Treatment Options

Advanced Laparoscopic Procedures

By inserting a thin, lighted tube – called a laparoscope – through a small incision near the navel, physicians can perform many diagnostic and surgical procedures with reduced risk, discomfort and inconvenience to the patient.

Angiogenesis Inhibitors

What is angiogenesis?
Angiogenesis, the formation of new blood vessels, is a process controlled by certain chemicals produced in the body. Although this may help in normal wound healing, cancer can grow when these new blood vessels are created. Angiogenesis provides cancer cells with oxygen and nutrients. This allows the cancer cells to multiply, invade nearby tissue, and spread to other areas of the body (metastasize).

What are angiogenesis inhibitors and how do they work?
A chemical that interferes with the signals to form new blood vessels is referred to as an angiogenesis inhibitor.

Sometimes called antiangiogenic therapy, this experimental treatment may prevent the growth of cancer by blocking the formation of new blood vessels. In some animal case studies, angiogenesis inhibitors have caused cancer to shrink and resolve completely.

In humans, angiogenesis inhibitors are only used in clinical trials at this time. These drugs are still considered investigational. Research studies are now underway to help scientists learn whether the approach will apply to human cancers. Patients with cancers of the breast, prostate, pancreas, lung, stomach, ovary, cervix, and others are being studied. If the research studies demonstrate that angiogenesis inhibitors are both safe and effective for cancer treatment in humans, these drugs will need approval by the US Food and Drug Administration (FDA) to become available for widespread use.

Apheresis Unit

Apheresis, most commonly used in the treatment of leukemia and lymphoma patients, is a process used to obtain peripheral blood stem cells for transplantation. Blood is collected from the patient; part of the blood, such as platelets or white blood cells, is removed by a machine; and the rest of the blood is returned to the donor. The collected cells may be treated with drugs to destroy cancer cells before being frozen until they are transplanted back to the patient.

Biologic therapy

This treatment is used to stimulate or restore the ability of the immune system to fight infections and other diseases. It's also used to lessen certain side effects that may be caused by some cancer treatments. Biologic therapy may also be refered to as immunotherapy, biotherapy or biological response modifier (BRM) therapy.

Blood and Marrow Transplant

The Blood and Marrow Transplant (BMT) program at Ohio State's Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute has earned international recognition for advancements in treating cancer.

Visit our Blood and Marrow Transplant section to learn more.

Breast Reconstruction

If you have a mastectomy performed, reconstruction may be an option and can be discussed with your oncology healthcare team. Reconstruction can occur at the same time, or later, as in delayed reconstruction.

Some women decide to wear a breast prosthesis in their bra instead of having reconstructive surgery. This is an individual choice; what is right for one woman may not be right for another.

If you choose to have reconstructive surgery, your plastic surgeon will be involved during the treatment planning process, before any surgery, to assist in planning out the best approach.

Your plastic surgeon will help outline the many options for breast cancer reconstruction, including:

DIEP flap – This procedure uses skin and fat from the lower abdomen with minimal disruption to the muscle to create a breast.

TRAM procedure – This procedure uses part of the patient’s abdominal muscle (the transverse rectus abdominis muscle, or the “sit-up” muscle), fat and blood supply to create a new breast.

S-GAP flap – Similar to a DIEP flap, this procedure uses buttock tissue to create a breast.

Implants – Silicone and saline implants are relatively simple to insert post-mastectomy, but potential complications may lurk down the road, and implants are not recommended for women who require radiation treatments.

Ohio State currently has the only surgeon in Ohio who regularly performs the DIEP and S-GAP flap procedures. For more information on breast reconstruction at Ohio State, call (614) 293-8566.

Chemotherapy

Chemotherapy is the use of drugs to treat cancerous cells. Chemotherapy can be administered intravenously (in the vein) or by pill, and usually involves a combination of drugs. Chemotherapy treatments are often given in cycles: a treatment period, followed by a recovery period, followed by another treatment period. Chemotherapy may be given in a variety of settings including your home, a hospital outpatient facility, a physician's office or clinic, or in a hospital. Hospitalization may be necessary to monitor treatment and to control chemotherapy's side effects.

