Conquering Colon Cancer - Renown Health

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Renown institute foR canceR 22 Feature WRITTEN by RoSEANN KEEGAN advanced treatment tool Pet/ct pairs the best of two technologies I n the past, doCtoRs tReatIng CanCeR often weRe fRustRated tRyIng to matCh pet Images wIth Ct Images to pInpoInt the loCatIon of a tumoR. positron emission tomography (pet) is a test that uses a special type of camera and a tracer, a radioactive chemical, to look at organs in the body. a computed tomography (Ct) scan uses X-rays to make detailed pictures of structures inside of the body. alone, the two images don’t provide a complete picture of the disease and its exact location. doctors would examine the two Renown joURneY separate images, and then estimate the tumor’s position. today, doctors have the advantage of these two machines being paired in one machine, the pet/Ct. the result ultimately benefits patients with earlier diagnosis, more accurate understanding of the cancer and how far it has spread, its exact position, and precise treatment and monitoring. time magazine honored pet/Ct as the medical science Invention of the year in 2000, noting that the pet/Ct scanner has “provided medicine with a powerful new diagnostic tool.” rick Hodge, mD, radiology and Nuclear medicine specialist at renown, studies a patient’s Pet/ct images. the Pet/ct scanner is a powerful diagnostic tool that can benefit patients with an earlier diagnosis. “we can see changes in the metabolism of the tumor. we can see whether treatments are working much sooner.” Rick Hodge, MD, Radiology and Nuclear Medicine Specialist at Renown, this technology can accurately tell where the tumor is. “we can see changes in the metabolism of the tumor. we can see whether treatments are working much sooner,” said Rick hodge, md, Radiology and nuclear medicine specialist at Reno Radiological associates. In one continuous, full-body scan, pet images show changes in the body’s metabolism caused by the growth of abnormal cells, while Ct images allow physicians to pinpoint the precise location, size and shape of the tumor. the comprehensive results of a pet/ Ct scan give a treatment team the entire picture of what is going on in the patient’s body. accuracy matters pet/Ct scans currently have three main applications: cancer, heart disease and brain disorders. for cancer, the technology is being used to assess tumor aggressiveness, to monitor the success of treatments, for early detection of recurrent tumors, to provide a whole-body survey for cancer that may have spread, and to identify benign and malignant growths. pet/Ct scans are most helpful in treating cancers of the lung, colon, esophagus, thyroid, ovaries and the head and neck, as well as skin cancers, according to dr. hodge. this is how it works: Ct scanners send X-rays through the body, which are then measured by detectors in the Ct scanner. the computer processes those measurements to produce pictures of the body’s internal structures. the pet images begin with an Iv of fdg, a type of harmless, radioactive glucose. metabolically active organs or tumors — which indicate cancerous activity — tend to consume sugar at high rates. these organs or tumors will show up in images as “hot spots,” and often indicate rapidly growing tumors. the entire exam at Renown typically takes an hour: 30 minutes or more to metabolize the injection and 20-25 minutes in the pet/ Ct machine. the results provide detailed information to the patient’s treatment team. In fact, following a pet/Ct scan, patient treatment plans are changed almost 40 percent of the time. according to a study by the national oncologic pet Registry, clinicians changed the intended care of more than one in three patients as a result of scan findings. this technology at Renown ensures patients are getting the most accurate treatment based on current information. “there have been several significant studies, especially in lung cancer, that (show) the combined pet/Ct technique increases accuracy in detecting lesions and has led to statistically significant improvements in affecting patient outcomes,” dr. hodge said. a few cancers aren’t as easily detected by the pet/Ct scans, including prostate cancer, since the tumors are slow-growing and not as metabolically active, dr. hodge said. Personalized care when doctors told Reno resident Jeanne mandella, 70, that they wanted her to undergo a pet/Ct scan, she was a bit apprehensive. “I was absolutely nervous,” she said. mandella has recurring colon cancer that was first diagnosed in January 2006. doctors recommended the pet/Ct scan after the regular Ct scan failed to show if her tumor had grown. she went through with that first pet/Ct scan and subsequent others. “they tell you what they are going to do,” she said. “they call you on the phone the day before, tell you what to eat: no sugar, just meat and eggs on the last day. I had apprehensions about them injecting a medication in my arm and then having to lie still while it went through my body, but I was ok. caNcer QuicK Fact: A third of all cancers could be cured through early detection and proper treatment. “you go into another room, then they put you through the machine head first, slowly,” she added. “It does a real slow scan in and out. then it goes in sections; the sections are three or four minutes apart. I’m very claustrophobic, so I tell them every time