Breast Cancer and Gynecologic Cancer Treatment Program

Primary tumour first develops in the breast and can become invasive and metastasize to other parts of the body usually through the lymph nodes and/or blood vessels. Most common sites to be involved include the lungs, skin, liver and soft tissue. The number of lymph nodes with cancerous cells continues to be the best indicator of how widespread the cancer is.

Most common types of breast cancer include:

• Ductal Carcinoma in Situ: most common non-invasive breast cancer which develops in the milk ducts.
• Invasive Ductal Carcinoma: most common invasive breast cancer which develops in the milk ducts. It is the breast cancer that men usually develop.
• Invasive Lobular Carcinoma: develops in the milk-producing gland.
• Medullary Carcinoma: a slow growing and a rare subtype of invasive ductal carcinoma.
• Paget Disease of the Nipple: a rare type of breast cancer that affects the skin of the nipple. People with this type of cancer usually have one or more tumours inside the breast.

MASTECTOMY

Part of the breast(s) is surgically removed for the treatment of this condition. The following are mastectomy programs offered:

• Quadrantectomy or Partial Mastectomy: Cancerous parts, as well as some tissues of the surrounding areas of the breast, aresurgically removed.
• Quadrantectomy with axillary dissection: the axilla (lymph nodes under the arm) is surgically removed. This is done while performing a partial mastectomy.
• Simple or Total Mastectomy: the breast issurgically removed. Muscle beneath the breast and lymph nodes under the arm are left intact with the exception of lymph nodes located within the breast.
• Modified Radical Mastectomy: The breast, as well as some of the lymph nodes under the arm, are surgically removed. Chest muscle is left intact.
• Radical or Halsted mastectomy: the breast, lymph nodes, chest muscle as well as surrounding tissue aresurgically removed.
• Surgery for local, regional and soft tissue recurrence of breast cancer: for recurrent breast cancer, asurgical removal of affected area is generally the preferred treatment. This surgical procedure is restricted to the breast or to the surrounding area.

In addition, the following implant procedure is offered:

• Silicone Implant Placement: a surgical breast implant after a mastectomy. It is simple and safe and causes little scarring.

Gynecologic Cancers

These are cancers that develop in the different organs of the female reproductive system within the pelvis (between the hip bone below the stomach) including the cervix, the uterus, the vagina, the ovaries, the vulva and the fallopian tubes. Most common among gynecologic cancers are endometrial cancer (uterine cancer), cervical cancer and ovarian cancer, with ovarian cancer being most dangerous due to the fact that, unlike cervical and endometrial cancers, it is often not detected before it has spread to other organs. Other less common gynecologic cancers include fallopian tube cancer, vulvar cancer, vaginal cancer and placenta cancer (molar pregnancy in which tissue rather than developing into a fetus become abnormal growth).

The following treatment programs for the different types of gynecologic cancers are offered:

PELVIC EXENTERATION

Pelvic exenteration is the the surgical removal of all or some of the inner organs in the pelvis and, in some cases, the rectum and anus for the treatment of recurrent gynecologic cancers.

The following pelvic exenteration operations are offered:

• Anterior exenteration: the removal of organs found in the front of the pelvic cavity including the urethra, lower part of the ureters, uterus, cervix, vagina, and bladder while sparing the rectum. In order for the urine to exit the body a cavity is created from the lower part of the ileum (the third portion of the small intestine) which is then connected to the abdominal wall. Vaginal reconstruction may be performed during the exenteration or later.
• Posterior Exenteration: the removal of organs in the back of the pelvic cavity including the vagina, uterus, adnexa, rectum, anus, and adjacent lymph nodes while sparing the bladder and urethra. This procedure requires a colostomy (the connection of the colon to the abdominal wall) a stoma is attached in order for feces to pass out of a body and is collected in a small bag.
• Total Exenteration: the removal of the bladder, rectum, uterus, fallopian tubes, ovaries, vagina, urethra, and parts of the levator muscles. A urinary stoma and a colostomy stoma are required in order to collect waste.

HYSTERECTOMY

Hysterectomy is the surgical removal of cervix, ovaries, uterus and/or fallopian tube in order to stop cancer from spreading to other organs.

The following hysterectomy programs are offered:

• Total Hysterectomy: the removal of the uterus and the cervix. This is the most performed hysterectomy for gynecologic cancers.
• Video-assisted Laparoscopic Pelvic lymphadenectomy with Vaginal Radical Hysterectomy: Vaginal hysterectomy is a surgery for the removal of the uterus through the vagina if the uterus has not greatly enlarged. The ovaries and the fallopian tubes may also be removed. Using a laparoscope (a thin lighted tube) lymph nodes in the pelvis are also removed and examined to determine they contain cancer. This may be used in early stage cancers of the cervix and uterus
• Videolaparoscopy with hysterectomy: a minimally invasive surgery for the removal of the uterus. The procedure is done by a small incision in the abdominal (in the belly button) and a tiny camera is inserted so that the surgeon can see the image on aTV screen and performs the operative procedure.
• Wertheim-Meigs: is the most extensive hysterectomy used mainly for the treatment of invasive cervix cancer; it may also be performed for the staging and treatment of endometrial cancer, upper vaginal carcinomas (cancer on the lining) and/or other cancerous tumours found in the cervix area.

OOPHORECTOMY

Also known as ovariectomy or ovarian ablation (detachment) is the surgical removal of one or both ovaries for the treatment of ovarian cancer or for the prevention of other diseases, such as breast cancer. Usually, the surgery is performed by making an incision in the abdomen so as to be able to separate the ovary(ies)  from the blood supply and surrounding tissue. Oophorectomy can be done with or without a hysterectomy.

The following oophorectomy is offered:

• Videolaparoscopy with Oophorectomy: the surgical removal of one or both ovaries by making few small incision in the abdomen. A tiny camera is then inserted in one of them while surgical tools in the others. The images from the camera will be displayed on a monitor so as to guide the surgeon during the operation.
• Unilateral Oophorectomy: is minimally invasive surgery for the removal of one ovary. This procedure allows for the continuation of menstruation and the ability to have children.
• Bilateral Oophorectomy: the removal of both ovaries.

VULVECTOMY

A vulvectomy is the surgical removal of all or parts of the vulva.

The following vulvectomy procedures are offered:

• Partial Vulvectomy: least severe and most common vulvectomy and involves the removal of only affected portion of the vulva and some of the surrounding tissue.
• Radical Vulvectomy: least common vulvectomy and involves the removal of all of the vulva, the clitoris, the lymph nodes and nearby tissue. The uterus, vagina and ovaries stay intact.
• Ultra-radical Vulvectomy with Lymphadenectomy: a radical vulvectomy with posterior exenteration (the removal of organs in the back of the pelvic cavity including the rectum but not the bladder) or total pelvic exenteration (the removal of both the bladder and the rectum). This procedure also includes the surgical removal of the lymph nodes.

PLEASE NOTE THE FOLLOWING IMPORTANT INFORMATION:

• The above program does not include medications for certain conditions such as
  depression, blood coagulation, etc.
• Medicaments, fluids, blood and derivatives to be used, as well as additional procedure(s)
  performed not included in the exact treatment would be invoiced
  separately on upon the conclusion of said treatment / procedure(s)