Jefferson University Hospitals

Frequently Asked Questions

Does my insurance cover blood and marrow transplants?

We recommend each patient go through the following steps with their insurance company.  While we are available to assist, many insurers will only provide this information directly to their patients.

Step 1: Contact your insurance provider to determine if they cover stem cell transplants.

Typically the member service number is provided on the back of your insurance card.  Once you are in contact with a customer service representative, verify that they are able to provide you information on your benefits and simply ask if your plan provide coverage for stem cell transplants.  You may be assigned a case manager to assist you in the pre-transplant process.

Step 2: Request a detailed summary of your benefits.

If you do not already have a summary of your covered benefits, request a full detailed version for your records.  This will assist you in understanding what you are responsible for throughout the transplant process, from tests, imaging, and pharmaceutical products.

Step 3: Ask detailed questions on your plan.

The following questions are helpful in determining the details of your insurance plan:
    • Am I covered for stem cell transplant for my diagnosis?
    • Does my policy restrict where I can receive care? Is Jefferson in my provider network?
    • Does my policy have a deductible and coinsurance amount? If so, for what and how much?
    • Does my policy have co-payments? If so, for what and how much?
    • Does my policy have co-payments for prescriptions? If so, for what and how much?
    • Is there a yearly or lifetime maximum amount of out of pocket expenses that I would be responsible for? If yes, how much? What costs are included in this amount?
    • Are there any coverage exclusions in my policy? If yes, how long is coverage excluded?
    • Does my policy cover unrelated transplants for my diagnosis?
    • Does my policy cover expenses for testing to find a matched donor?
    • Are there any limits or exclusions for my donor coverage?
    • Does my policy limit the number of transplants I can receive in a lifetime?
    • Is pre-authorization required for pre-transplant testing?
    • Is pre-authorization required for treatment? If so, to whom should the request be sent?
    • Does my policy cover indirect expense for me, my family/caregiver, such as travel, food, and lodging costs while I receive care? If so, how much?
    • If I have a complaint, or want to appeal my coverage, how do I do that?
Step 4: Contact Theresa McNeil, 215-955-9384, for an initial insurance discussion.

Theresa will be your insurance company's primary contact at Jefferson during the transplant process and will work to make sure your care is properly covered according to your benefits.

Is surgery the only treatment needed?

When a polyp is removed by colonoscopy, it is usually the only treatment needed.

For colorectal cancer, surgery is the normal treatment and is often the only treatment needed when the cancer is detected early. In some cases, your specialist can remove the cancer using colonoscopy. Often, an open surgical procedure will be required. Treatment may also include radiation therapy before, during or after surgery; chemotherapy after surgery; or immunotherapy to strengthen the body’s immune system so it can attack and destroy cancer cells. These cancer treatments may be given separately or in combination. Your doctor will recommend the treatment methods best for you, depending on the size of the tumor, the stage of malignancy and whether it has metastasized, or spread, as well as other factors

If I have colorectal cancer, will I have to have a colostomy?

Usually not. Surgeons can almost always treat colon cancer by removing the cancerous part of the colon and joining the remaining two ends together. Other times, a procedure called a colostomy may be needed. In this surgery, the cancerous part of the bowel is removed, after which the surgeon creates an artificial opening in the abdomen, bypassing the lower colon and rectum for the elimination of body waste. The waste is collected in a special bag attached to the opening.

Usually, a colostomy is only temporary, to give your bowel time to heal. In fact, thanks to new medical and surgical developments in recent years, the need for permanent colostomies has been significantly reduced. Today, even patients with rectal cancer, whose only choice in the past was usually a permanent colostomy, have other options. Preoperative radiation therapy and innovative surgical techniques can treat cancer in the lower rectum without jeopardizing the natural function of the muscles that control bowel habits, thereby dramatically reducing the likelihood of needing a colostomy.

Will I have to come back after treatment?

Once you have been treated for polyps or, especially, colorectal cancer or its precursors, you must remain vigilant. Your doctor will want to use blood tests, as well as other screening tests described above, to watch for any reoccurrence, suspicious areas or warning signs of any additional cancer.

Can you tell me a little about the Infusion Center?

The Center features spacious, light-filled treatment bays, individual flat-screen TVs and relaxing décor. There are 20 reclining chairs in the unit along with chairs for anyone who may have accompanied you. There are curtains around each unit that can be used for privacy.

The Infusion Center tends to be cold. We can provide blankets if you are feeling chilly or feel free to bring a blanket from home if it will make you feel more comfortable.

Laptops and cell phones are permitted and can provide instructions on how to connect to the Internet through our Hospital Wi-Fi system, JeffGuest.

Can I bring a family member with me?

On the day of treatment, we encourage you to bring one family member or friend with you. Depending on the length of treatment and medication administered, you may be too tired to drive home. Please understand that many of our patients are at an increased risk for infection from viruses due to compromised immune systems. It is for this reason that a strict policy has been implemented that no children under the age of 16 may be permitted in the Infusion Center unless they are receiving treatment themselves.

Am I allowed to eat before treatment?

There are no restrictions on what you can eat on the day of treatment and you can eat anything during the treatment process. You can bring in your own food or eat what is provided by the Infusion Center. We have snacks, juices, coffee, tea and sodas available at all times and sandwiches are available at lunchtime.

There are also many places outside of the Infusion Center where you may purchase food.

Am I allowed to take my medications on the day of treatment?

If you are taking any prescription medications for any conditions, you are permitted to take those on the day of treatment unless your oncologist has instructed otherwise. If you are unsure, contact your doctor.

Where can I park?

Valet parking is available on 10th street between Market and Chestnut Streets in the Rothman Building. The cost of parking is dependent upon the length of stay. Your parking ticket will be validated at the end of your stay and costs can range anywhere from $2.00 to $4.00. You may also self-park in the Laz Parking Garage on 10th and Chestnut Streets.