I go: ‘please talk to me.’ they say, ‘ok, you have this much time left, you’re doing great.’” mandella credits lynn Jarvis, Rn, and theresa peterson, patient access Representative, for making her pet/Ct scans comfortable and worry-free. “you have to go in there and remember that these people are professionals, and they do everything in their power to make you comfortable and make you feel like a person,” she said. “you’re not just laying there. they’re really kind to you.” for mandella, the pet/Ct scans have been critical for measuring the size and progression of her tumor. “there’s no growth, and that’s a good thing,” mandella said. ■ Visit www.renown.org for more information about X-ray and Imaging services offered at Renown Health. richard G. Hodge, mD Richard G. Hodge, MD, specializes in nuclear medicine and PET/ CT imaging and is a staff radiologist with Reno Radiological Associates. He earned his medical degree from the bowman Gray School of Medicine at Wake Forest University in Winston-Salem, North Carolina, and served his residency at the University of New Mexico. He also completed a fellowship in nuclear medicine at the oregon Health Sciences University. Dr. Hodge is board Certified in Radiology and Nuclear Medicine. renown.org 23
Renown institute foR canceR 24 Feature WRITTEN by bRANDI SCHLoSSbERG modeling the way renown becomes an industry leader in physician-guided da vinci robotic surgery S InCe the maRCh 2008 aRRIval of the da vInCI RoBotIC suRgICal system, Renown health has BeCome a natIonal Role model foR thIs hIgh-teCh pRoCeduRe. Renown was the first to bring da vinci technology to northern nevada, and physicians have put the sophisticated, minimally invasive procedure to use for urologic, heart and gynecologic oncology. “I think it’s phenomenal — it’s clearly an advancement Renown joURneY in care,” said peter lim, md, medical director of gynecologic oncology at Renown Institute for Cancer. “there’s a tremendous advantage for patients.” patients benefit from reduced trauma to the body, quicker recovery, shorter stay in the hospital, significantly less blood loss, lower risk of infection, reduced scarring and less post-surgery pain. “I’m controlling the robot, and the robot uses very precise movements, driven by the computer, as opposed to a surgeon actually manipulating the instruments,” dr. lim said. “This really is the wave of the future for surgery.” Peter Lim, MD, Medical Director of Gynecologic Oncology at Renown Institute for Cancer the da vinci robotics team, from doctors to nurses to anesthesiologists are highly specialized in physician-guided robotic surgery. renown has become a model-site for other hospitals interested in starting a robotic surgery program. dr. lim was the first Renown physician to operate with the da vinci system, and he has since performed more than 100 pelvic operations with this advanced technology. “uterine cancer, cervical cancer, early stage ovarian cancer - these are all examples of conditions we’re treating with robotic surgery,” he said. “we’re removing the actual cancer itself and also assessing lymph nodes to see whether the cancer has spread.” Intuitive surgical, makers of the da vinci Robotic surgical system, have asked dr. lim — a usC women’s and Children’s hospital-trained physician — to serve as an instructor for those learning to use the da vinci Robotic surgical system. In addition, Renown has become a model site for other hospitals that hope to use the da vinci system with similar success. at Renown, there is a specific operating room team for each da vinci procedure, which allows for the utmost expertise and efficiency with every operation. “Intuitive surgical considers Renown a best practice reNoWN team Pat Cruz-Hernandez RN Jane Dela Rosa RN Laura Flynn RN Donna Keisler RN Heather Lim RN Laurel Mengel RN Karen Schrimpf RN Stephanie Swartz RN Rick Williams RN Curt Ainsworth oRT Kitty Florez CST Mimi Longballa CSTFA Virginia Soderquist CST Robert Zumoff oRT surGeoNs aND tHeir staFF Karen Abbott MD hospital for people who want to learn how to start a robotic program,” dr. lim said. “this really is the wave of the future for surgery.” ■ For more information about the da Vinci Surgical System at Renown, visit the Web site www.renown.org/davinci. Peter Lim, mD, FacoG Peter Lim, MD, is Medical Director of Gynecologic oncology and the Center of Hope at Renown Regional Medical Center. He is one of fewer than 1,000 boardcertified gynecological oncologists in the nation. After completing his obstetrics and gynecology residency at University of Southern California Women’s Hospital, he secured a highly competitive fellowship at the Mayo Clinic in Minnesota. He has been in private practice since 1997. robotics team at reNoWN HeaLtH John Freeman MD Christos Galanopoulos MD Elizabeth Hutson MD Angelo Kanellos MD Peter Lim MD Terry McCaskill MD Matt McCormick MD Matrtin Naughton MD Pam Netuschil MD Richard Raefel MD Athan Roumanas MD Liz Kang PA-C Kate Willenborg PA-C Joe Ravelli oRT aNestHesioLoGists Peter billharz MD brian brewer MD Carrie buehler MD Catherine burton MD Gordon Curry MD Silver Dwinell MD Joann Ellero MD Harry English MD Daryl Fenio MD Michael Glass MD Henry Hicks MD Matt Hoberg MD David Kang MD Keith Libert MD Jay Markin MD Shannon Martin MD Paul Picetti MD James Van Antwerp MD John Wark MD brett Winthrop MD renown.org 25
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