Kidney Cancer Treatments

Treatments for Kidney Cancer

The kidney is a bean-shaped organ that is situated in the back, just below the ribcage, on both sides of the body. Their job is to clean the blood from any impurities. This extra waste is sent to the bladder, where it is stored until urination. Approximately 30,000 cases of kidney cancer will be diagnosed in the United States yearly, according to the American Cancer Society.

The MedStar Georgetown Cancer Institute specialists provide comprehensive care for kidney cancer including:

  • Laparoscopic radical nephrectomy
  • Open radical nephrectomy for large tumors
  • Partial nephrectomy for preservation of the kidney. This procedure can be done through traditional open surgery, laparoscopically or through robotic surgery.
  • Small molecule targeted therapy for late stage treatment
  • Palliative​ services

Fortunately, the treatment for kidney cancer has become technologically advanced. Sophisticated imaging scans like CTs and MRIs make finding smaller tumors easier. In some cases, your doctor will be able to determine if the mass on your kidney is malignant from a scan.

Minimally Invasive Techniques

One of the main goals of kidney cancer treatments is to use minimally invasive techniques such as laparoscopic and robotic surgeries to speed healing and recovery after surgery. During laparoscopic surgery, small instruments are placed into the abdomen and the kidney or part of the kidney is removed through smaller incisions. This often results in markedly reduced pain, shorter hospital stays, and quick resumption of normal activities than traditional surgery.

Gastrointestinal Cancer Treatments

Gastrointestinal (GI) cancer includes cancer of the:

  • Esophagus, the tube used to bring food from your mouth to your stomach
  • Stomach
  • Small bowel
  • Colon and rectum
  • Pancreas, an organ which produces enzymes that aid in digestion
  • Bile duct, a tube which carries bile, a fluid used to digest fat
  • Liver
  • Gallbladder

Treating Gastrointestinal Cancer

If you received a cancer diagnosis, or if you are still awaiting a final diagnosis, we understand how scared and anxious you probably feel. Your team at MedStar Health will be with you every step of the way. Our knowledgeable doctors and nurses can answer any questions you may have, and we will support you throughout your journey, from diagnosis to treatment and follow-up.

Here is what you can expect during the cancer process:

  • Diagnosis: Our doctors will carefully examine you, using blood tests, imaging scans and biopsies in order to get the most accurate diagnosis possible.
  • Treatment: Once your health team confirms your diagnosis, we will work with you to create an individualized treatment plan. Treatment options differ from patient to patient, but most often include surgery and/or radiation therapy and/or chemotherapy.
  • Recovery: After you have completed your treatment, we will monitor you closely during the recovery process. Proper follow-up care is the final crucial step in cancer treatment.

If you have a cancer of the gastrointestinal tract, surgery will likely be recommended to remove the tumor and/or to help maintain normal function.

Gastrointestinal Cancer Surgery Expertise

Surgical oncologists at MedStar Health are experts in a wide range of surgeries, from minimally invasive laparoscopic procedures to more complicated surgeries that remove and rebuild portions of the gastrointestinal tract.

They are also leading the latest research on new drugs to treat unusual tumors, such as gastrointestinal stromal tumors (GISTs). Each patient's treatment plan is tailored to his or her specific case and needs, with the input from a wide range of specialists dedicated to his or her care.

Our patients benefit from a multidisciplinary approach that devotes a team of specialists to their care:

  • Our surgical oncologists work with specialists in the fields of radiation oncology and chemotherapy
  • Each patient is evaluated weekly multidisciplinary to formulate the best plan of care
  • We offer the whole spectrum of surgical options, from minimally-invasive laparoscopic procedures to complex resections and reconstructions of the gastrointestinal tract
  • We regularly treat even the rarest forms of stomach cancer, such as GIST tumors, and lead the clinical trials that have revolutionized the treatment of this disease
  • Our doctors are experts in intraperitoneal chemotherapy for peritoneal metastases from gastrointestinal cancers, allowing direct contact of cancer-fighting drugs into the abdomen
  • Diagnostic procedures for gastrointestinal cancers

Patients with gastrointestinal cancers may undergo several tests to diagnose their cancer and/or determine its location and extent:

  • Endoscopic ultrasound (EUS): This procedure allows your doctor to examine your esophageal and stomach linings and the walls of your upper and lower gastrointestinal tract, using a thin probe that records high-quality ultrasound images. Your doctor will look for signs of cancer, determine if your cancer has spread or biopsy a mass.
  • Laparoscopic surgery: Your doctor may need to perform exploratory surgery to find out if your cancer has spread. Laparoscopic surgery is a minimally invasive procedure that allows your doctor to insert a small camera and surgical instruments through several small abdominal incisions.
  • Imaging tests: Your doctor may order other imaging tests, including computed tomography (CT scan), positron emission tomography (PET) and magnetic resonance imaging (MRI). 

Treatment Options for Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumor, commonly called GIST, is a rare type of sarcoma that forms along the gastrointestinal tract, but mostly starts in the stomach or small intestine.