What is the check-in process at the Infusion Center?

Upon arrival you will check in on the 2nd floor. At the reception desk, you will see a computer monitor and you need to enter your name in the computer and take a seat in the waiting room. If you have any questions on how to do this, one of the receptionists can help you.

Within a short time, someone will call your name and you will be asked to verify your identity and contact information some questions and asked to provide copies of insurance cards, referrals if needed and any co-pays to complete your registration.  Once you have completed the registration process, you take a seat in the waiting room until your name is called to have your lab work done. If you do not have a port, you will be brought back to have a phlebotomist or nurse draw your blood.

If you do have a port, you will be taken into the Infusion Center to have your labs done via your port by an assigned registered nurse.

If you are seeing your physician on the same day of your treatment, you will do that after your labs have been drawn. The physician offices are located on the 3rd or 4th floors.

Once you have completed your physician visit, you will come back to the Infusion Center where you will be seated and treatment will begin.

What lab work will I need done?

Your physician will order blood work to be drawn prior to each treatment to ensure that your lab values are within range to proceed with treatment. Labs will either be drawn from our highly skilled phlebotomists or by a registered nurse if you have an infusaport.

Once the labs are drawn and sent to the lab, it will take approximately 60 to 90 minutes for your physician to get the results. We encourage: You can ask your doctor to have your lab work done several days prior to treatment to avoid the wait time and to speed up your treatment process.

How long can I expect my treatment to take?

The length of your treatment is dependent on the type of chemotherapy your physician has ordered based on your type of cancer.

On your first visit, your chemotherapy is mixed specifically for you and your type of cancer at our onsite pharmacy. The pharmacist does not start mixing the chemotherapy until they receive a checklist from your assigned nurse.

This checklist contains your lab results and weight, which needs to be a certain range for you to receive treatment. If the lab values and weight are acceptable, the pharmacist will mix the therapy. This process can take approximately 30-60 minutes depending upon the type of chemotherapy you are receiving.

Overall you can expect to be there anywhere from an hour to several hours.

Will I need an IV to receive treatment?

When you come in for your treatment a registered nurse will be assigned to you. They will determine whether you require an IV or if you have a port that needs to be accessed.

What happens if I miss my appointment?

If you miss your appointment, please be sure to notify your physician so you can be rescheduled for another time. Please contact your physician’s office directly to reschedule.

What if I am running late for my appointment?

If you are running late, please notify the front desk. The telephone number is 215-955-8874. You will not be cancelled but you may be delayed in being seated.

How many times will I need to receive chemotherapy treatments?

Your physician will discuss your treatment and determine how often you will need to receive treatment. Depending upon your type of cancer, a chemo cycle could be every week, every two weeks or every three weeks.

What is a Complete Blood Count (CBC)?

This is a lab value that helps your physician determine if you are able to receive treatment. It looks at your white blood count, hemoglobin (the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.)  and platelets (important for blood clotting). If any of these values are extremely low, treatment may be delayed and you will be rescheduled in a week or so to give your counts time to recover.

If your white blood count is too low, you may receiving an injection that will boost your count to prevent you from developing an infection or your physician may put you on antibiotics. If your hemoglobin level or  platelet count are too low, you may require a blood transfusion.

Where do I go for blood transfusions if I need one?

If you need a blood transfusion because of a low hemoglobin level or platelet count, a blood specimen is drawn and sent to the Blood Bank so that they can match your blood type.

Once your blood type is matched, a bag is prepared and we are notified that it’s ready. Your physician may order pre-medication (Tylenol or Benadryl) prior to the infusion to avoid a possible blood transfusion reaction. Typically the doctor will order 2 units.

This entire process can take up to 4 hours.

What if I have a problem after I get home?

If you have any issues after you receive your treatment please call 215-955-8874 and you will be directed on what to do.

If it is an emergency, please call 911 immediately or go to the nearest hospital.

What are the side effects of chemotherapy?

You may experience some side effects after receiving your treatment. The most commonly reported symptoms are nausea, vomiting, diarrhea, hair loss, peripheral neuropathies, and fatigue. Before your treatment begins, you will be given anti-nausea medications, which will help you during your stay.

It’s important to remember that everyone is different and you may experience none of these effects, some or all. It’s important to share the side effects with your physician who may be able to help you manage the side effects with medications. If your symptoms are severe, please contact your physician immediately.

Also, the Jefferson-Myrna Brind Center of Integrative Medicine offers an Integrative Cancer Care Program that provides complementary therapies such as vitamins, special diets, herbs and acupuncture that may help with some of your symptoms.

You also have access to oncology social workers who are trained in individual and family therapy and are available to meet with you to assist with the psychosocial impact of cancer treatment, and can provide a valuable link to available community resources.

I understand I may lose my hair after treatment. Where can I purchase a wig?

Jefferson's Wig Program for Cancer Patients was created to help ease the stress and/or embarrassment of sudden hair loss experienced by our patients. If you are being treated for cancer, either as an inpatient or an outpatient at Jefferson, and you have hair loss, we are happy to provide you with a free synthetic wig, turban or hat.

To make an appointment, place call Patient Services at 215-955-7777 or 5-7777 (from inside the Hospital).

What is leukemia?

Leukemia occurs when abnormal white blood cells accumulate in the blood and bone marrow.

There are two main types of leukemia:

  • Lymphocytic leukemia is marked by an increased number of white blood cells called lymphocytes. These cells are made chiefly in the lymph nodes (lymph glands). In leukemia, most lymphocytes produced are abnormal or immature.
  • Granulocytic leukemia is marked by an increase in white blood cells called granulocytes. These are made in the bone marrow. Normal granulocytes are essential to the body's defense against infection, but abnormal leukemic cells lack this capability.

Both types of leukemia occur as acute (fast-growing) or chronic (slow-growing) diseases.

Acute leukemia can occur at any age, but it is most often seen in children. It accounts for about half of all leukemia cases.

