Prostate

Prostate cancers are the most common cancer among men in the United States. More than 192,000 cases are diagnosed each year. It is second on the lung cancer as a cause of cancer deaths among men in this country. One out of every 7 American men will be diagnosed with this disease in their lifetime.

The prostate is approximately the size of a walnut and is a gland in the male reproductive system. It is located just below the bladder and in front of the rectum. The urethra travels through the center of the prostate and is the tube and empties urine from the bladder. The prostate helps produce semen and nourished sperm.

Almost all prostate cancers begin in the gland cells of the prostate, and are known as adenocarcinomas.

Age is the most important risk factor for the development of prostate cancer. Most men who developed prostate cancer are older than 50. Approximately two thirds of prostate cancer is diagnosed in men older than 65. Family history is also a risk factor for prostate cancer, for instance, when other members of your family (especially father, brother, son) have or had prostate cancer, especially if they were young when they were diagnosed. African-American men have nearly double the risk of prostate cancer as white men. A diet high in animal fats may increase the risk, and diets high in fruits and vegetables may decrease the risk.

Radiation therapy is the time tested nonsurgical treatment for prostate cancer. In comparison to surgery which has fairly significant rates of urinary leakage after treatment of prostate cancer, it is extremely unlikely that patients treated with radiation will leak urine after radiation treatments. Unlike other more recently approved treatments for prostate cancer, there are literally decades of research showing the effectiveness of radiation therapy for the treatment of prostate cancer.

When used as a primary treatment for prostate cancer, radiation therapy offers a very high cure rate for prostate cancer. Radiation therapy can also be utilized after prostatectomy for various indications including persistent PSA, positive margins, extracapsular extension of the prostate cancer through the capsule of the prostate, and invasion into the seminal vesicles after prostatectomy.

Over the past decade improvements in radiation therapy equipment, and planning software have led to a significant decrease in toxicity from treatment, as well as significantly higher cure rates.

Radiation is delivered Monday through Friday, usually once daily, over the course of approximately 8 weeks. Patients are at the radiation center for approximately 20 minutes each day and then can return back to their normal activities. Most patients that are working can continue to work throughout treatment. The most common side effects during radiation therapy are minor fatigue and increased urinary frequency, which is most noticeable during the final few weeks of treatment. These symptoms then generally quickly resolve over the first few weeks after completion of therapy.

Each day just prior to treatment the radiation therapy equipment will perform a small focused CT scan and then computer matching will be utilized to match the treatment plan to the daily image. This daily imaging allows for extremely precise delivery of radiation to the prostate in order to decrease radiation dose to surrounding normal structures.

At Winter Park Oncology we follow strict National treatment protocols regarding treatment volumes and radiation therapy dose. We pride ourselves on adhering to national guidelines to ensure that your treatment at our center will meet the highest standards of major academic centers.

Since we are your local community cancer center, at Winter Park Oncology we will continue to follow you after completion of your treatment and will see you for years after completion of therapy. We will continue to work with your local physicians to ensure that they're aware of your progress throughout and after treatment.

We look forward to meeting you in helping you through your cancer journey. We pride ourselves on having lengthy discussions with our patient during and after treatment in order to ensure that they fully understand their cancer diagnosis and prognosis.

Breast

Breast cancer is responsible for more than 40,000 deaths in United States each year, along with more than 265,000 cancer diagnoses. Fortunately, new treatments have pushed this disease's five-year survival rate to nearly 90%.

Traditionally most breast cancers have been classified as either ductal or lobular. Lobular carcinomas start in the breasts milk producing glands, call the lobules. Ductal carcinomas start in the cells of the milk ducts, which carry milk from the lobules to the nipples. Both of these types of breast cancer can be noninvasive, meaning the diseased cells have not spread into surrounding normal tissue. Noninvasive diseases are by definition early in the cancer development process. In fact, non-invasive lobular carcinoma is so early that is not even classified as cancer. Instead it is considered a cancer risk factor and may not even require surgery.

Both ductal and lobular carcinomas can also be invasive, meaning the cancer spreads beyond the lobular or duct where it first started into the nearby tissues.

Breast cancer treatments are designed on several factors, including whether the cancer is ductal or lobular, and invasive or noninvasive. For invasive breast cancers, another key factor is the molecular receptor status of the cancer cells. Receptors are molecules that cancer cells produce on their surface. These receptors can interact or bind with specific proteins and hormones and the patient's body. This interaction is known as recognition.

Researchers have identified certain types of receptors that feed the growth and spread of breast cancer when they recognize, or bind, with a specific molecule. As expected, as research on breast cancer continues, more subtypes with different treatments are likely to emerge. Today the 3 main subtypes are (1) HER-2 positive breast cancer, (2) hormone receptor positive/estrogen receptor positive breast cancer (sometimes called luminal A), and (3) triple negative breast cancer (sometimes called basal breast cancer).

HER-2 is a protein the promotes cell growth and multiplication, and is found on the surface of all breast cells. Breast cancer is HER-2 positive when it has much higher levels of the protein than normal.

A HER-2 positive diagnosis was at one time associated with a higher risk of recurrence. Recent treatment advances, particularly with targeted therapies, have made the disease curable in its early stages. The same targeted therapies have also extended the survival for patients whose cancer spreads beyond the breast and nearby lymph nodes.