Surgery is the standard treatment, but not all GISTs can be removed. Our clinical trials have studied the newest drugs available to target GIST, including imatinib, sunitinib and nilotinib. Our cancer team was among the first to study imatinib, the first targeted therapy developed for GIST.

These drugs do not cure the disease, but they do help some tumors stop growing or shrink, which has extended the survival rate for patients with recurrent or metastatic GIST.

Intraperitoneal Chemotherapy for Peritoneal Metastasis from Gastrointestinal Cancers

Gastrointestinal cancers, such as appendix cancer, colon cancer and gastric cancer, can spread to the peritoneum. The peritoneum is the lining of the peritoneal cavity.

In the past, patients with peritoneal cancer had few or no treatment options. An innovative treatment option is now available for patients with peritoneal metastases, involving cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC). Heated intraperitoneal chemotherapy allows your doctor to target chemotherapy drugs directly at cancer cells, and minimize exposure to healthy tissues.

Gastrointestinal Cancer Surgery

Surgical procedures we use to treat esophageal cancer and gastric, or stomach, cancer include:

  • Esophagectomy: This procedure removes all or part of the esophagus. The patient's stomach or part of the colon may be transplanted into the neck to take its place.
  • Subtotal/total gastrectomy: These surgeries remove a portion or all of the stomach. In a total gastrectomy, the patient's esophagus is connected directly to the small intestine.

Pancreatic Cancer Surgery 

Surgery is the only way to cure pancreatic cancer that has not spread (metastasized), and the best way to contain tumors. Unfortunately, doctors often see later-stage disease, with tumors wrapped around arteries and veins, nerves and the bile duct—making operations more challenging or even impossible.

Our goal in surgery is to leave enough of the pancreas to produce digestive juices and insulin, reattaching the remaining organ so that it functions like it did before. But sometimes that’s not possible. We often have to remove all or other parts of nearby organs as well, to ensure we get as much of the cancer as possible. 

We provide a full range of pancreatic cancer treatment, with our recommendations based on:

  • The cancer’s stage (the size of the tumor, how far it has grown into the wall of the pancreas and whether the cancer has spread to nearby tissues, lymph nodes or other parts of the body)
  • Whether the tumor is operable
  • Whether the cancer is newly diagnosed or has returned
  • Your overall health

At MedStar Health, we’re pioneering new ways to make these tumors operable, including chemotherapy followed by precise radiation (CyberKnife). We’re also looking at a new way to give heated chemotherapy (HIPEC) immediately after surgery, to reduce the chance the cancer will return (recur).

While pancreatic surgeries are the most complex abdominal operations, we have the most experienced team in the area, performing more procedures than any other group.

Colorectal Surgery

Surgery is usually the cornerstone of colorectal cancer treatment, with the goal to remove the tumor, or as much of it as possible. Our experienced specialists can also remove parts of other organs such as the liver, lungs and ovaries when colorectal cancer has spread or returned.

Small Bowel Cancer Surgery

Surgery is the most common treatment of small bowel cancer. One of the following types of surgery may be done:

  • Resection: Surgery to remove part or all of an organ that contains cancer. The resection may include the small intestine and nearby organs (if the cancer has spread). The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together). The doctor will usually remove lymph nodes near the small intestine and examine them under a microscope to see whether they contain cancer.
  • Bypass: Surgery to allow food in the small intestine to go around (bypass) a tumor that is blocking the intestine but cannot be removed. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Small Bowel Cancer Treatment

patient at MWHC

There are different types of treatment for patients with small bowel cancer.

Different types of treatments are available for patients with small intestine cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Types of Treatments

Three types of standard treatment are used:

  • Surgery: Surgery is the most common treatment of small intestine cancer. One of the following types of surgery may be done:
    • Resection: Surgery to remove part or all of an organ that contains cancer. The resection may include the small intestine and nearby organs (if the cancer has spread). The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together). The doctor will usually remove lymph nodes near the small intestine and examine them under a microscope to see whether they contain cancer.
    • Bypass: Surgery to allow food in the small intestine to go around (bypass) a tumor that is blocking the intestine but cannot be removed. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
  • Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
  • Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Treatments by Stage

Small Intestine Adenocarcinoma

When possible, treatment of small intestine adenocarcinoma will be surgery to remove the tumor and some of the normal tissue around it.

Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following:

  • Surgery to bypass the tumor.
  • Radiation therapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.
  • A clinical trial of new anticancer drugs.
  • A clinical trial of biologic therapy.

Small Intestine Leiomyosarcoma

When possible, treatment of small intestine leiomyosarcoma will be surgery to remove the tumor and some of the normal tissue around it.

Treatment of small intestine leiomyosarcoma that cannot be removed by surgery may include the following:

  • Surgery (to bypass the tumor) and radiation therapy.
  • Surgery, radiation therapy, or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of new anticancer drugs.
  • A clinical trial of biologic therapy.