Chemotherapy for Prostate Cancer

What is chemotherapy?
Chemotherapy is the use of drugs to treat cancerous cells. Specific treatment for prostate cancer will be determined by your physician based on:

- your age, overall health, and medical history
- stage of the cancer
- your tolerance for specific medications and procedures
- expectations for the course of the disease
- your opinion or preference

Often chemotherapy is not the primary therapy for men with prostate cancer, but may be used when prostate cancer has spread outside of the prostate gland, or in combination with other therapies.

According to the American Cancer Society, chemotherapy is not effective against early prostate cancer. And although it may slow tumor growth and reduce pain, it also has had limited success for the treatment of advanced prostate disease.

How is chemotherapy administered?
Your oncologist will determine how long and how often chemotherapy treatments are necessary, if at all. Chemotherapy can be administered intravenously (in the vein) or by pill, and usually involves a combination of drugs. Chemotherapy treatments are often given in cycles: a treatment period, followed by a recovery period, followed by another treatment period.

Chemotherapy may be given in a variety of settings including your home, a hospital outpatient facility, a physician's office or clinic, or in a hospital. Hospitalization may be necessary to monitor treatment and to control chemotherapy's side effects.

What are the most common side effects of chemotherapy?
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Most side effects of chemotherapy disappear once treatment is completed. Common side effects of chemotherapy depend on the drug used, the dosage, and the length of treatment, and may include the following:

- nausea and vomiting
- hair loss
- anemia
- reduced ability of blood to clot
- mouth sores
- increased likelihood infection
- fatigue

Clinical Trials

What are clinical trials?
Clinical trials are studies, managed by government agencies, educational institutions, private not-for-profit organizations, or commercial businesses, to develop, produce, and evaluate the effectiveness of new treatments and therapies for diseases.

What are the risks and benefits of participating in a clinical trial?
Individuals who participate in research studies are given the opportunity to benefit from treatments that are not currently available to the general public, but have shown promise in previous research.

Risks from participating in a clinical trial vary depending on the study. It is important to understand that not all new treatments produce the desired effect.

Are there clinical trials for prostate cancer?
Several clinical trials to evaluate prostate cancer have been completed or are currently underway, including the following:

Prostate Cancer Outcomes Study
In 1994, the National Cancer Institute (NCI) started the Prostate Cancer Outcomes Study (PCOS) to investigate the impact of treatments such as radical prostatectomy (removing the prostate), radiotherapy, and hormonal therapy, versus no treatment for primary prostate cancer on the patients' quality of life. By looking at the health outcomes of prostate cancer treatments, the goal of the study is to provide patients, their families, and physicians information to make decisions about which treatment options are best for their situation. The results of this study are ongoing and will be published in various medical journals over the next few years.

PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial)
Sponsored by the National Cancer Institute (NCI), the goal of this 16-year study is to determine whether screening tests for prostate, lung, colorectal, and ovarian cancer will reduce the number of deaths from these cancers. Screening tests are medical tests designed to look for a disease in a healthy individual who has not yet developed symptoms of the disease.

Cancer Genetics Network (CGN)
In 1998, the National Cancer Institute (NCI) developed a national network of centers specializing in the study of inherited predisposition to cancer. A number of genetic issues related to cancer are being explored, including the following:

- How often are genetic mutations that predispose an individual to cancer found in various populations?
- If you have one of these mutations, why do some of these persons develop cancer, while others do not?
- Are there any environmental exposures that interact with these susceptibility genes to cause cancer?
- What are the issues - ethically, socially, psychologically - for individuals who carry cancer susceptibility genes?

The CGN is compiling a registry of families who have a significant number of relatives with various forms of cancer, in order to answer these questions.

SELECT (Selenium and Vitamin E Cancer Prevention Trial)
This largest-ever prostate cancer prevention clinical trial will examine whether either vitamin E or selenium protects against prostate cancer. Previous research indicated that selenium and vitamin E may reduce prostate cancer risk by 30 to 60 percent. The trial is sponsored by the National Cancer Institute. Study participants will be followed for seven to 12 years.