Chronic leukemia occurs most often in adults, but can occur at any age. It accounts for about half of all leukemia cases.

What happens in leukemia?

Leukemia, like other cancers, is a disease of the body's cells. Cells of different shapes and functions make up various parts of the body: the skin, heart, lungs, bones and so forth. All cells reproduce themselves by dividing. Normal growth and repair of body tissues take place in this orderly manner. When cell division is not orderly, abnormal growth takes place.

Both acute and chronic leukemia affect three types of blood cells: red blood cells, white blood cells and platelets.

Red blood cells carry oxygen to all parts of the body. Made in the bone marrow, they number several million in each drop of blood. In leukemia, the red cell count drops, robbing the body of necessary oxygen. This results in anemia, causing paleness, weakness and fatigue.

White blood cells fight infections by destroying bacteria, viruses and foreign matter in the blood and help build immunity to disease. In leukemia, white blood cells don't function normally. This results in infections occurring repeatedly because the leukemic white cells are unable to fight off bacteria or viruses. An extremely high number of abnormal white blood cells accumulate, flooding the bone marrow and preventing normal blood formation.

Platelets are tiny blood components formed in the bone marrow. They are essential for clotting. They collect around  a wound and form a “plug” (clot) to stop bleeding. In leukemia, platelet production goes down. This results in excessive bleeding, bruising and hemorrhaging because the blood won't clot.

Both acute and chronic leukemia cause the same effects, except those of chronic leukemia are less dramatic and typically occur later in the disease course.

In chronic lymphocytic leukemia, the main effect may be simply an increase in lymphocytes circulating in the blood and bone marrow. Multiple lymph node tumors may also develop. The condition may go for many years with few or no ill effects, but infections and bleeding or bruising eventually develop.

In chronic granulocytic leukemia, overgrowth and overproduction of abnormal bone marrow often causes an increase in platelets as well as white cells. The condition can be controlled for several years, but many cases eventually convert to an acute phase.

What causes leukemia?

It is believed that a change in gene structure causes the abnormalities and uncontrolled multiplication of white cells in leukemia. Genes are the “blueprints” for cell growth. They are located on the chromosomes, inside the nucleus of every cell. Scientists at Jefferson's Sidney Kimmel Cancer Center have been world leaders in describing the genes associated with many leukemia types, and new treatment approaches are being designed based upon this new information.

The cause of the change in gene structure is unknown, but several factors are suspected, such as certain birth defects, X-rays, other forms of radiation, viruses and chemical irritants from the workplace or environment.

What are the symptoms of leukemia?

Symptoms of acute leukemia are varied and can progress rapidly. Therefore it is important to consult a doctor promptly.

The lymph nodes, spleen and liver may be enlarged because they are infiltrated with white blood cells. Other common symptoms are bone pain, paleness, tendency to bleed or bruise easily and frequent infections.

With chronic leukemia, a patient most often seeks medical treatment because of increasing fatigue or weight loss. There may be a sense of fullness or heaviness under the left ribs, and the doctor may discover a mass in the abdomen. Less frequently, the complaints result from anemia, abnormal perspiration, fever, bleeding, pain in the spleen or an attack of gout. Sometimes the discovery of the disease may be accidental, in the course of routine clinical or laboratory examinations.

Chronic lymphocytic leukemia usually occurs in older people and develops slowly. In fact, symptoms are entirely absent in some cases, and the disease discovered accidentally when a patient is examined for another complaint. When symptoms do occur, they may be a general feeling of ill health, fatigue, lack of energy, fever, loss of appetite and weight, or night sweats. Enlarged lymph nodes in the neck or groin may be noticed in some patients. Some may show signs of anemia or infections.

How is leukemia diagnosed?

Leukemia can be diagnosed only by microscopic examination of the blood and the bone marrow. If leukemia cells are present in these tissues, they can be identified and the diagnosis made.

Blood tests may show low hemoglobin, low white cell levels and a low platelet level. Blast cells (immature cells) may also be present in the blood.

Because these findings suggest a diagnosis of leukemia, a bone marrow biopsy may be done. A sample of bone marrow is obtained by inserting a needle into the bone and withdrawing a tiny amount of tissue. The bone marrow is examined under the microscope by a pathologist. A pathologist is a physician who interprets and diagnoses the changes caused by disease in body tissues. The bone marrow biopsy establishes the specific type of leukemia, which is essential in determining the best form of treatment. It also is used as a way of checking on the progress of therapy.

When a diagnosis of leukemia is confirmed, it is best that a patient begin treatment in a hospital that has an expert staff and resources to apply all forms of effective treatment right from the beginning.

Do I need a second opinion?

Since treatment decisions are complex, a patient might want a second doctor to review the diagnosis and treatment plan before actually starting treatment.

  • Patients can call the Jefferson Cancer Network at 1-800-JEFF-NOW.
  • The patient's doctor may be able to suggest a doctor who has a special interest in leukemia.
  • Patients can obtain the names of doctors from their local medical society, a nearby hospital or a medical school.

How is leukemia treated?

While treatment must be tailored to individual needs, leukemia can respond well to a program combining chemotherapy and a team approach for total care.

Chemotherapy uses powerful drugs in various combinations to kill abnormal cells and/or slow their growth, giving normal cells a chance. The goal of the therapy is remission, or the apparent disappearance of symptoms and evidence of leukemia. This enables a patient to return to apparently normal health and remain so for weeks, months or years.

Repeated chemotherapy can bring repeated remissions. Some patients have been in remission long enough to be considered cured. Since anti-leukemic drugs also affect normal cells, side effects are common. Therapy must be carefully administered and constantly monitored.