Recurrent Small Intestine Cancer

Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or biologic therapy.

Treatment of locally recurrent small intestine cancer may include the following:

  • Surgery.
  • Radiation therapy or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
  • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.

 

 

Blood Cancer Treatments

 

Hematology at MMMC

Blood cancers remain a challenging group of diseases, with many types and subtypes. But we’ve made great strides in diagnosis and treatment, with additional, promising therapies on the way. 

Our treatments are research-backed and individualized, with the latest approaches for chemotherapy and radiation and a full range of newer targeted therapies. We also take part in some of the most promising research and clinical trials in the nation and offer the region’s largest stem cell transplant program.

Blood Chemotherapy 

Chemotherapy is one of the main treatments for blood cancers, and is usually swallowed or injected into a vein. The drug(s) travel throughout the bloodstream to destroy cancerous cells, and are often used in combination with other therapies — sometimes preceding stem cell transplants to restore healthy blood cells.

We offer the latest, most effective chemotherapy drugs, with our researchers and others studying and developing ways to improve therapy while limiting side effects:

  • New drugs, new combinations and new sequences
  • Ways to counter cell resistance to chemotherapy
  • Less intense doses and shorter regimens that still kill cancerous cells
  • Identifying which patients need more intensive treatment and which can do with less

Chemotherapy Precautions for Blood Cancer Patients

While we always work to minimize chemotherapy side effects, we take additional precautions for those at higher risk:

  • Older patients, who often have a harder time tolerating treatments
  • Pregnant women, who should either deliver before treatment (ideally) or only receive certain drugs in certain trimesters
  • Younger patients, who often respond to and tolerate chemotherapy better than adults but who are still growing

We also use drugs to speed the recovery of white blood cells after chemotherapy, to reduce your risk of infection.

Intrathecal Chemotherapy and Blood Cancer

Regular chemotherapy usually doesn’t reach the brain and spinal cord (the central nervous system, or CNS), which can provide a hiding place for cancerous cells. If needed, we can avoid that by injecting drugs into the cerebrospinal fluid, a procedure called intrathecal chemotherapy.

Blood Cancer and Stem Cell Transplants

Sometimes higher doses of chemotherapy drugs are required to treat blood cancers, doses that damage the bone marrow where blood cells are produced. If that’s the case, we provide a restorative transplant of blood-forming stem cells, taken either from the blood (more common) or the bone marrow (less frequent now). There are two possible sources:

  • Allogenic: the stem cells come from a donor (most likely a close relative because of the need to match immune system characteristics)
  • Autologous: the stem cells are taken from your body before the chemotherapy and stored

Stem cell transplants are a normal part of multiple myeloma treatment. But we usually don’t turn to high-dose chemotherapy and a stem cell transplant for leukemia or lymphoma unless other treatments have not worked or the disease has returned (recurred). In the case of chronic myeloid leukemia (CML), we now try a targeted therapy (like Gleevac) first. Learn more about our blood targeted therapy.

Blood Targeted Therapy 

Targeted therapy represents a new front in attacking cancer — drugs and other substances aimed at specific molecules that help a disease grow, progress and spread. The idea is to target a cancer’s unique characteristics, including genes, proteins, supporting blood vessels or host tissue, while limiting damage to healthy cells.

Several targeted therapies are already approved for treating blood cancers, with additional prospects in clinical trials. Targeted therapies are typically used by themselves or in combination with chemotherapy. They are given as an initial treatment or in more challenging scenarios, such as when there’s no response to other therapies or the cancer has returned (recurred).

Types of Blood Cancer Targeted Therapy

We offer a number of targeted therapies, aimed at various blood cancers and the specific characteristics of the cells they create:

  • Tyrosine Kinase Inhibitors (TKIs): TKIs target the gene BCR-ABL, which is formed by an abnormal chromosome (the Philadelphia mutation) and makes a protein that helps cancer grow. TKIs are the main treatment for chronic myeloid leukemia (CML) and are also used for some acute lymphoblastic leukemia (ALL) patients who have the mutation.
  • Monoclonal Antibody: These drugs replicate a natural antibody and target certain substances on cancer cells — either alone or with a drug, toxin or radioactive material to kill the cells, block their growth or keep them from spreading.
  • Proteosome Inhibitors: These inhibitors stop cell enzymes from breaking down proteins that keep cell division under control. They are often used to treat multiple myeloma but are also helpful for some types of non-Hodgkin lymphoma.
  • Histone Deacetylase (HDAC) Inhibitors: These drugs change which genes are active by working with a chromosome protein called histone.
  • FLT3 Inhibitors: These drugs target mutations in the FLT3 gene in patients with acute myeloid leukemia (AML).
  • Cancer Vaccines: They are designed to treat, not prevent, blood cancer by boosting the immune system’s response.
  • Interferon: This manmade version of a white blood cell protein can interfere with cancer cell division and slow tumor growth. It is used to treat multiple myeloma or lymphoma in some patients.