Where do I find additional information about participating in a clinical trial?
You can find a clinical trial taking place at The James on our Web site, or access additional information about clinical trials and ongoing research from the National Cancer Institute's Web site. Then, on their home page, type in the words "prostate cancer clinical trials" in the Search box.

Clinical Trials of New Therapeutic Agents

Ohio State's Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute uses many resources of The Ohio State University to develop or participate in clinical trials for the prevention, diagnosis and treatment of cancer. Through clinical trials, we can offer patients some of the most sophisticated cancer treatments available, including the latest drugs, radiation and other therapies. For more information, see the Find a Clinical Trial section of our Web site.

Corticosteroid therapy

Corticosteroids are steroids that have antitumor effects in lymphomas and lymphoid leukemias.

Distal Pancreatectomy

Removal of the body and tail of the pancreas.

Embolization

The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor.

Expectant Therapy - Watchful Waiting

What is expectant therapy?
Expectant therapy is to "watch and wait" while carefully observing and monitoring the prostate cancer. This may be recommended by your physician if the prostate cancer is in a very early stage, especially in the cases of older men with small tumors that are:

- expected to grow very slowly.
- confined to one area of the prostate.
- not causing any symptoms or other medical problems.

Because prostate cancer cells often spread very slowly, many older men who have the disease may not need more extensive treatment. However, expectant therapy usually includes routine physician examinations, including digital rectal examinations (DRE) and prostate-specific antigen (PSA) tests.

Gamma Knife & Stereotactic Radiosurgery

Stereotactic radiosurgery is a radiation therapy technique for treating brain tumors without surgery. A rigid head frame is used to help aim high-dose radiation beams directly at the tumors and not at normal brain tissue. One stereotactic radiosurgery technique is called a gamma knife.

Gamma knife surgery, a form of medical technology used to treat people with neurological disorders, was developed in Sweden in 1967. It has gradually gained acceptance and become more widely available in the past 20 years, and has been used to treat 70,000 to 80,000 individuals to date. The James Cancer Hospital and Solove Research Institute is the only central Ohio facility which offers gamma knife surgery.

The gamma knife is not actually a "knife," in the sense of a surgical blade. It is a method of administering high-dose radiation with surgical precision to a very specific area of tissue within the cranial region while affecting an extremely small volume of surrounding healthy tissue. Gamma knife surgery delivers a beam of gamma radiation (photon particles) from 201 distinct Cobalt 60 sources . The individual beams do not harm healthy tissue as they travel through the brain, but as they arrive at the abnormal target tissue, the concentration of all 201 beams has the capacity to destroy that tissue's ability to survive.

Hepatic Artery Infusional Chemotherapy

In hepatic artery infusional chemotherapy, drugs are given to the patient through a catheter inserted into the hepatic artery, the major blood vessel in the groin that leads directly to the liver.

Herbal Remedies for Prostate Cancer

What are herbal remedies?
Over the centuries, man has gone from a simple diet consisting of meats, fruits, vegetables, and grains, to a diet that often consists of foods rich in fats, oils, and complex carbohydrates. Nutritional excess and nutritional deficiency have become problems in today's society - both contributing to several chronic diseases. Many dietary and herbal approaches attempt to balance the body's nutritional well-being. Dietary and herbal approaches may include: dietary supplements and herbal medicine.

Herbal medicine or "herbal remedies" for treatment of prostate cancer have not been studied scientifically (in a randomized clinical trial, a highly regarded approach). In particular, combination herbal remedies currently on the market should be approached with caution, as reported side effects have included venous thrombosis (blood clots in veins), breast tenderness, and loss of libido (desire for sex.) For example, a popular supplement sometimes used by men with prostate cancer, called PC-SPES, was taken off the market after a warning by the US Food and Drug Administration (FDA) in 2002. PC-SPES was found to contain other prescription drugs that could cause serious health problems, according the American Cancer Society. In addition, many herbal preparations have not been studied in men with prostate cancer.

Are herbal remedies considered to be a form of complementary and alternative medicine?
Yes. Complementary and alternative medicine (CAM) encompasses unconventional approaches to healing, beyond standard medicine.

Standard/conventional medicine refers to medical treatments that have been scientifically tested, found to be safe and effective, and approved by the US Food and Drug Administration (FDA).