The best chance for a long-term remission is total care treatment in specially equipped medical facilities by a team of specially trained doctors, nurses and paramedics. Total care includes:

  • Initial treatment, with drugs given daily to induce remission. Usually within four weeks, a patient is free from any signs of disease.
  • Maintenance therapy is employed, sometimes for several months, with selected drugs used to extend and maintain remission.
  • Sometimes a bone marrow or peripheral stem cell transplant is performed to maintain remission.
  • Supportive therapy is required when disease is active. It may include blood transfusions, platelet transfusions or antibiotics.

The result of successful treatment means a longer life expectancy than ever for leukemia patients, with a significant number achieving a normal lifespan. Though recovery from leukemia was once considered hopeless, major treatment advances mean that acute leukemia is now considered a potentially curable disease.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial, you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science. Many clinical trials take the best-known therapy and modify it a little in an effort to improve on it further.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call either the Sidney Kimmel Cancer Center at Jefferson's Research Management Office at 215-955-1661 or 1-800-JEFF-NOW.

The lungs – a pair of cone-shaped organs made up of spongy, pinkish-gray tissue – are part of the respiratory system. They take in oxygen, which body cells need to live and carry out their normal functions, and they rid the body of carbon dioxide, a waste product of the cells.

The right lung has three sections, called lobes, and is a little larger than the left lung, which has two lobes.

What is lung cancer?

Normally, lung cells divide to produce more cells only when the body needs them. Lung cancer occurs when cells divide and form more cells uncontrollably, creating a mass of tissue called a tumor.

Malignant tumors are cancers, which can invade and damage nearby lymph nodes, tissues and organs. Cancer cells can also break away from a malignant tumor and enter the bloodstream, spreading to other parts of the body where they can form new tumors. Build up of fluid around involved lung, or plural effusion, could be an indicator of lung cancer.

It is also possible to have a non-cancerous (benign) tumor in the lung which rarely poses a threat to life. Despite that such lesions still may need to be removed to make sure that no malignancy is present in that area.

What causes lung cancer?

Lung cancer is caused by cigarette smoking in 90 percent of cases. Tobacco smoke contains many carcinogens, substances that damage lung cells; over time, these damaged cells can become cancerous. The more people smoke, the higher their risk of developing lung cancer.

As soon as smokers quit, the risk of developing lung cancer begins decreasing slowly. The earlier smokers quit, the more their risk of developing lung cancer approaches that of a person who never smoked.

Exposure to other people's tobacco smoke, whether at home or in the workplace, increases the risk of developing lung cancer among nonsmokers. This is commonly referred to as second hand smoke.

Exposure in the workplace to certain carcinogens, such as asbestos, also increases the risk of developing lung cancer. The risk is especially high for workers who smoke. People should carefully follow work and safety rules to reduce their exposure to workplace carcinogens.

Also at increased risk for developing lung cancer are workers, especially those who smoke, exposed to high levels of the radioactive gas, radon, in some underground mines.

What are the types of lung cancer?

Nearly all lung cancers are carcinomas – cancers that begin in the lining or glandular tissues of an organ.

Lung cancers are generally divided into two major groups: nonsmall cell lung cancer and small cell lung cancer. The tumor cells of each type of lung cancer grow and spread differently and each type needs different treatment.

Nonsmall cell lung cancer is the more common of the two groups. The three main types of nonsmall cell lung cancer are named for the type of cells in the tumor:

  • Squamous cell carcinoma, also called epidermoid carcinoma, is the most common type of lung cancer in the United States and many other countries. This disease often begins in the bronchi, or large air tubes leading to the lungs. It usually spreads less quickly than other types of lung cancer.
  • Adenocarcinoma usually begins along the outer edges of the lungs and under the lining of the bronchi. This is the most common type of lung cancer in women and in people who have never smoked. The incidence of adenocarcinomas is on the rise.
  • Large cell carcinomas, which usually begin along the outer edges of the lungs, are a group of cancers with large, abnormal-looking cells.

Small cell lung cancer grows rapidly and spreads quickly to other organs. This type of lung cancer accounts for 10 percent to 20 percent of all lung cancers.

What are the symptoms of lung cancer?

At first, lung cancer usually doesn't cause symptoms. Doctors sometimes discover it in people without symptoms after a chest X-ray for another medical reason. Usually, however, lung cancer is found after the growing tumor causes symptoms to appear.

A cough, which is the most common symptom of lung cancer, is likely to occur when a tumor irritates the lining of the airways or blocks the passage of air. The person may have a “smoker's cough” that worsens.

Another symptom is constant chest pain. Others may include shortness of breath, wheezing, repeated bouts of pneumonia or bronchitis, coughing up blood or hoarseness.

A tumor that presses on large blood vessels near the lung can cause swelling of the neck and face. If the tumor presses on certain nerves near the lung, it can cause pain and weakness in the shoulder, arm or hand. Problems with vision could be an indirect sign of nerve involvement as well.

In addition, there may be symptoms that don't seem to be related to the lungs. Like all cancers, lung cancer can cause fatigue, loss of appetite and loss of weight. If the disease spreads elsewhere, it may cause headache, pain or bone fractures.

Other symptoms result from substances the lung cancer cells make. For example, certain lung cancer cells produce a substance that sharply reduces the level of sodium (a component of salt) in the blood. This can cause many symptoms, including confusion and sometimes even coma.

None of these, however, is a sure sign of lung cancer. Only a physician can tell whether a patient's symptoms are caused by cancer or another problem.

How is lung cancer diagnosed?

To find the cause of any of these symptoms, the doctor asks about the patient's personal and family medical background, as well as smoking and work history.

The physician also performs a physical examination and usually orders chest X-rays and other tests.

In addition, the doctor may order a computerized tomography (CT) scan, which is a series of X-ray images put together by a computer. These detailed pictures can reveal a tumor in the lung, but they cannot show whether the tumor is benign or malignant.

The only sure way to know whether cancer is present is to obtain cells from the lungs for examination under the microscope. Sometimes, cancer cells are in the sputum, a thick fluid that the patient coughs up from deep in the airways. Also, the doctor usually does a biopsy to remove a sample of cells from the lung.