Blood Radiation 

Radiation therapy for blood cancers uses high energy X-rays or other particles from an external machine to kill cancerous cells and shrink tumors. While radiation is not used as frequently as other treatments like chemotherapy and targeted therapy, there are useful applications:

  • Hodgkin Lymphoma: While radiation is usually very effective for killing diseased cells in Hodgkin lymphoma, we try to limit its use because of side effects. Thanks to advanced imaging, we can target the disease more precisely and further avoid damage to healthy tissues.
  • Non-Hodgkin Lymphoma: We might recommend radiation alone for early-stage tumors, or with chemotherapy for more aggressive disease. We might also pair it with high-dose chemotherapy before a stem cell transplant.
  • Multiple Myeloma: Radiation is a possible treatment for painful bone damage when chemotherapy doesn’t help.

Whatever the application, we are careful to minimize radiation side effects, particularly for patients who are younger, pregnant or older.

Merkel Cell Carcinoma Treatment

Washington Cancer Institute 1

If you suffer from Merkel cell carcinoma, you need access to the most advanced and effective treatment.  We offer the highest standard of care and the most experienced team available in our area.

Our team of fellowship trained surgical oncologists has years of experience treating people with cancer. Through our multidisciplinary approach, we work with experts who specialize in a wide variety of fields. We base our treatment options on the latest research, and offer you access to cutting edge cancer clinical trials.

We also have special expertise for seeing patients for a second opinion for Merkel cell carcinoma.

Merkel Cell Carcinoma Diagnosis

  • Medical history – You will talk about your medical history and whether you have ever had cancer or other serious illnesses.
  • Physical examination – Your surgical oncologist will check to see if you have any unusual looking bumps.
  • Skin biopsy – We will either review the results of a previous biopsy, or perform our own. In a biopsy, we remove cells from the suspicious area to examine them under a microscope for signs of cancer.

Merkel Cell Carcinoma Treatment

Depending on the extent and location of your cancer, your team of surgical oncologists will recommend any of the following treatment options:

  • Surgery – This can include removing the cancerous tissue itself, healthy tissue surrounding it, as well as any affected lymph nodes.
  • Radiation – This procedure uses high energy rays to target and destroy cancer cells.
  • Chemotherapy – This treatment delivers powerful medication either orally or through an IV to stop cancer cells from spreading.

Merkel Cell Carcinoma Follow-Up Care

Your team of surgical oncologists will closely monitor your recovery after treatment. We may recommend repeating the imaging and diagnostic tests previously performed. These tests help us determine how well the treatment is working and make sure the cancer is not spreading or returning.

Skin Cancer Procedures

davidson, head neck surgery

One of the primary ways that skin cancer can spread to other parts of the body is through the lymph nodes.  Lymph nodes are especially vulnerable because their job is to protect the body from bacteria.  They fight against the diseased fluid that leaks from a tumor.  If this cancerous fluid builds up in the lymph nodes, the cancer can spread.

Using a multidisciplinary approach, we consult with specialists in a wide range of fields to determine the most effective procedure for you.  We base our practice on the most current research. We also offer you access to cutting edge cancer clinical trials whenever available.

We offer our patients the most highly specialized procedures for skin cancer. These include:

Sentinel Lymph Node Biopsy

The first lymph node that cancerous fluid can attack is called the sentinel lymph node. A sentinel lymph node biopsy determines whether cancer has spread to the sentinel lymph node. If the sentinel lymph node is cancerous, it is likely that other lymph nodes are too.

To perform the procedure, your surgical oncologist injects the tumor with radioactive dye. The dye identifies the sentinel lymph node and your surgical oncologist can surgically remove it. Then, a pathologist will inspect the lymph node carefully under a microscope to identify any signs of cancer.

Lymph Node Dissections

If your surgical oncologist determines that cancer has spread to your lymph nodes, you will need to have more lymph nodes removed. This procedure is called a lymph node dissection. The following are two types of specialized lymph node dissections we use for skin cancers or certain extremity soft tissue sarcomas:

  • Axillary lymph node dissection – A surgical procedure that removes tissue containing a group of affected lymph nodes from under the arm.
  • Inguinal-femoral lymph node dissection – A surgical procedure that removes tissue containing a group of affected lymph nodes from the groin area. 

Recovering From Skin Cancer Procedures

Your surgical oncologist will discuss with you the specifics of your procedure and what you can expect afterwards. Some side effects you may experience include:

  • Pain or swelling at the procedure site
  • Difficulty moving the arm or leg affected by the procedure

For Referring Physicians

Our Bone Marrow & Stem Cell Transplantation team works with referring physicians to provide advanced, comprehensive care for our patients.