Complementary medicine is any form of therapy used in combination with other treatments. Complementary therapy usually serves to relieve symptoms and improve quality of life.

Alternative medicine is used alone, without recommended standard treatment.

Some people use complementary treatments to relieve symptoms or side effects while undergoing standard/conventional treatment (such as pain relief during cancer treatment).

Consult with your physician prior to utilizing any type of dietary or herbal supplements in the treatment or prevention of prostate cancer.

Hormone Therapy for Prostate Cancer

What is hormone therapy?
Produced mainly in the testicles, the male hormone testosterone causes prostate cancer cells to grow. Reducing testosterone levels can make the prostate cancer shrink and become less active.

The goal of hormone therapy is to lower the level of male hormones in the body, particularly testosterone. Hormone therapy does not cure the cancer, and is often used to treat persons whose cancer has spread or recurred after treatment. Most studies show that hormone therapy works better if it is started early.

What are the different types of hormone therapy?
There are several types of hormone therapy, including the following:

orchiectomy
the surgical removal of the testicles to prevent male hormones, ones that stimulate growth of the prostate cancer, from being produced.

LHRH (luteinizing hormone-releasing hormone) analogs
drugs that decrease the amount of testosterone produced in a man's body by interfering with the normal chemical signals sent from the pituitary gland in the brain to the testicles.

anti-androgens
substances that block the body's ability to use testosterone, because even after orchiectomy or LHRH-analog treatment, a small amount of testosterone may still be produced in the body. Other hormonal drugs may be used for periods of time during treatment.

What are side effects of hormone therapy?
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Possible side effects of hormone therapy for prostate cancer may include the following:

- hot flashes
- a degree of impotence (inability to achieve or maintain an erection)
- diminished libido (desire for sex)
- enlargement of the breasts

What is the duration of hormone therapy?
The duration of hormone therapy varies, but usually lasts a period of a few months, depending on the individual situation. Research presented at the 2000 American Society of Clinical Oncology meeting suggests that long-term hormone therapy (an additional two years) for those men who have locally advanced prostate cancer may control the disease better than short-term hormone therapy. Always consult your physician for more information regarding hormone therapy treatment.

Laparoscopic Partial Nephrectomy

The majority of kidney cancers today are being discovered incidentally when they are small and localized. For tumors that are less than 4 centimeters in size and in a favorable location, a partial nephrectomy (removal of the tumor without removing the kidney) is often considered the procedure of choice.

The traditional method to perform a partial nephrectomy requires a flank or abdominal incision 10 to 20 inches long and the removal of a rib. A newer technique, called laparoscopy, allows the same operation to be performed using small (one centimeter) incisions. The mass is removed from a one- to two-inch incision often hidden in the patient’s beltline.

Procedure
Three to four small cylindrical tubes called trochars are placed into the abdominal or retroperitoneal cavity. A video-telescope, called a laparoscope, is placed through one of the trocars. The laparoscope provides the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Specially designed laparoscopic instruments are placed through the other trochars.

This technique allows the surgeon to secure the renal vessels and excise the mass from the kidney with more accuracy and better visualization than traditional open techniques.

Results
Not only does the surgeon benefit from better visualization, but the patient also benefits from significantly less post-operative pain, a shorter hospital stay and faster recovery.

Several investigators, including the OSU James Cancer Hospital kidney cancer team, have compared laparoscopic partial nephrectomies to standard open partial nephrectomies. All investigators concluded that the pain medication requirement, length of stay in the hospital and time to return to work is significantly less in the laparoscopic group. For example, the typical hospital stay for a patient undergoing a traditional open partial nephrectomy is five days and return to baseline activities about two months. Using laparoscopic techniques, most patients go home within two days and are back to normal activities in less than a month. Finally, this minimally invasive technique provides a better cosmetic result.

Liver Transplant

Replacement of liver with a liver from another person. Replacement livers come from deceased donors.

Lymphedema Clinic at JamesCare Comprehensive Breast Center

The Lymphedema Clinic at the JamesCare Comprehensive Breast Center is devoted to preventing and treating lymphedema, a condition that sometimes occurs after the removal of lymph nodes during breast cancer surgery.

