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Types of Cancer

In order to provide optimal care for our patients, staff at the Juravinski Cancer Centre are organized into Disease Site Teams. These teams include:

  • Breast Cancer
  • Lung Cancer
  • Head and Neck Cancer
  • Gastrointestinal Cancer
  • Gynecological Cancer
  • Genitourinary Cancer
  • Cancers of the Central Nervous System
  • Hematological Cancers (Leukemia, Lymphoma)
  • Sarcoma
  • Melanoma and Skin Cancer

Each team is made up of professional staff from a number of disciplines with expertise in diagnosing and treating specific cancers. Members of these multidisciplinary teams include surgeons, medical oncologists, radiation oncologists, nurses, radiation therapists, pharmacists, social workers, nutritionists, and psychiatrists. Care provided by the members of the Disease Site Team is coordinated with family physicians and other community services in order to ensure patients are supported throughout their cancer journey.

For information on clinical trials available, please visit cancertrialshamilton.ca.

Breast

The Breast Disease Site Team (DST) exemplifies the finest principles of teamwork in cancer care. Members of the team have led the country in setting standards for care, have developed innovative ways of involving patients in shared decision-making, and have developed extremely successful after care and outreach programs in direct response to needs expressed by patients.

The DST is made up of a wide range of experts including:

  • Medical Oncologists
  • Radiation Oncologists
  • Surgical Oncologists
  • Radiologists
  • Nurses
  • Plastic Surgeons
  • Pathologists
  • Social Workers
  • Physicians specializing in Genetics
  • A Genetic Counselor
  • Dieticians
  • Pharmacists
  • Residents
  • Radiation Therapists
  • Clinical Research Assistants

The team meets weekly to review and collaborate on complex cases to determine the best treatment for patients. The team also meets once a month via video conference with other physicians and healthcare professionals from hospitals across the LHIN, including Joseph Brant Memorial Hospital, Niagara Health System, Brantford General Hospital and Norfolk General Hospital. These video-case conferences present an opportunity for the team to provide input on complex cases and learn about new treatments, research and advances in breast cancer care. This regional approach to care also means that all breast cancer patients from across the LHIN receive the same standard of care.

Gastrointestinal

The Gastrointestinal (GI) Disease Site Team is focused on the care of patients diagnosed with or suspected of having malignancies of the esophagus, Gastroesophageal junction, stomach, liver, pancreas, bile duct, small bowel, colon, rectum, anal canal, neuroendocrine tumours and other rare cancers of the gastrointestinal tract.

We are leaders in clinical and health services research, education and knowledge transfer both locally and nationally. Our multidisciplinary team is committed to providing evidence-based treatment and management through potentially curative therapies and symptom control including surgery, radiation therapy and chemotherapy.

Typically, all patients will be referred to an Oncologist who specializes in gastrointestinal cancer. Patients will be seen either by a Radiation Oncologist, Medical Oncologist or Surgical Oncologist or combination of specialties, depending on the treatment required.

Patients are followed by their Oncologist and a primary care nurse who is specially trained to provide care and support. Your primary care team will provide individualized care with opportunities to participate in research and clinical trials as available.

In addition, you and your family can also access supportive care services which include psychosocial support, pain and symptom management, dieticians, genetic counseling, chaplaincy services, as well as an onsite Aboriginal Navigator.

Depending on the care plan for each patient, treatment for GI cancers may include one or more of the following:

  • Multi-disciplinary clinic
  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Concurrent treatment
  • Clinical trials
  • Genetics clinic

Genitourinary

The Genitourinary Disease Site Team is a multidisciplinary team caring for patients with urological cancers. The team consists of surgical, medical and radiation oncologists, oncology nurses, social workers, dietitians, radiation therapists, dosimetrists, physicists, clinical trials nurses and a dedicated new patient referral clerk.

All disciplines work together to provide an individualized treatment plan for each patient in the safest and most effective way.