Bone Marrow & Stem Cell Transplantation Program at MedStar Georgetown

We have built relationships with referring physicians in the region and around the country, working together to give our patients the best results possible. Our transplantation program features:

  • Dedicated transplantation specialists: When you refer patients to our program, you can feel confident they are receiving the most specialized care available. Our physicians focus exclusively on transplantation, giving us a superior level of expertise.
  • Expertise in high-risk patients: Some programs may turn patients away due to age, health, or other reasons. Our physicians have extensive experience in treating a wide range of patients considered high risk. We have experience in guiding patients safely through the transplantation process.
  • Largest bone marrow collection site: MedStar Georgetown is home to the largest collection site for the National Marrow Donor Program, a program started by the U.S. Department of Defense. This high volume gives our bone marrow experts unparalleled expertise in safe and effective bone marrow collection procedures.

Eligibility Guidelines

We carefully evaluate patients to determine if they will benefit from a bone marrow and stem cell transplantation. Eligibility depends on many factors, including specific disease, patient’s age, and prior therapies. If we are considering an allogeneic transplant, we need to identify available donors or cord blood units as soon as possible.

During the evaluation process, our transplant team will:

  • Determine the patient’s overall health and performance, using the HCT comorbidity index (HCT-CI)
  • Assess the patient’s disease, including stage of the disease
  • Guide patients through the informed consent process
  • Identify any psychosocial issues that would prevent a successful transplant and recovery
  • Ensure the patient has a competent and willing caregiver to provide care during the often lengthy recovery period

Referral Process

Our staff is available to make the referral process easy.

To refer a patient, please call Physician Access at 202-442-4200 or 202-342-3300.

Bone Marrow or Stem Cell Transplantation Procedures

At the MedStar Georgetown Cancer Institute, we provide the full spectrum of care for our bone marrow and stem cell transplantation patients. We want you to feel informed and prepared for your procedures. Our team will take the time to explain every step in detail and answer any questions you may have. We tailor your treatment plan for your needs, factoring in your age, general health and specific condition. Our team will discuss your individual transplantation process with you.

Establishing Candidacy

Our expert transplantation team works with you to determine your candidacy. The evaluation process, which may last a few days, includes many different types of tests:

  • Thorough physical examination and review of your medical history
  • Blood tests
  • Imaging scans, including chest X-rays and computed tomography (CT) scans
  • Tests to check your heart, lung, and other organ functions
  • Bone marrow biopsy (removing a small piece of your bone marrow for analysis), which gives us a deeper understanding of your condition
  • Psychosocial evaluation

You may begin the process by either:

  • Referring yourself directly to our program by calling 202-444-3736
  • Having your hematologist/oncologist refer you to one of our transplant physicians

Preparation

Your overall health contributes greatly to the success of your transplant. At the MedStar Georgetown Cancer Network, we want to ensure that you are in the best health possible before your procedure. Our pre-transplant coordinators and support staff will help guide you through the preparation phase, helping you lower your risk of complications and increase your chances for a positive, long-term outcome. They may recommend some exams or tests prior to your transplant, to treat existing infections and plan for your postoperative care. These include:

  • Dental exam: It’s important to treat any sources of infection. Your dentist may also recommend fluoride treatments to prevent decay.
  • Gynecological exam: Women are required to undergo a gynecological exam before transplantation to treat any infections.
  • Dietary changes: We will most likely place you on a special diet before your procedure. Our experienced dietitian will create a personalized food plan that meets your nutritional needs. In addition, achieving a close-to-normal weight can contribute to a better result. Our dietitian can work with you to help you gain or lose weight safely and effectively.
  • Fertility planning: Chemotherapy and radiation can cause sterility (inability to have children). Talk to your doctor about banking sperm or ova if you wish to start or add to your family after the procedure. We can also make a referral for you to a fertility center.
  • Baseline tests: We will run a number of tests before the procedure to establish baseline information. This gives us a detailed picture of your body’s current health and functioning so we can evaluate any changes that occur during or after the procedure. Tests include imaging scans, a hearing test and a heart evaluation.

We will then begin preparing you for the actual procedure.

Harvesting

Once we have completed the evaluation and determined that you are a stem cell transplant candidate, we will begin the first step: a harvesting procedure. We will collect the cells from you or from a donor, depending on the type of transplant procedure you are having:

  • Allogeneic: We harvest healthy cells from a family member or unrelated donor.
  • Autologous: We harvest your own cells. We collect the cells from the bloodstream (or, occasionally, from the marrow) and store them for transplant.

Bone Marrow Harvesting

Bone marrow or peripheral blood stem cell harvesting is the first step in your bone marrow or stem cell transplant process. During harvesting, we obtain the stem cells we need for your transplant. We may harvest the cells from you, a relative, or an unrelated donor, or we may obtain cells from an umbilical cord.

At MedStar Georgetown University Hospital, we have unique expertise in this area. We are home to the National Marrow Donor Program, the largest marrow and blood stem cell harvesting site in the nation. This high volume gives our team a superior level of experience and expertise in cell collection.

The timing of the harvesting procedure depends on the type of transplant you are having:

  • If the bone marrow is coming from a donor, we will harvest it from him/her on the day of the transplant procedure.
  • If we are harvesting the bone marrow from you, we will harvest these cells before you receive chemotherapy conditioning for transplantation.