The JamesCare Comprehensive Breast Center offers an on-site physical therapist five days a week to work with patients on post-operative arm care and prevention of lymphedema. Our Lymphedema Clinic also features preventive education and complete physical therapy for the treatment of this condition.

The JamesCare Comprehensive Breast Center is conveniently located off SR 315 on the corner of Olentangy River Road and 3rd Avenue at 1145 Olentangy River Road. There is ample, free parking. To make an appointment, or for more information on any services, call the JamesCare Comprehensive Breast Center at (614) 293-0043.

The Center for Palliative Care

The Center for Palliative Care at The James offers consultation for controlling persistent pain and treatment of symptoms including fatigue, weakness, nausea and vomiting, constipation or diarrhea, depression, shortness of breath as well as psychological issues associated with chronic illness or disease.

The Pain and Palliative team consists of professionals from various specialties with expertise in disease process, treatment options and pain/symptom management. The team works together to ensure each patient receives the most appropriate, personalized treatment available.

For more information or to make an appointment, please call (614) 293-2957.

Robert M. Taylor, MD
Pain and Palliative Medicine
Medical Director

Michael D. Adolph, MD
Pain and Palliative Medicine
Associate Fellowship Director

Kristen Coller, MD
Palliative Medicine

Ellin Gafford, MD
Palliative Medicine

Jillian Gustin, MD
Palliative Medicine

Sharla M Wells-DiGregorio, PhD
Psychologist

Other Caregivers

Helen McCarthy, NP
Nurse Practitioner

Didi Loseth, RN, MA

Helen McCarthy, NP
Physician Assistant

Sharla Wells-DiGregorio, PhD
Psychologist

Contact

David D. Soland
Program Coordinator

Palliative Surgery

When pancreatic cancer has spread making it impossible to remove, surgical procedures can be done to ease symptoms and side effects of cancer. These procedures will not cure the disease but can improve the quality of life. Palliative surgeries include:

Surgical biliary bypass to enable a pathway if cancer is blocking the small intestine and bile is building up in the gallbladder.

Endoscopic stent placement to insert a stent (thin tube) to drain bile that has built up in the area.

Gastric bypass to allow flow of food from the stomach so the patient can continue to eat normally.

Partial Nephrectomy

A partial nephrectomy is a nephron-sparing procedure that removes a kidney tumor while leaving the non-cancerous part of the kidney intact. Long-term studies have shown that in appropriately selected patients the results of partial and radial nephrectomy are similar in terms of long-term survival. Partial nephrectomy can be performed with open or laparoscopic surgery.

Open partial nephrectomy
This involves an open flank or abdominal incision to localize the kidney. The tumor is located and removed while the rest of the kidney is left intact. The long-term results for cancer control have been favorable.

Laparoscopic partial nephrectomy
This involves the creation of small holes in the abdomen through which small cameras are passed to visualize and remove the tumor while leaving the rest of the kidney intact. Advantages include:

- Smaller incisions
- Less blood loss, transfusions
- Less pain
- Less narcotic intake
- Shorter hospital stay
- Faster recovery

Robotically assisted laparoscopic partial nephrectomy
The use of robotics in kidney surgery is becoming increasingly prevalent. The da Vinci surgical robot can be used to assist in laparoscopic kidney removal. The patient enjoys the benefits of laparoscopic surgery listed above, with additional benefits for the surgeon:

- Magnified three-dimensional visualization
- Miniature wristed surgical instrumentation
- Intuitive motion with tremor filtration and motion scaling

Photodynamic Therapy

Photodynamic therapy (PDT) is a two-part process that uses a combination of lasers and drugs to treat lung and esophageal cancers. The first step involves injecting the patient with a photosensitizing drug selectively absorbed by cancer cells. During surgery – typically two days after the injection – the surgeon inserts an endoscope carrying a flexible quartz fiber and places it near the tumor. When the laser is turned on, the light activates the toxic properties of the photosensitizing drug, killing the cancer through a chemical reaction.

Radiation Oncology

The Department of Radiation Oncology at The Ohio State University provides advanced personalized radiation oncology care to cancer patients, specific to their individual tumor and clinical situation.