The G.U. Disease Site Team treats patients suspected with or diagnosed with cancers of:

  • Prostate
  • Testis
  • Kidney
  • Bladder
  • Penis
  • Other rare G.U. cancers (ureter, urethra)

Treatments & Services

At the JCC we have a Multidisciplinary Genitourinary Team that works with patients in the care of prostate, testis, kidney, bladder, penis and other rare GU cancers. This collaborative approach provides patients with the opportunity to obtain several consultations with multiple specialties on the same visit.

Our specialized clinical service and programs include:

  • Bladder Cancer
  • Low Risk Prostate Cancer
  • High Risk Prostate Cancer
  • Kidney Cancer Clinic

Gynecologic Oncology

The Gynecologic Oncology team specializes in the care of women with gynecological malignancies including:

  • Uterine
  • Ovarian/Primary Peritoneal/Fallopian Tube cancers
  • Cervical
  • Vulvar
  • Vaginal
  • Gestational Trophoblastic Disease

Treatment modalities may include surgery, chemotherapy and/or radiation therapy based on the most current literature and Best Practice Guidelines.

Members of the team include physicians, nurses, pharmacists, social workers, clinical trials nurses, radiation therapists, supportive care and administrative support.

The members of the team interact frequently with hospital-based experts with special interest in the management of Oncology related issues. These include experts in pathology, radiology, internal medicine, infectious disease, and laboratory medicine.

We offer minimally invasive surgical (MIS) procedures such as laparoscopy for appropriate indications, as well as fertility sparing procedures where possible.  An example is Radical Trachelectomy for select early invasive cervical cancer patients.

Our radiation department allows the delivery of highly specialized treatment including IMRT (Intensity Modulate Radiation Therapy) for patients that require external beam boost and HDR (High Does Rate) Brachytherapy to optimize cure and minimize potential side effects.

Our provision of care services a population of over 2 million in our area, with regular on-site satellite participation in the care of women from Thunder Bay.

In Hamilton, daily clinics are held within the centre to screen, diagnose, treat and care for patients along their journey.

Hematology

The Hematology Disease Site Team focuses on the special care of people living with hematological cancer (cancer involving the blood and/or bone marrow). This team is made up of Hematologists and many nurses. This team works together to provide the best care to all patients and you could see them:

  • in the ward
  • in the outpatient and inpatient clinics
  • as a part of Oncology Day Services
  • in the Stem Cell Unit

For more information, please visit the Hematology page.

Head & Neck

All new patients are seen and assessed in our  clinic before developing any formal decisions. This clinic is held every Friday morning at the JCC between 9 a.m. and 12 noon.

It is important to note that your new patient appointment will last all morning. We encourage patients to bring family members to your appointments. We also ask that you bring all of your medications, including any vitamins or minerals you are taking.

Our team is comprised of surgical oncologists, radiation oncologists, medical oncologists, advance practice nurse, oncology nurses, radiation therapists, dietitians and social workers.

Our Supportive Care Department is very important part of our team. Supportive Care is comprised of dietitians, social workers, psychiatry, pain and symptom management and our palliative care team. We draw on their expertise regularly to assist with patient care.

The choice of the most appropriate management for any patient with head and neck cancer is a decision unique to the individual’s circumstances. There are many factors that need to be taken into account including:

  • site, stage and type of cancer;
  • the patient’s general medical condition;
  • specific contra-indications to any of the major treatment modalities; and
  • individual patient’s and family’s wishes.

Treatments and Services for Head & Neck Cancers

Head and Neck Cancers can originate in several different sites within the head and neck area, but generally treatments are similar. Localized cancers are usually treated with either surgery or radiation.

Patients with more extensive disease, for example, those with larger tumours or those that have lymph node involvement are usually treated with a combination of surgery, radiation and/or chemotherapy.

Specific resources for patients will be provided in educational packages given during clinic appointments and during teaching sessions prior to treatments.

Mycosis (CTCL)

Cutaneous T-Cell Lymphoma (Mycosis Fungoides) is a very rare lymphoma of the skin. Radiation therapy is one of the primary treatment options and delivery of this treatment is very specialized. As such, the Juravinski Cancer Centre (JCC) is one of only two facilities in Canada that offer Total Skin Electron Beam Radiation to patients with Mycosis Fungoides.