With either you or your donor under general or spinal anesthesia, your specialist will remove a small portion of bone marrow from your or the donor’s hips with a syringe. The amount of marrow taken depends on the patient’s weight and the specific condition to be treated. The body can replace marrow in about two weeks.

Stem Cell Harvesting

Blood stem cell harvesting is another way to obtain the stem cells needed for transplantation.

Your specialist will place a needle into a vein in each of your arms to collect blood into a leukapheresis machine, which removes the white blood cells and returns the other blood cells back to the patient. For some patients, a catheter will be placed into a vein to gain access to blood. This collection procedure has few side effects, and our experienced transplantation nurses will monitor you regularly and a physician will be onsite at all times.

You will be awake the entire time, and after the session, you may go home.

Radiation and Chemotherapy

After the cells are harvested, you will receive radiation and/or chemotherapy to kill cancer cells and prepare your body for the transplant. This type of treatment is called conditioning and is necessary for a few reasons:

  • If you are receiving donor cells (allogeneic transplantation), chemotherapy and/or radiation therapy suppresses your immune system so your body does not reject the new cells. If you have cancer, it also helps destroy the tumor.
  • If you are receiving your own treated cells (autologous transplantation), chemotherapy or radiation can be used immediately before the transplant to destroy any tumors.

Radiation therapy

You may receive one of two types of radiation therapy:

  • Targeted radiation therapy treats a specific area of your body.
  • Total body irradiation (TBI) is administered to your entire body.

Chemotherapy

Chemotherapy is another treatment that rids the body of cancer or blood disease. Chemotherapy is a mixture of medications that destroys diseased tissue. Depending on your particular condition, we may need to administer one or more types of chemotherapy (with or without radiation therapy) as part of your transplantation treatment. Our goal is to rid your body of all traces of the disease. We may administer the drugs intravenously (an IV) or in pill form.

Features of MedStar Georgetown University Hospital’s radiation and chemotherapy program include:

  • Convenience: Everything you need for your care is located onsite. If we recommend chemotherapy or radiation therapy, you can usually receive the necessary treatments at our facility. We provide for all aspects of your care at MedStar Georgetown. In some cases, we may recommend that your referring physician give you chemotherapy or radiation before your transplantation in the management of our disease leading up to the transplant.
  • Seamless communication: Your transplant team will work closely with the chemotherapy and radiation teams. We provide continuous, integrated care and communicate regularly regarding your treatment.
  • Expert team: Our radiation and chemotherapy team has years of experience working with bone marrow and stem cell transplantation patients. We will help you manage any side effects and discomfort you may experience. 

Infusion and Transplantation

Once we have finished the harvesting, we can begin the transplant procedure. The actual transplantation procedure for bone marrow or blood stem cell infusion is relatively quick and simple. You may be receiving your own bone marrow/stem cells or bone marrow/stem cells from a donor. In either case, the transplant resembles a blood transfusion. There are generally few side effects.

Here is a general idea of what you can expect:

  • We give you medicine approximately 30 minutes before the infusion to help reduce any potential side effects.
  • The stem cells are injected through your IV catheter.
  • You remain awake during the procedure; it will not hurt.
  • The process takes anywhere from 30 minutes to four hours. The amount of time depends on the amount of fluid in the stem cell product.

Recovery

After your transplant, you will need to remain in the hospital’s transplant unit for two to three weeks, until your bone marrow is functioning normally. While you are recovering, our experienced, dedicated transplant nurses will care for you. During this period, we will test your blood daily to track your progress. We will also monitor you carefully for side effects from chemotherapy and radiation, as well as for infections, graft vs. host disease (if you have an allogeneic transplant), and graft failure.

Bone Marrow and Stem Cell Transplant Program

Stem Cell Transplantation: Treatment for Cancer and Blood Diseases

Stem cells, found in the bone marrow, are crucial to our health because they can develop into the three types of blood cells that the body needs:

  • Red blood cells, which carry oxygen to the body
  • White blood cells, which fight infection
  • Platelets, which help the blood clot

A bone marrow or stem cell transplant is a procedure for patients whose bone marrow does not produce healthy stem cells. Certain diseases (and sometimes treatments for diseases) can damage a person’s stem cells. Transplantation, which replaces the damaged stem cells with healthy, functional stem cells, can be one of two types:

  1. Autologous, using your own cells
  2. Allogeneic, using a donor’s cells

Once considered an experimental treatment, it is now a standard of care for patients with certain types of cancer and blood disorders, including:

  • Acute and chronic leukemias
  • Aplastic anemia
  • Non-Hodgkin and Hodgkin lymphoma
  • Multiple myeloma
  • Primary amyloidosis
  • Myelodysplastic syndromes
  • Myeloproliferative disorders
  • Sickle cell anemia

Bone Marrow and Stem Cell Transplant Program at MedStar Georgetown University Hospital

MedStar Georgetown University Hospital’s Bone Marrow and Stem Cell Transplant Program is the only adult academic program of its kind in the Washington, D.C., area, giving patients access to life-saving treatment options not otherwise available in our region. Our specialists have extensive experience performing this complex procedure and work to provide a safe, effective, and comfortable procedure.  We are also proud of our partnership with the John Theurer Cancer Center at Hackensack University Medical Center and the physicians and scientists of Georgetown University School of Medicine. Together, we are able to deliver comprehensive, advanced care to our patients.