Learn more in our section on Radiation Oncology

Radiation Therapy for Colorectal Cancer

Intraoperative radiation (IORT)
Radiation treatment aimed directly at a tumor during surgery.

3-D conformal radiation with CT planning
A procedure that uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible.

Intensity Modulated Radiation Therapy (IMRT)
A type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor.

Image-guided radiation therapy
the process of frequent two and three-dimensional imaging, during a course of radiation treatment, used to direct radiation therapy utilizing the imaging coordinates of the actual radiation treatment plan.

Radiation Therapy for Esophageal Cancer

Intraoperative radiation
Radiation treatment aimed directly at a tumor during surgery.

3-D conformal radiation with CT planning
A procedure that uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible.

Intensity Modulated Radiation Therapy (IMRT)
A type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor.

Image-guided radiation therapy
The process of using various imaging technologies to locate a tumor target prior to a radiation therapy treatment

Radiation Therapy for Prostate Cancer

What is radiation therapy?
Radiation therapy uses high-energy rays to kill or shrink cancer cells, and to decrease their ability to divide. Radiation is often used to treat prostate cancer that is still confined to the prostate gland, or has spread only to nearby tissue. If the disease is advanced, radiation may be used to reduce the size of the tumor and to provide relief from symptoms.

What are the types of radiation therapy?
There are generally two types of radiation therapy:

external radiation (external beam therapy)
a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. This type of radiation therapy may be given daily for several weeks.

internal radiation (implant therapy)
a procedure that uses small, radioactive seeds (each about the size of a grain of rice) that are implanted directly into the cancerous prostate tumor. The implanted seeds may be left in permanently or may be only temporary. The seeds emit small amounts of radiation for a period of weeks or months.

What are side effects of radiation therapy?
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.

Possible side effects of external beam radiation therapy for prostate cancer may include the following:

diarrhea (with or without blood in the stool) and colitis

problems associated with urination

a degree of impotence (inability to achieve or maintain an erection), which may occur within two years of radiation therapy

fatigue, especially during the later weeks of treatment

Possible side effects of internal radiation therapy for prostate cancer may include the following: slight bleeding soon after the seeds are placed

occasional loss of the seeds when urinating

irritation of the rectum

Radical (Total) Nephrectomy

A radical nephrectomy is the complete removal of an affected kidney with the surrounding tissue, including the fat, adrenal gland, lymph nodes and Gerota’s fascia. This is currently the gold standard for removal of kidney tumors and can be performed in several ways:

Open radical nephrectomy
Removal of the kidney via a large flank or abdominal incision.

Laparoscopic radical nephrectomy
The majority of renal tumors these days can be removed laparoscopically using small incisions and cameras to visualize and remove the kidney intact. The same kidney specimen is delivered as with the open procedure, and the long-term cancer control results are no different. The advantages to the patient include:

- Smaller incisions
- Less blood loss with no need for blood donation or transfusion
- Less pain
- Less narcotic usage
- Earlier discharge home
- Earlier ambulation
- Faster recovery

Robotically assisted laparoscopic radical nephrectomy
The use of robotics in kidney surgery is becoming increasingly prevalent. The da Vinci surgical robot can be used to assist in laparoscopic kidney removal. The patient enjoys the benefits of laparoscopic surgery listed above, with additional benefits for the surgeon:

- Magnified three-dimensional visualization
- Miniature wristed surgical instrumentation
- Intuitive motion with tremor filtration and motion scaling

Radiofrequency Ablation

Radiofrequency ablation (RFA) is a procedure in which a surgical oncologist uses a small probe to deliver heat from radiofrequency energy to kill cancerous tissue. The procedure is used to treat liver, prostate, renal, bone and breast cancer.

RFA can be a valuable alternative to surgical kidney removal for cancer patients with multiple tumors, limited kidney function or only one kidney, or for patients who cannot risk surgery because of other health problems. The use of ultrasound and laparoscopic guidance, combined with impedance (resistance to electrical current) and temperature monitoring, allows for a safe, effective ablation.

Benefits of RFA include a shorter recovery time and less pain than experienced with surgery.