The JCC works closely with Dermatologists at Women’s College Hospital and Hematologists at Sunnybrook Hospital to provide the optimum evidence based treatment for patients. Patients may be asked to travel to Toronto to see one of the specialists there.

Our team at the JCC is comprised of Radiation Oncologists, Radiation Therapists, Registered Nurses and Supportive Care. Mycosis Fungoides is very hard to diagnose because it can look like other skin diseases. It often takes several biopsies over several years to confirm the diagnosis. This is why the JCC requires two independent pathology reviews before we can see a new patient.

As many of our patients come from across the province and the country, the initial consultation with the Radiation Oncologist is often through a teleconference which saves our patients a trip to Hamilton. Once you and your Radiation Oncologist have agreed to proceed with Total Skin Electron Beam Radiation, we will work closely with you to find accommodation and support while away from home.

Neuro-oncology

The Neuro-Oncology Team is provides care to patients who are diagnosed with or suspected of having central nervous system tumours. These are tumours that involve the brain and spinal cord and include both malignant and benign tumours.

Patients are seen in our multidisciplinary clinic which has representation from medical oncology, radiation oncology, neurosurgery and oncology nursing.We are also actively involved in clinical trials and research. Patients may have the option to participate in these studies if there is an opportunity.

Supportive Care Services such as social work, mental health, nutrition, drug access facilitator, pain and symptom management, spiritual and religious care and palliative care are also available and accessible to patients and their families at any point during their care journey.

The Neuro-Oncology Team at the JCC is committed to applying evidence-based best practices and standards according to Cancer Care Ontario’s Program in Evidence Based Care to all patient care plans.

Individualized care plans may include one or more of the following:

  • Surgery
  • Chemotherapy
  • Radiation therapy – including Intensity Modulated Radiation Therapy (IMRT), which is a new technique that focuses the radiation on the tumour and preserves the surrounding normal tissues, during the usual 3 to 6 weeks of treatment
  • Stereotactic Radiosurgery (SRS) and Stereotactic Radiation Therapy SRT) are very focused techniques for small tumours where the radiation can be given in one (SRS) or several (SRT) treatments

Neuro-oncology Tumour Management

Sarcoma

The Sarcoma Disease Site Team is a multi-disciplinary team consisting of surgical oncologists, orthopedic oncologists, radiation oncologists, medical oncologists, specialized primary nurses, pathologists, radiation therapists, physicists, radiologists and dedicated support staff, including a new patient referral clerk and pharmacist. A clinical trials nurse also helps the team in coordinating patient enrollment in sarcoma related clinical trials and research.

Patients with Sarcoma are seen in the sarcoma clinic weekly. Weekly multi-disciplinary rounds are held to provide a forum for the team to discuss any new patient cases, review pathology and decision-making regarding potential treatments and to discuss the care of patients currently receiving treatments.

What is Sarcoma?

Sarcomas are malignancies that arise in soft-tissue and bone. They are rare tumours that affect all age groups and may arise in any part of the body.

The goals of sarcoma management include both cure and functional preservation of involved or adjacent organs and critical structures. A primary focus of recent research into sarcoma management is on the investigation of the optimal combination and sequencing of these different treatment modalities including radiation, surgery and chemotherapy. In addition, the use of more limited surgery and improved reconstructive techniques has increased the preservation of function, while maintaining a high level of local tumor control.

Treatment Management of Sarcoma

Sarcomas present unique challenges in provision of optimal cancer care.

Management is usually both complex and multidisciplinary by virtue of the anatomy, natural history of the disease, and the vast number of tumour types that can originate in the mesenchymal (ie: middle tissues) tissue. These include tumours originating in fat, bone, fibrous tissue, blood vessel structures, cartilage, nerves and muscle.

The diversity of sarcoma tumour subtypes requires that treatment be highly individualized.

Ultimately, complete surgical removal of the tumour with a margin of normal tissue is the most important treatment. Additional therapy pre or post operatively for most high grade tumours is often necessary.

Skin

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