Features of our program include:

  • Dedicated transplant specialists: Our physicians are full-time transplant specialists who have dedicated their entire careers to bone marrow and stem cell transplantation. We offer all of the treatment options available today and can confidently recommend the optimal techniques and procedures for you. Learn more about what to expect during bone marrow and stem cell transplantation.
  • Experienced team: Our physicians have decades of experience performing transplantation procedures, making us one of the top transplantation teams in the region. We translate the latest research into results, leading to improved techniques and outcomes. We combine our experience with the expert team at MedStar Georgetown’s Lombardi Comprehensive Cancer Center, the only National Cancer Institute-designated cancer center in the Washington, D.C., region. Expertise with high-risk patients: Patients who may have been turned away from other programs—either due to age, health or other reasons—often find hope and treatment at MedStar Georgetown. We are confident in our ability to guide high-risk patients safely through the treatment and recovery process.

  • Holistic care: At MedStar Georgetown, we know a sickness affects more than just your physical health. Our robust team consists of many different health care professionals, who are here to care for your physical, emotional and social needs.
  • World’s largest marrow harvesting site: MedStar Georgetown is home to the largest collection site for the National Marrow Donor program, a program started by the U.S. Department of Defense. This gives us an unmatched level of experience and expertise in cell collection. Learn more about bone marrow harvesting.

Our Team

At MedStar Georgetown University Hospital, our bone marrow and stem cell transplantation team consists of highly specialized physicians, nurses, and other health care professionals, including

  • Pre-transplant coordinators, who can help you manage appointments, paperwork and all of your pre-procedure needs
  • Dedicated inpatient and outpatient nursing staff, with experience caring for transplant patients
  • Insurance coordinator
  • Social worker
  • Dietitian

Every member of our team is committed to providing comprehensive and compassionate care to our patients. We have one of the few dedicated transplant programs in the region, giving our team a high level of expertise and experience. And, our care doesn’t begin or end with the procedure—we are with you from the moment you walk through our doors and continue to provide services throughout your treatment and follow-up care.

Sarcoma Treatments

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Surgery

Surgery is usually the best treatment for a sarcoma—especially now that the growth and spread of the disease is better understood and imaging tests have improved—all of which helps us plan surgeries that remove tumors while sparing as much healthy tissue as possible.

Our surgeries are performed by specialists who:

  • Are internationally recognized for their expertise with complex sarcoma surgery—treating patients referred from across the country and the world
  • Help patients who received initial surgery elsewhere and now need additional care
  • Use advanced techniques on arm and leg tumors to preserve a greater degree of function, often sparing the whole limb (98 percent success rate)
  • Repair surgical areas (when needed) with sophisticated bone grafts or special prostheses, many of which can expand with younger patients as they grow

We offer top follow-up care, too, with a full rehabilitation program—often a crucial part of making treatment a success.

Types

Our team has developed a number of innovative surgical techniques to remove tumors safely and accurately. We use several types of sarcoma surgery:

  • Wide Local Excision: Excision removes the tumor and some healthy tissue around it—a step we try to minimize, especially when the cancer is in the head, neck, abdomen, or trunk. After the tumor is removed, the bone is fixed, the soft tissues repaired and the skin closed, with the goal of preserving function and appearance.
  • Lymphadenectomy (Lymph Node Dissection): Lymph nodes are removed and samples are checked under a microscope for cancer.
  • Rotationplasty: Doctors remove the tumor and knee joint, using the ankle as a new knee when the leg is reconstructed and usually attaching a prosthesis to the foot.

Surgery is often combined with chemotherapy, radiation (mainly for soft tissue sarcomas) or, in the case of a soft tissue sarcoma called a gastrointestinal stromal tumor (GIST), a targeted therapy.

Limb-Sparing Sarcoma Surgery

Thanks to advances in surgery, radiation, and chemotherapy, we can usually save arms and legs with sarcomas rather than amputate them. But limp-sparing surgeries remain complex and are best left to specialized experts like ours:

  • Surgeons not only have to ensure the entire tumor is removed, but save tendons, nerves, and blood vessels to preserve as much function and appearance as possible.
  • Once the tumor is gone, surgeons must then make repairs. This may include transferring muscles and tendons and replacing bone and joints—either with a graft taken from another part of the body or with a manmade implant (prosthesis).

We have a 98 percent success rate with saving limbs, though patients still require full rehabilitational support to make their surgery a success and retain function.