Radioisotope (Radioiodine) Therapy

A radioactive form of iodine is often used as a treatment for thyroid cancer and some other cancers. For treatment of thyroid cancer, the patient takes a large dose of radioactive iodine, which kills thyroid cells. Radioactive iodine is also used in internal radiation therapy for prostate cancer, intraocular (eye) melanoma and carcinoid tumors. The radioactive iodine is given by intravenous infusion or in seeds which are placed in or near the tumor to kill cancer cells.

Renal Ablation

Renal ablation destroys the tumor on the kidney using minimally invasive nephron-sparing techniques. The tumor is localized and treated with energy that kills the tumor cells while leaving the surrounding tissue intact and functioning. This results in preservation of the rest of the kidney while the tumor is destroyed.

The technology is relatively new and is currently only performed in select centers that have experience with ablative technologies. Short-term results have been promising and have provided a new surgical treatment option to patients that desire not to have the whole kidney removed. Currently, there are two main types of renal ablation:

Radiofrequency Ablation
This involves laparoscopic and/or radiographic localization of the kidney tumor, followed by delivery of heat via a small percutaneously placed needle. This allows heating of the tumor and ablation of the cancerous cells.

Cryoablation
This involves laparoscopic and/or radiographic localization of the kidney tumor, followed by freezing the tumor with percutaneously placed needles. This allows cooling of the tumor and ablation of the cancerous cells.

Both of these procedures are monitored in real time via temperature probes, visually and with the use of ultrasound. Recent experience shows that the procedures are safe and effective for treatment of renal tumors. Further long-term study is ongoing.

Robotic Gynecologic Surgery

Physicians at The James are using robotic instrumentation to perform hysterectomies and lymph node dissections for treating uterine cancer as well as radical hyterectomies and lymph node dissections for patients with cervical cancer.

Robotics have been used in heart and prostate surgeries for years, but now the federal Food and Drug Administration has approved the minimally invasive technique for treatment of gynecological disorders, including hysterectomies (removal of the uterus) and myomectomies (removal of uterine fibroids).

Typically, these procedures have required large abdominal incisions, resulting in blood loss, pain and scarring – and a lengthy recovery period.

With the da Vinci robotic system, patients can expect to have a shorter hospital stay and a faster overall recovery, often within two weeks instead of six weeks. There is much less blood loss, pain and scarring, and less risk of infection with this surgery.

The da Vinci is a refrigerator-sized robot with arms that allow surgeons to perform precise and delicate movements with tiny surgical instruments. Just a few small incisions, rather than a major incision, are needed to accommodate the miniaturized robotic instruments and tiny camera inserted in the patient’s abdomen.

The multilens camera provides a magnified, three-dimensional image of the internal organs, enabling the surgeon to watch the surgery on a monitor at an adjacent workstation while manipulating joysticks to precisely control the surgical instruments.

Robotic Nephrectomy

The kidneys are located in the posterior abdomen and are responsible for filtering urine from the blood. Surgery is the most common treatment for kidney cancer.

The da Vinci Surgical System used at the OSU James Cancer Hospital and Solove Research Institute enables our surgeons to perform three types of robotic nephrectomies:

Robotic partial nephrectomy
is a procedure to remove a small tumor from the kidney, without removing the entire kidney.

Robotic simple nephrectomy
is the total removal of a kidney when it becomes a chronic problem or loses its function.

Robotic radical nephrectomy
is the removal of the kidney with all the surrounding fat, fascia and the adrenal gland.

All three procedures use minimally invasive techniques, such as operating through tiny ports. The robot allows great precision in disconnecting large blood vessels from the kidney, which is a vital part of the operation.

Robotic Prostatectomy

Robotic prostatectomy is the most advanced surgical option for qualified prostate cancer patients. In this minimally invasive procedure, surgeons remove cancerous tissue with less disruption of surrounding healthy tissue and with less blood loss than traditional open surgery.

Visit the Robotic Prostatectomy section to learn more.

Stem cell transplantation

This is a method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

Stereotactic radiosurgery

Stereotactic radiosurgery is another way to treat brain tumors. An MRI or CT scan is used to pinpoint the exact location of the tumor, and the treatment is given in one session. High-energy rays are aimed at the tumor from many angles. A high dose of radiation reaches the tumor without damaging other brain tissue. This may be referred to as the gamma knife.