To perform a biopsy, physicians use one of the following procedures:

  • Bronchoscopy – this permits the physician to look into the breathing passages through a bronchoscope, which is a thin, flexible, lighted tube inserted through the nose or mouth under local or general anesthesia. The doctor can brush or wash cells from the walls of bronchi or snip off small pieces of tissue for study under the microscope. Depending on the location of the tumor, transbroncheal biopsy of the tumor may be performed.
  • Percutaneous Needle biopsy – removal of tissue hard to reach with the bronchoscope. With the patient under a local anesthetic and using CT or X-ray fluoroscopy guidance, the doctor inserts a needle through the chest wall into the tumor to withdraw a small sample of tissue.
  • Thoracentesis – an examination of fluid from the pleura (the fluid-filled sac surrounding the lungs). With the patient under local anesthesia, the physician uses a needle to remove a fluid sample and to have it checked for cancer cells.
  • Mediastinoscopy – Permits surgeons to sample lymph nodes that drain the lungs and may be the first defense barrier to a tumor spread. It allows for better staging of lung cancer thus influencing treatment. Done under general anesthesia, media-stinoscopy does not require overnight stay.
  • Video-Assisted Thoracic Surgery (VATS) – a minimally invasive procedure involving the introduction into the chest of a video camera that transmits a picture to a video monitor. This allows surgeons to see structures within the chest so they can remove tissue samples to have them checked for cancer. This procedure requires general anesthesia. Removal of certain lesions with this technique is a possibility as well.
  • Thoracotomy – the surgical opening of the chest that requires general anesthesia, used for some patients who require surgery for diagnosis or for treatment.

If the physician feels an enlarged liver or swollen lymph nodes (small bean-shaped structures that store special cells to trap cancer cells or bacteria traveling through the body), these areas may also be biopsied. The doctor may also biopsy other areas of the body where cancer is suspected.

What is staging and how is it performed?

If lung cancer is diagnosed, physicians need to learn the stage, or extent, to which the disease has progressed so they can give appropriate treatment.

Staging is a careful attempt to find out whether the cancer has spread and, if so, to what other parts of the body.

To learn whether a patient's lung cancer has spread to the lymph nodes in the chest, physicians remove a sample of tissue either with a needle or surgically.

Surgery to biopsy lymph nodes in the chest can often be done through a small incision near the breastbone. If a thoracoscopy or a thoracotomy is planned, physicians will remove lymph nodes at that time. Patients receive general anesthesia for these operations.

Doctors may order CT scans to detect the spread of lung cancer to the lymph nodes and other parts of the body, including the brain, liver and other abdominal organs.

Radionuclide scans of the bones may also help determine whether the cancer has spread. For these procedures, a small amount of a radioactive substance is injected into a vein, after which a machine scans the body to reveal abnormal areas.

Radiolabeled monoclonal antibodies against lung cancer could also be used to detect the spread of the disease.

In another technique, called magnetic resonance imaging, a strong magnet linked to a computer produces images that indicate whether lung cancer has spread to the brain or spinal cord.

What are the main methods of treating lung cancer?

The earlier cancer is detected, the more successful treatment is likely to be.

Physicians develop a treatment plan comprising surgery, radiation therapy, chemotherapy, or a combination of the three, and tailor it to each patient's needs.

The type of plan depends on many factors, including the type of lung cancer, the size and location of the tumor and the stage of the disease. Other factors to consider are the patient's age, medical history and general health.

Patients may have just one form of treatment or a combination, depending on their needs; several specialists may work as a team to provide treatment.

  • Surgery
    Surgery is performed for early-stage lung cancers when it's likely that all of the tumor can be removed. Three main types of surgery are used to treat lung cancer. The choice depends on the size, location and extent of the tumor; the general health of the patient, and other factors.
  • An operation to remove only a small part of the lung is called a segmental or wedge resection.
  • A lobectomy is the procedure in which the surgeon removes an entire lobe of the lung.
  • Pneumonectomy is the removal of an entire lung.
  • Radiation therapy
    Radiation therapy, like surgery, is a local treatment that kills the cancer in the treated area and is usually given five days a week for several weeks at the hospital on an outpatient basis.
  • Chemotherapy
    Chemotherapy is the systemic treatment with medications that kill cancer cells. This means that the medications flow through the bloodstream to nearly every part of the body. Most anticancer medications are injected into a blood vessel or a muscle; some are given by mouth. Chemotherapy is most often given in cycles – a treatment period alternating with a "rest" period.

Usually, patients have chemotherapy as outpatients: at the hospital, at the physician's office or at home. Sometimes, depending on which medications the physician orders, patients may need to stay in the hospital a few days to be monitored for side effects.

Because of the proven association of cigarette smoking with the development of lung cancer, the best form of treatment is prevention. If you don't smoke or stop smoking, your chances of getting lung cancer are greatly reduced.

Do I need a second opinion?

Treatment decisions for lung cancer are complex. Before starting treatment, patients might want another doctor to review the diagnosis and the treatment plan. Here are ways to find another doctor to give a second opinion:

Patients can call Thomas Jefferson University Hospital's free physician referral service at 1-800-JEFF-NOW.

The patient's doctor may be able to suggest a specialist. Specialists who treat lung cancer include thoracic (chest) surgeons, radiation oncologists and medical oncologists.

Patients can obtain the names of physicians from their local medical society, a nearby hospital or a medical school.

How is nonsmall cell lung cancer treated?

Patients with nonsmall cell lung cancer may be treated in several ways. The choice of treatment depends mainly on the stage of the disease.

Surgery is the usual treatment for patients whose cancer is in only one lung or in one lung and the closest lymph nodes. New studies are designed to assess whether additional forms of systemic therapy before or after surgery can prevent further recurrences of the cancer.

