physical activity, and weight management can reduce our chances of developing cancer. The three guidelines are closely related to each other:
It is easier to understand and follow three goals rather than 10 recommendations. The three goals were created as realistic guidelines you can think about and gradually adopt when making everyday choices related to diet and exercise. Following any one of these guidelines is likely to reduce your chance of getting cancer, but following all three offers the greatest protection.
A whole grain is the entire edible part of any grain. It contains the bran, endosperm, and germ. The bran is the outer layer of the grain and is often high in B vitamins and fiber. As you may recall, bran cereal is known for being high in fiber. The endosperm is the inner part of the grain that contains most of the carbohydrate. There is a small amount of vitamins and minerals in the endosperm. The germ provides nourishment to the seed. It’s rich in antioxidants, Vitamin E, fiber and B vitamins.
When grains are refined, the bran and the germ are removed resulting in a depletion of many nutritious compounds. It’s always best to choose whole grains to increase your intake of fiber and nutrients that may lower cancer risk. When reading labels, be sure to choose foods that list whole or whole grain before the grains name as the first ingredient. Do not rely on color to identify a whole grain as ingredients such as molasses or caramel coloring may have been used during processing. The following terms do not necessarily indicated a whole grain either:
Examples of whole grains include:
There is convincing evidence that red meat (beef, lamb and pork) increases the risk of developing colorectal cancer. Also, most vegetables and fruit are rich in fiber, and fiber probably protects against colorectal cancer. Furthermore, evidence shows that eating more vegetables and fruits probably protects against cancer of the mouth, pharynx, larynx, esophagus and stomach. A typical American meal features red meat, such as an 8-ounce steak with mashed potatoes or a cheeseburger with fries. The recommendation to limit red meat helps leave more room for plant-based foods such as vegetables, fruits, whole grains and beans to be included in the diet. If you do consume red meat, it’s recommended that you limit consumption to 11 ounces, or roughly two servings, a week. Red meat is generally high in calories and fat so choose lean cuts to help control calorie intake. In terms of cancer risk, people do not need to become vegetarian or vegan as no evidence connects fish or poultry to increased cancer risk. In fact, poultry and fish can be a valuable source of nutrients, particularly protein, iron, zinc, and Vitamin B12.
Processed meat is defined as meat that is preserved by smoking, curing, salting or adding other chemical preservatives. Examples include:
Similar to red meat, evidence is convincing that processed meats can increase your risk of colorectal cancer; however, the risk is considerably greater. If you are concerned with avoiding colorectal cancer and stomach cancer, it’s best to try to eliminate processed meat from your diet. For lunch, try a tuna sandwich or buy lunch meat that contains no nitrates or nitrites. Also, try to look at processed meats as something you save for a special occasion, maybe ham at a holiday meal or a hot dog at a baseball game. Once you start to include more plant-based foods in your diet, it will be easier to avoid foods such as red meat and processed meat.
When planning a meal, think first about plant-based foods. Visualize your breakfast plate, for example, and aim to cover one-third with a whole grain, one-third with a fruit, and one-third with a protein. An example could be eggs with 100 percent whole wheat toast and an orange or 100 percent whole grain cereal with milk and fresh berries. A good rule of thumb for your lunch or dinner plate is cover half of it with vegetables, one-quarter with whole grains or beans and one-quarter with lean protein such as poultry or fish. An example for a dinner could be a chicken and vegetable stir-fry over brown rice with a side salad. Ask yourself these questions: What vegetables or fruits will I include? How can I incorporate a whole grain or beans into the meal? If you are looking for a recipe, check out aicr.org for some tasty ideas.
In early hunter-gathering societies, physical activity was necessary for survival. Today, if we are hungry, we have drive-thru fast food restaurants and vending machines. More people are spending their leisure time sitting in front of computer or television screens instead of being active. Cancer rates have increased as the population has become more sedentary. Research has proven that regular physical activity protects against cancer. It’s important to make sure it’s part of your daily routine just like brushing your teeth. Sometimes we may be too tired at night to brush but we do it anyway because we want to avoid cavities. The same goes for exercise. Sometimes you may not feel like doing it, but the benefits both physically and mentally are well worth it. Research has shown that physical activity protects against colon cancer, post-menopausal breast cancer and cancer of the uterine lining (endometrium).
What’s interesting is that regular exercise reduces cancer risk alone, not including reduced risk with weight loss that is often seen with exercise. You may wonder how exercise decreases the risk of certain cancers. In terms of breast and endometrium cancer, exercise may prevent cancer by lowering the levels of hormones in the body that elevate cancer risk. Regular exercise keeps your digestive system working well and more rapid passage of waste through the colon may be associated with lower incidence of colorectal cancer.
BMI or body mass index is one tool used to measure body fat. It measures weight in relation to height. To calculate your own BMI, go to aicr.org/bmi. There are four ranges of BMI:
Of course. Physical activity is any form of movement that uses muscles. Basically you are physically active any time you are not sitting or laying down. Each day, we make several choices related to physical activity:
The more physically active you are the better. There are three terms used to describe the intensity of physical activity: light, moderate and vigorous. An example of light exercise is weeding the garden. Leisurely cycling would fall into the moderate category. Running at 10-minute mile would be considered a vigorous level of intensity.
The good thing about exercise is that it actually increases energy levels, doesn’t have to be expensive, it’s never too late to start and everyone can do it at their own pace. Just as regular physical activity reduces the risk of cancer, the opposite is true also. These people may want to ask themselves if they are too tired, too busy, too broke or too out of shape to enjoy a longer life? Research does show that people who are more active live longer. Exercising can be as simple as waking up a few minutes early and going for a walk or meeting a friend for a walk instead of lunch. It’s important to first identify your barrier and develop a strategy to overcome the barrier. “If you can find a path with no obstacles, it probably doesn’t lead to anywhere.” A great inexpensive way to increase physical activity is to purchase a pedometer and track your daily steps. This way, you can quantify your goals such as aiming to walk 5,000 or 10,000 (the recommended amount) steps a day. The bottom line is if you truly want to increase your activity level, you can. The key is to find something that you find enjoyable and that you look at as fun rather than a chore. Maybe dance lessons or learning a new sport may be in your future.