Surgery for Spine Tumors

Surgery is sometimes a treatment options for spine tumors. The type of surgery that your doctor recommends will depend on the type of tumor, the location, and the symptoms you are experiencing.

If you have weakness, numbness of paralysis of arms and legs, change in bladder or bowel function, an open surgical procedure may be necessary.

Closed Procedure:
Vertebroplasty – a needle is injected with special cement into the vertebral body damaged by the tumor.

Open Procedures:
An open procedure can include some or all of the following procedures. Your surgeon will provide a full explanation of the planned surgery during your appointment.

Decompression:
to remove bone that has the tumor and to increase the space around the spinal cord and nerves.

Stabilization:
application of screws, rods, or cement to stabilize the spinal column. This can be done through an incision in your back, alone, or may require an incision in your back and in your abdomen. This will depend on your tumor and your surgeon’s decision of the best way to achieve the stabilization needed.

Combination:
both of the above procedures; may be staged one or more days apart.

Surgery Options for Esophageal Cancer

Esophagectomy
An operation to remove a portion of the esophagus

Esophagogastrectomy
Surgery to remove the esophagus and part of the stomach. The esophagus is then replaced in one of two ways: by moving the remaining portion of the stomach upwards, or by replacing it with a section of the large bowel (colonic reconstruction). Lymph nodes near the esophagus may also need to be removed.

Surgical Oncology

The Ohio State University Division of Surgical Oncology offers a wide variety of services aimed at providing state-of-the-art care to cancer patients. The surgical oncology physicians are trained in general surgery, have been certified by the American Board of Surgery, have received additional training in surgical oncology and are active members in the Society of Surgical Oncology.

Surgical Options for Colorectal Cancer

Local excision
Surgery to cut out the cancer and some healthy tissue around it

Resection
A procedure that uses surgery to remove tissue or part or all of an organ

Resection and colostomy
Surgery to remove tissue or part or all of an organ. A colostomy creates an opening into the colon from the outside of the body. It provides a new path for waste material to leave the body after part of the colon has been removed

Radiofrequency ablation
The use of electrodes to heat and destroy abnormal tissue

Cryosurgery (cryoablation)
A procedure in which tissue is frozen to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide.

Surgical Options for Liver Cancer

Surgical options for liver cancer include: cryosurgery (freezing or destroying abnormal tissue); partial hepatectomy (removing part of liver where cancer is found); and radiofrequency ablation (using a special probe with tiny electrodes that kill cancer cells).

Surgical Options for Prostate Cancer

What are the different types of surgery for prostate cancer?

The following are some of the different surgical options used to treat prostate cancer:

Open Retropubic Radical Prostatectomy
an open-surgery procedure in which the entire prostate gland and some tissue around it are removed. This surgery involves an incision in the abdomen.

Robotic Prostatectomy
very precise surgery performed through five small incisions in the abdomen. This procedure also removes the entire prostate, but offers many benefits for the patient.

Cryosurgery
a procedure that involves killing the cancer by freezing the cells with a small, metal tool placed in the tumor.

Thalidomide Therapy

Thalidomide is a drug that prevents the growth of new blood vessels into a solid tumor.

Total Pancreatectomy

Surgery to remove the entire pancreas. Part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen and nearby lymph nodes also are removed.

Vertebroplasty

Vertebroplasty is a procedure that helps ease pain, improves mobility, and keeps patients from having surgery with compression fractures. The procedure involves injecting bone cement into the spine bones to reinforce collapsing vertebrae. The bone cement, which is also used in joint replacements, quickly hardens inside the vertebra. This gives strength to the vertebra.

While this procedure cannot restore the original shape to the crushed vertebra, it prevents further collapse of the bone. Patients often have significant pain relief.

Whipple Procedure

A type of surgery used to treat pancreatic cancer. The head of the pancreas, the duodenum, a portion of the stomach and other nearby tissues are removed.

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) 460 W. 10th Avenue, Columbus, OH 43210 Phone: 1-800-293-5066 | Email: jamesline@osumc.edu