Patients who can't have surgery because of other medical problems often receive radiation therapy. Radiation therapy is also the usual treatment for patients whose cancer has spread within the chest to more distant lymph nodes or other tissues.

It has recently been shown that chemotherapy enhances the effects of radiation therapy and is now used with radiation in most instances. Some patients have both surgery and radiation therapy.

Chemotherapy is used to treat patients whose cancer has spread from the lung to other parts of the body. Radiation therapy is used to control specific symptoms caused by the spread of cancer to specific parts of the body. Although it's very difficult to control lung cancer that has spread, treatment can often shrink the tumors. This can help relieve pain and other symptoms.

How is small cell lung cancer treated?

Small cell lung cancer may spread quickly. To be sure that treatment affects all cancer cells in the body, chemotherapy is used for virtually all patients, even when the disease appears to be limited to the lung and nearby lymph nodes. Usually, chemotherapy for small cell lung cancer includes a combination of two or more anticancer drugs.

When the disease appears clinically limited to the lung, treatment also includes radiation therapy. Radiation therapy is also used to treat the brain, even without evidence of cancer, to prevent tumors from forming there; this treatment is reserved for patients whose lung tumor has responded well to treatment.

Surgery combined with chemotherapy can also be part of the treatment plan for small cell lung cancer, but only for a small number of patients.

Because of the proven association of cigarette smoking with the development of lung cancer, the best form of treatment is prevention. If people do not smoke or stop smoking, their chances of getting lung cancer are greatly reduced.

What hope does research hold for patients with lung cancer?

Scientists are continuing to identify factors that increase the risk for lung cancer. Recent research has shown that genetic factors play an important role in this disease. For example, certain genetic traits make some people very sensitive to cancer-causing agents. Smokers with these traits may be more likely than other smokers to develop lung cancer.

Researchers are also studying ways to help people lower their risk of lung cancer by using natural and laboratory-made substances to prevent or delay cancer. Vitamin A and similar substances may offer some protection against lung cancer; additional compounds are also under study. Because some vitamins can be dangerous if taken in large doses, it's best to get a doctor's advice before taking vitamins or other nutrients. Furthermore, investigators are involved in a large study to determine whether a special form of Vitamin A can decrease the risk of developing a second cancer.

The earlier cancer is detected, the more successful treatment is likely to be. Since lung cancer is difficult to diagnose early, scientists are studying ways to check, or screen, for lung cancer in people without symptoms.

Because lung cancer is also difficult to control, researchers seek more effective treatments, plus ways to reduce the side effects of treatment and improve the quality of patients' lives.

Trials of new treatments are under way for patients with all stages of lung cancer. Some trials involve treatments to shrink or destroy the primary tumor. Others test ways to prevent lung cancer from recurring in the chest or spreading to other parts of the body after the primary tumor has been treated. Still others involve treatments to slow or stop the spread of lung cancer.

Also under study are the timing of treatments and new ways to combine various types of treatment, as well as new anticancer drugs and drug combinations, new forms of radiation therapy and drugs that make cancer cells more sensitive to radiation.

Another method being studied is photodynamic therapy. In this treatment, cancer cells are destroyed with a combination of laser light and light-sensitive drugs. Other types of laser therapy are being investigated to open the airways in patients whose tumors block the bronchi. Some researchers are also working with biological therapy to help the body's immune system fight cancer more effectively or to protect the body from some of the side effects of treatment.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.

Ovarian cancer is the rapid growth of abnormal cells in the ovaries of the female reproductive system. The ovaries are the two small egg-filled sacs on each side of the uterus which produce estrogen and play a key role in conception and menstruation. Cancer can occur in one or both ovaries. When there is a malignancy, the ovaries typically enlarge, and cancer cells may fall off the ovary's surface and implant themselves throughout the abdominal cavity. Each one of these seedlings can then grow into a separate ovarian cancer tumor nodule.

Who is at risk for ovarian cancer?

Each year, more than 20,000 American women will be diagnosed with ovarian cancer. The disease most often affects post-menopausal women, although women of any age may develop it. While scientists have not uncovered the cause, women in any of the following categories are known to be at higher risk: those who are infertile, who have never been pregnant, who bore children at a later age, who have had breast cancer, and women with family members who have had ovarian cancer. You cannot transmit the disease through physical or sexual contact.

Taking birth control pills reduces your risk for the disease. Women who have had tubal ligations are also less likely to get ovarian cancer. And the more often a woman has been pregnant, the less likely she is to develop ovarian cancer.

What are the symptoms of ovarian cancer?

Cancer of the ovaries often develops with no early warning signs. The first indication of the disease may be a swelling or feeling of fullness in the lower abdomen. Ovarian cancer can also cause indigestion, unusual bowel or rectal pressure, and abdominal pain or discomfort. Persistent digestive problems such as stomach discomfort, distention and gas might also be symptoms.

Your doctor may notice an ovarian cyst or other growth during your regular pelvic exam. Cysts on the ovaries rarely turn out to be cancerous, especially in women under 40. Most of these growths are normal and related to the menstrual cycle, but your physician will want to watch you closely to be certain the cyst resolves.

Can ovarian cancer be prevented?

Women who have annual pelvic exams increase their chance of early detection and a better treatment outcome if the disease is discovered. If any family relative has had cancer of the ovaries, your physician may advise you to have checkups more frequently. The genes for ovarian cancer are not “sex linked,” which means that the gene for the disease can be inherited from either your mother or father.

What if my doctor detects a growth on my ovaries?

If your doctor suspects cancer of the ovaries based on your symptoms and on a pelvic examination – a number of diagnostic procedures can help determine whether the abnormal growth is cancerous. Frequently, growths on the ovaries turn out to be nonmalignant cysts.