On the rare occasions we need to amputate, we provide a full range of physical and emotional support, including reconstruction specialists.

Reconstruction and Prostheses

After removing a tumor, our surgeons may need to replace portions of the skeleton with a manmade implant (an internal prosthesis, or endoprosthesis) to help with stability and function.

We specially select and customize each implant to ensure the best possible fit and performance for each patient. Many newer implants can even grow with younger patients, so we don’t have to perform more surgery to replace or adjust the equipment. But these prostheses may still need replacement with an adult model once a child stops growing.

Shoulder Girdle Surgery

After the limbs, the shoulder girdle (several major bones in the shoulder area) is the most common site for bone sarcomas. It’s now possible to avoid amputation and maintain function of the shoulder, arm, wrist, and hand, removing the cancer and using a prosthesis to reconstruct the bone and joint.

But the shoulder girdle is a very complicated area and requires an experienced and skilled team. Our surgeons are world leaders in performing this complex surgery.

Complex Sarcoma Surgeries and Revisions

Sarcoma surgery is particularly complex when it involves large tumors or hard to treat areas such as the pelvis and spine. Other centers (even some from around the country and the world) refer these cases to us because of our skilled orthopedic surgeons and their access to other MedStar Cancer Georgetown Network specialists.

This same experience is also useful for providing revision surgery—surgery to finish or redo a previous operation to correct problems or improve function, including for tumors that were only partially removed or have grown back.

Our team has a great deal of experience dealing with these cases and offers innovative solutions to very challenging problems. Many of the revision surgeries we perform are for patients who were treated at other institutions and then got referred to us.

Minimally Invasive Sarcoma Ablation

For some tumors, we destroy their cells with minimally invasive ablation—either heating them (radiofrequency ablation) or freezing them (cryosurgery). This is done after surgery or instead of surgery, with a needle-like probe, advanced imaging equipment, and collaboration between our orthopedic oncologists and interventional radiologists.

Chemotherapy

Chemotherapy drugs are swallowed or injected then travel through the bloodstream to kill cancer cells. They are used to shrink sarcomas before surgery or given afterward to make sure the cancer does not return or spread. In some cases, chemotherapy is given by itself to treat a tumor.

The type of chemotherapy depends on the type of tumor, its stage, and whether the cancer is newly diagnosed or has returned. Drugs are typically given together, and we are studying new medications, new combinations, and more effective ways of delivering them.

While we always try to minimize the side effects of chemotherapy, we are particularly sensitive to limiting toxic exposure as much as possible for children who are still growing.

Chemotherapy and Arterial Embolization

For certain sarcomas, we can inject chemotherapy drugs directly into the blood vessels that feed the tumor, to stop its growth and minimize the exposure of healthy tissue. This is called intra-arterial chemotherapy (IAC).

Radiation

Radiation therapy uses high-energy X-rays or other radiation to kill cancerous cells. When needed in sarcoma treatment, we use it with surgery or chemotherapy to shrink tumors or prevent cancer from returning . In some cases, radiation is used by itself—usually when surgery is not an option.

Radiation treatment depends on the type of sarcoma and the cancer’s stage. While we always try to minimize the side effects of radiation, we’re particularly sensitive to the vulnerability of children who are still growing. We try to limit doses and, whenever possible, avoid the therapy altogether.

Radiation therapy is getting safer and sparing more healthy tissue, though, thanks to specialized, focused beams of radiation, sophisticated computer programs, and advanced imaging.

Types

When needed, sarcomas are treated with external radiation delivered by a machine. We use two types:

  • Three-Dimensional Conformal Radiation Therapy (3D-CRT): Radiation beams are sculpted to a tumor’s particular shape—useful when they are irregular or close to healthy tissues and organs. We view the tumor in 3D and deliver radiation from several directions.
  • Intensity-Modulated Radiation Therapy (IMRT): Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue. This is particularly useful for tumors in hard-to-treat areas such as the spine or pelvis.

Targeted Therapy

Targeted therapy represents a new front in attacking cancer—drugs and other substances aimed at specific molecules that help tumors grow, progress, and spread. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells.

Targeted therapies may replace current sarcoma treatments, or complement them, and we are studying a number of new targets and approaches:

  • Growth Factor Receptors: Block proteins on some cancer cells that cause them to grow
  • Monoclonal Antibody: Replicates a natural antibody, then targets certain substances on cancer cells—either alone or with a drug, toxin or radioactive material to kill the cells, block their growth or keep them from spreading
  • Kinase Inhibitor: Blocks a protein cancer cells need for their division
  • Immune Modulators: Boost the body’s own immune system to fight cancer

Gastrointestinal Stromal Tumor (GIST) Treatment with Gleevac

The targeted therapy imatinib (trade name Gleevac) is already approved for treating gastrointestinal stromal tumors (GIST), a type of soft tissue sarcoma. Imatinib is typically recommended for a year after surgery to ensure the cancer does not return. It’s also used when tumors are too large for surgery, in attempt to shrink them and make them operable.