Hormone receptor positive breast cancer has receptors that bind with 1 or 2 naturally occurring hormones, estrogen and progesterone. These hormones feed the growth of the cancer by binding to these receptors. Endocrine therapies target the receptors for hormone recognition. These therapies can limit the body's production of estrogen and progesterone, or stop the receptors from recognizing the hormones. Thanks to endocrine therapy, and these cancer's tendency to spread relatively slowly, hormone receptor positive breast cancer is considered the most treatable form of all the 3 main types of breast cancer.

Triple negative breast cancer covers most breast cancers that don’t have one of the other 3 receptors. Besides this, triple negative breast cancers can have very little in common with other breast cancers. Since there isn't an established receptor to target in triple negative breast cancer, this is the most difficult of the 3 receptor subtypes to treat. Triple negative breast cancer also tends to be more aggressive, so the prognosis for this subtype is often worse than the others. Some triple negative breast cancers, however, do respond well to chemotherapy. In some cases, chemotherapy works so well that no cancer is found at the time of surgery. This is called a pathologic complete response.

In addition to these main 3 types of breast cancer, there are additional subtypes including inflammatory breast cancer, metaplastic breast cancer, and male breast cancer.

Breast cancers Key risk factors include age, with most breast cancers diagnosed over the age of 50. In addition, certain inherited genetic mutations including BRCA1 and BRCA2 mutations predisposed to breast cancer. Normally BRCA1 and BRCA2 genes repair damaged DNA. When these genes are mutated in certain ways, they fail at DNA repair, which could lead to breast and/or ovarian cancer. Other gene mutations associated with higher risk of cancer include PALB 2, another DNA repair gene, CHEK2, tumor suppressor gene, and PTEN which controls how quickly cells multiply.

Family history also plays a factor in a woman's odds of developing breast cancer. A woman's odds increases if a parent, sibling, or child has had the disease. Early menstruation especially when women began menstruating before age 12 leads to a higher risk of developing breast cancer. Women who have no full-term pregnancies, or the first pregnancy after age 30 her at a higher risk of breast cancer.

Prior breast cancer diagnosis is also a risk factor for breast cancer. Prior radiation therapy to the chest as a child her during early adulthood for certain lymphomas can increase breast cancer risk. Obesity, particularly after menopause, increases a woman's breast cancer risk. Dense breast tissue based on its appearance and mammogram is a known risk factor for breast cancer.

Breast cancer symptoms may include the following:

Lump or mass in your breast. Enlarged lymph nodes in the armpit. Changes in breast size, shape, skin texture or color. Skin redness. Dimpling or puckering on the breast. Scaliness on the breast or nipple. Discharge from the nipple. Nipple changes, including the nipple turning inward, pulling to one side or changing direction. However, these symptoms do not always mean you have breast cancer. It is important to discuss any symptoms with your doctor since they may also signal other health problems.

Treatment:

Surgery is a cornerstone management of breast cancer. Like all surgeries breast cancer surgery is most successful when performed by a specialist with a great deal of experience of the particular procedure. In Orlando we are fortunate to have a significant number of highly trained and highly skilled surgeons who can perform this type of surgery.

Some patients receive chemotherapy or targeted therapies (systemic therapy) prior to surgery. The goal of these treatments is to shrink the tumor and any involved lymph nodes in order to make the procedure and recovery as easy as possible and the patient. This also allows the treatment team to assess how the cancer has responded to systemic treatment, which can be important for some types of breast cancer.

Surgeries themselves fall into 1 of 2 categories: Lumpectomies and mastectomies. Your surgeon will recommend the best option for you based on the size and location of the tumors in the breast, the size of the breast itself and the need for radiation treatment.

In a typical lumpectomy surgery, the tumor and a small amount of surrounding normal tissue is removed. Lumpectomies are generally outpatient procedures, and have shorter recovery times. These procedures are usually followed by radiation therapy. In the case of invasive breast cancer, a sentinel lymph node procedure is performed which will allow the surgeon to identify the first lymph nodes that this particular tumor would spread to, thereby allowing a very targeted approach to surgical lymph node evaluation.

The surgical procedures are a critical part of your breast cancer treatment, yielding a significant amount of extremely important information. The information from the surgical pathology report, as well as the surgeon's operative report, allows us to make decisions regarding designing your radiation treatment fields.

The radiation fields themselves are designed based on strict adherence to national radiation trial protocols. These treatment fields can be extremely complicated, and the radiation treatment planning can take up to a week or more depending on the complexity of the plan. Modern radiation treatment fields are designed to decrease toxicity to the lungs, heart and adjacent breast, and to ensure that the radiation is delivered in a homogeneous (even) dose distribution throughout the breast tissue and lymph node regions at risk of microscopic disease.

At Winter Park oncology we follow strict National radiation protocols, regarding treatment volumes and radiation therapy dose. We pride ourselves on adhering to the National Guidelines to ensure that your treatment at our center will meet the high standards of any major academic center.

Since we are your local community cancer center we can continue to follow you after completion of your treatment, and will see you for years after completion of therapy. We will continue to work with your local physicians to ensure that they're aware of your progress both throughout, and after treatment.

We look forward to meeting you in helping you through your cancer journey. We pride ourselves on having lengthy discussions with our patients during and after treatment, in order to ensure that they fully understand their individual cancer diagnosis and prognosis.