To determine whether the tumor is malignant, you may be referred to a gynecologic oncologist (cancer specialist) for one or a combination of the following tests:

  • Ultrasound – a painless, non-invasive sound wave technique that enables your doctor to examine the inside of your abdomen and the ovaries
  • Lower GI series – produces an X-ray of your colon to determine whether pressure from an ovarian tumor is changing the shape and position of the colon and rectum
  • CT or CAT Scan – an X-ray procedure that provides detailed pictures of cross sections of the body. The pictures are created by a computer
  • Laparotomy or Laparoscopy – these surgical procedures involve making an incision in the abdomen to biopsy the suspicious ovarian tissue. The surgeon removes the entire affected ovary so that the disease, if present, doesn't spread. You may wish to obtain a second opinion from another physician before scheduling a laparotomy.

What are some questions I need to ask my physician if ovarian cancer is diagnosed?

  1. Have you had special training in the management of gynecologic cancers or can you refer me to such a specialist?
  2. Has the cancer spread?
  3. What are the surgical options?
  4. Will I need chemotherapy or radiation, too?
  5. What are the potential side effects of the recommended treatments?
  6. Will I be infertile after treatment or are there other options?
  7. Can I work and continue my normal activities during treatment?

How is cancer of the ovaries treated?

Treating ovarian cancer requires inpatient surgery, usually performed by a gynecologic oncologist. After confirming a diagnosis of cancer, your doctor will surgically remove the affected ovary. Most often – as a precautionary measure or because the cancer has spread – your doctor will remove both ovaries, along with the fallopian tubes and uterus. In addition, the surgeon will also take samples of nearby lymph nodes, and other internal structures including fluid from the abdomen to determine whether the cancer has spread.

After surgery, most patients receive chemotherapy (anti-cancer drugs) for approximately six months to destroy any remaining cancer cells.

What are the side effects of treatment?

For several days after surgery, a woman may have problems emptying her bladder and having normal bowel movements. Doctors generally advise patients not to have sexual intercourse for 6 to 8 weeks after surgery. Removal of the ovaries also triggers menopause immediately. Symptoms such as hot flashes may be more severe than when menopause happens naturally.

The side effects of chemotherapy depend on the drug that is administered. Each woman will also respond differently to the medication. Typical temporary side effects may include lowered resistance to infections, loss of energy, loss of appetite, nausea, vomiting, hair loss, hearing problems, mouth sores and tingling or numbness of the fingers or toes.

What is the prognosis for ovarian cancer?

Follow-up care is important. You will require regular pelvic exams and lab tests to be sure the cancer has not returned. Your physician may recommend a "second look" laparotomy after completion of therapy to ensure the treatment has been successful. Women treated for ovarian cancer also have an increased risk of developing other types of cancer later in life and need special monitoring.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Jefferson also offers a number of cancer support and education programs as well as a Buddy Program in which survivors of cancer provide support and encouragement to patients who are newly diagnosed and an active cancer advocacy group. You'll find information on the Jefferson web site about these programs or by calling 1-800-JEFF-NOW.

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

Men usually develop prostate problems only when they're older.

Fortunately, most prostate problems are not life threatening. However, prostate cancer is serious and can be fatal if left untreated. Currently, a man dies from prostate cancer every 16.4 minutes. Your doctor can do a simple annual exam and blood test that can detect prostate cancer early. Below are answers to some frequently asked questions about prostate problems.

What is the prostate gland?

The prostate gland is located inside the body, right beneath the bladder and in front of the rectum (see illustration right). The urethra is the tube that carries urine from the bladder. The urethra passes through the center of the prostate. The prostate gland is one of the male sex glands. It produces semen, the substance that carries sperm.

What are signs of prostate problems?

Some prostate problems can cause trouble with urination. That's because the prostate gland is near the bladder and urethra, the tube that carries urine out of the body. Visit your healthcare provider as soon as possible if you:

  • Are unable to urinate
  • Need to go to the bathroom more often, especially at night
  • Have difficulty starting or stopping the stream of urine
  • Have a weak stream of urine
  • Feel pain or burning when you urinate
  • Have blood in the urine
  • Have painful discharge of semen (ejaculation) during sex
  • Feel pain in the lower back, pelvis or upper thighs that does not go away

These symptoms may mean you could have a prostate or other urinary tract problem that may or may not be cancer. However, in most cases, prostate cancer presents without any symptoms.

What are some of the prostate problems men may have that are not cancer?

Prostate problems that are not cancer include infections (prostatitis) or an enlarged prostate. Prostate infections affect men of all ages. Bacteria from infections in the urinary tract may cause this condition. Inflammation or congestion of the prostate may be due to aging or a buildup of prostate fluid in the gland.

An enlarged prostate, also known as benign prostatic hypertrophy (BPH), is quite common in older men. That's because the prostate gland usually grows larger as a man gets older. As the prostate grows, it may push against the bladder or close around the urethra. This can cause problems with urination. Urinary problems due to an enlarged prostate should not be considered a normal sign of aging, though. You should seek treatment. Without proper treatment, an enlarged prostate sometimes can interfere with a normal lifestyle, and sometimes can cause severe bladder or kidney damage.

Are some men at greater risk for getting prostate cancer?

Men get prostate cancer more than any other type of cancer. Men who are over 50 are more likely to have the disease than younger men. Men with a father or brother who had prostate cancer are also at greater risk than men with no family history of the disease.

What about African-American men and prostate cancer?

African-American men have a higher risk of developing prostate cancer than white men, and more African-American men die from this disease. The reason is not clear, but when prostate cancer is found in African-American men, it is more likely to be late-stage cancer, which is hard to cure. But African-American men who have regular screening exams and who are diagnosed with prostate cancer have a better chance of surviving. Regular screening exams can catch tumors when they're smaller and more curable, and should start at age 40 if you are African-American.

How can I tell if I have prostate cancer or a benign prostate condition?

You can't make a diagnosis on your own. Early-stage prostate cancer usually has no symptoms, which is why regular screenings are so important. Urinary difficulties could be a sign of either prostate cancer or another, benign condition. That's why you should see your doctor as quickly as possible if you have any urinary-related symptoms.

How is prostate cancer detected?

Prostate cancer screening is done by a rectal exam and a prostate specific antigen (PSA) blood test. During the rectal exam, your doctor places a gloved finger in the rectum and feels the prostate, checking its size and shape. A prostate with a hard spot may indicate cancer. The PSA blood test measures the level of a protein produced by the prostate. A high PSA level could be a sign of an enlarged prostate or inflammation of the prostate, or it may indicate the presence of cancer. These tests are quick and easy and can help find prostate cancer early when it's more treatable. Prostate cancer can only be diagnosed by a biopsy of the prostate. Your doctor may recommend a biopsy to make the diagnosis. Discuss with your physician at what age you should begin having yearly screenings, including the risks and benefits.

What causes prostate cancer?

No one knows what causes prostate cancer. Researchers are looking at heredity, diet (especially fatty foods), hormones, and environmental factors. There is no definite way to prevent prostate cancer, so early detection is key.

What are the stages of prostate cancer?

Once prostate cancer has been found, more tests must be done to determine if cancer cells have spread outside the prostate gland. The size of the cancer and the extent to which cancer cells have spread are described in terms of "stages." Stage T1 and Stage T2 are early stages, which mean the cancer is probably within the gland and has not spread. Stage T3-T4 means the tumor has grown beyond the prostate gland but is confined within the surrounding areas. Stage N0-N2, M0-M1 means the cancer has spread, usually to lymph nodes on distant sites. This process is called metastasis. You and your doctor need to know the stage of your disease to plan treatment.

How is prostate cancer treated?

Treatment is based on how aggressive the cancer is and how far it has spread. The good news is that today, most cases of prostate cancer are found early, before the tumor spreads widely. The most common forms of treatment today are careful observation, surgery, radiation therapy and hormonal therapy.

Careful observation is also called "watchful waiting" or "active surveillance." If the cancer is not aggressive, or if you are older or in poor overall health, this treatment approach can be considered. It involves periodic exams and blood tests to see if the cancer changes over time.

Surgical treatment options include radical prostatectomy (removal of the entire prostate) or cryotherapy.

  • Radical prostatectomy removes the entire prostate that contains the tumor. Prostate cancer is often found in several different areas of the prostate, making a partial removal impractical. Sometimes, your doctor may decide to also remove the surrounding lymph nodes to see if the cancer has spread. The benefits of radical prostatectomy are that the entire prostate is removed, the extent of the cancer can be clearly identified, and the PSA level should be undetectable after a successful operation. The risks include infection, bleeding and reaction to the anesthesia. Impotence (inability to get an erection) may be a side effect but is less likely with modern techniques that use "nerve sparing." Incontinence (leakage of urine) is also possible but not common using the latest techniques.

    There are several ways to remove the entire prostate surgically. The standard technique uses an incision in the lower abdomen below the belly button. Laparoscopic prostatectomy, which was first performed in the Philadelphia region by Jefferson urologists, requires smaller incisions and telescopes. The next advance uses a robot to assist the surgeon in performing the laparoscopic prostatectomy known as the "robotically assisted laparoscopic radical prostatectomy," or the "da Vinci® Prostatectomy." These minimally invasive techniques offer the potential of less blood loss and more rapid convalescence. Jefferson has several urologic surgeons who have advanced fellowship training in laparoscopic and robotic prostatectomy techniques.

  • Cryosurgery kills cancer cells through deep freezing. The procedure is available but is not considered a primary surgical treatment for most patients.

Radiation therapy uses high-energy forms of X-rays to kill cancer cells and shrink tumors. Radiation may be delivered to the prostate by an external radiation machine or by radioactive seeds ("brachytherapy") placed directly into the prostate gland. The benefits of radiation therapy are that it does not involve a major operation and can usually effectively treat the cancer. The side effects are usually mild and can include irritation of the bowels and bladder. Loss of sexual function can also be seen.

  • The external-beam radiation is done on a daily basis over six to seven weeks. Sidney Kimmel Cancer Center at Jefferson radiation oncologists use the state-of-the-art technique known as Intensity Modulated Radiation Therapy (IMRT), which delivers tightly focused radiation to the prostate while minimizing the dose to the surrounding normal tissues. The latest in image-guided therapy, also used at Jefferson, involves the placement of tiny markers in the prostate that allow the radiation beam to be even more precisely aimed at the prostate. Studies have also shown that some men may benefit from a short course of hormonal therapy along with the radiation to improve the tumor killing.
  • If your prostate cancer is early stage and you do not have severe urinary symptoms, brachytherapy may also be an option. This one-time procedure is performed under anesthesia and delivers a high dose of radiation directly into the prostate to kill the tumor.

Hormone therapy slows the growth of prostate cancer and is most often used when the cancer has spread beyond the prostate gland. Hormonal treatment is also sometimes used along with other treatments, such as radiation, to shrink the prostate and improve the results of the treatment. Hormonal treatments are drugs that reduce the body's production of the male hormone testosterone, a hormone that acts like a fertilizer to help prostate cancer grow. These drugs are usually given as some type of shot – sometimes, along with pills. Some men can experience loss of sexual desire, reduced muscle strength and hot flashes as side effects of the treatment.

Chemotherapy is used if hormonal therapy stops working. It is not currently considered a primary treatment for prostate cancer.

What is the outlook for prostate cancer patients?

The outlook for prostate cancer patients has improved steadily over the years. The death rate has fallen dramatically over the last 10 years. Doctors now have a better understanding of how to diagnose this disease early. Better treatment methods have improved survival rates. Today, most men with prostate cancer can be treated effectively and resume their normal lifestyles.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols. By participating in a clinical trial, you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call either the Sidney Kimmel Cancer Center at Jefferson's Research Management Office at 215-955-1661 or 1-800-JEFF-NOW.