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The first few weeks of shock and uncertainty after diagnosis are a traumatic experience and in many ways rob the patient and the family of their security and peace of mind.
We will assure you that you will be treated with the best equipment and treatment methods in the world. Our oncologists provide both medical and radiation oncology services. The addition of Dr Netshituni provides convenience for our paediatric oncology patience because they had to travel outside the province for their treatment
The oncologists are assisted by competent nurses and radiotherapists to ensure that you will receive the correct treatment as prescribed. We have professional ancillary support in our team who specialise in the following fields:
Oncology is the study, diagnosis and treatment of cancerous tumours. The word "cancer" still instils fear in the minds of the population at large, this despite the advances made over the last few decades. It is still widely regarded as one of the most dreaded diseases of our era and the diagnosis is often still associated with feelings of fear and hopelessness in the newly diagnosed.
The word ‘chemotherapy’ describes the use of chemicals or drugs used to treat cancer. These drugs can be used as follows:
Chemotherapy is the treatment of cancer by means of chemical drugs. It is administered to kill cancer cells or to retard or prevent their growth. Sometimes a combination of more than one drug is given in order to fight the tumour cells in different ways. Chemotherapy makes cancer cells more sensitive to the effect of irradiation, therefore these two methods are often combined to obtain the best result for a specific condition. The chemotherapeutic drugs reach the cells via the blood stream. Cancer cells divide very rapidly and consequently absorb most of the chemotherapy, therefore they will die off and not divide and grow any further. The abnormal cells die, while the normal cells recover. The damage to the normal cells may nevertheless cause temporary side effects. The effect of chemotherapy differs from one person to another and also according to the type of cancer being treated.
Each treatment is followed by a rest period to give the normal cells time to recover. The schedule differs from one person to another, and the oncologist will explain it to you. The chemotherapy is normally given at the oncologist's consulting rooms. If it requires an intravenous infusion over several days, however, there are two options that can be followed, namely:
Use of the latter method is only possible if you are provided with a "port". A port is a small metal chamber (the size of a two-rand coin). It is implanted under the skin under local anesthetic. A catheter runs from this small chamber into one of your main veins. Access to this chamber (port) is gained through a special needle that is inserted vertically through the skin into the port. This needle will remain in position for the duration of the chemotherapy. An elastomeric administration system ensures that the chemotherapeutic drug flows directly into your blood stream at a specific rate per hour. When the chemotherapy has been completed, the needle is removed.
Chemotherapy drugs stop or retard the growth of cancer cells. Cancer cells undergo rapid division and chemotherapy drugs interfere with their division. By virtue of this mechanism of action, they may in some cases also harm healthy body cells which undergo rapid divisions, causing certain side effects.
Chemotherapy is the treatment of cancer by means of chemical drugs. It is administered to kill cancer cells or to retard or prevent their growth. Sometimes a combination of more than one drug is given in order to fight the tumor cells in different ways.
Chemotherapy makes cancer cells more sensitive to the effect of irradiation, therefore these two methods are often combined to obtain the best result for a specific condition. The chemotherapeutic drugs reach the cells via the blood stream. Cancer cells divide very rapidly and consequently absorb most of the chemotherapy, therefore they will die off and not divide and grow any further.
The abnormal cells die, while the normal cells recover. The damage to the normal cells may nevertheless cause temporary side effects. The effect of chemotherapy differs from one person to another and also according to the type of cancer being treated.
Each treatment is followed by a rest period to give the normal cells time to recover. The schedule differs from one person to another, and the oncologist will explain it to you.
The chemotherapy is normally given at the oncologist's consulting rooms. If it requires an intravenous infusion over several days, however, there are two options that can be followed, namely:
Use of the latter method is only possible if you are provided with a "port". A port is a small metal chamber (the size of a two-rand coin). It is implanted under the skin under local anaesthetic. A catheter runs from this small chamber into one of your main veins.
Access to this chamber (port) is gained through a special needle that is inserted vertically through the skin into the port. This needle will remain in position for the duration of the chemotherapy.
An elastomeric administration system ensures that the chemotherapeutic drug flows directly into your blood stream at a specific rate per hour. When the chemotherapy has been completed, the needle is removed.
Chemotherapy is no more painful than any other injection or blood tests and the agents are administered in following ways:
The nursing staff rinse the vein during and after administration of chemotherapeutic drugs to prevent the vein from burning or being damaged.
If the injection area becomes painful or burn, you must report this to the nursing staff immediately. If you take medication other than that prescribed to you, you must keep the oncologist and / or nursing staff informed of this at all times.
It is also very important that you make separate appointments for your weekly and monthly chemotherapy treatments.
These appointments can be made with the oncologist's receptionists.
It is only human to be concerned about the side effects of irradiation, especially as there are so many misconceptions about irradiation. However, if you understand what may or may not happen, you can avoid unnecessary anxiety and fear.
The aim of the following information is to give you peace of mind.
Some medication may cause nausea and vomiting, the severity of which varies from one person to another. Anti-emetic medication is always given together with chemotherapy. There are also a variety of tablets, injections and suppositories that can be used to combat nausea. Please ask the nursing staff to arrange a prescription for you and use this medication regularly.
Diet also plays a role, and the following is recommended:
Take anti-emetics regularly while you are receiving chemotherapy, and for a few days afterwards.
Report irritation of the bladder to the oncologist so that, if any infection is present, it can be treated. Remember to increase your fluid intake.
Some of the medication may cause discoloration of your urine. It is recommended that you increase your fluid intake so that the kidneys are flushed through properly.
Diarrhea: If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and ± two litres of water per day). Also consult your general practitioner or oncologist immediately.
You must prevent your body from dehydrating.
Eat a lot of bananas, carrots (cooked), grated apple (without the skin) and maizena porridge. If you want more information, please talk to the nursing staff or dietician to assist you with this.
Constipation: You could become constipated as a result of the chemotherapy. Drink a lot of fluids and follow a balanced diet rich in fibre. It is important that you take all types of fibre, so ask the dietician to advise you. Laxatives may be taken, but you must first obtain the oncologist's permission for their use.
You could try the following remedy for constipation (it is not habit-forming): One sachet of Duphalac dry = ½ teaspoon of Epsom salts, dissolved in a glass of water. You may request a prescription for this.
Some of the drugs will cause your hair to fall out, but it will grow back after the treatment has been stopped or completed.
In some cases a scalp-cooling device (ice bonnet) is used to limit hair loss as far as possible. For a small donation you could also obtain a wig from your nearest branch of the Cancer Association.
If you develop sores in your mouth or throat, you must report this immediately. If necessary, your oncologist can prescribe medication for you. You can also do the following to provide relief:
Certain vitamins provide relief for sores in the mouth. Consult our dietician for more information.
If you can no longer eat, or have difficulty in swallowing, you must contact the dietician immediately so that a nutritional supplement can be prescribed.
The bone marrow forms new blood cells in the body.
Each of the different types of blood cells plays an important role, namely:
Because bone marrow cells grow more rapidly, they also absorb more of the chemotherapy; therefore it is necessary that a blood count be taken before each treatment. If the white blood cell count is too low, you will be very susceptible to infections. It is therefore advisable that you avoid, as far as possible, people who are suffering from colds or other infections. If you experience fever or cold fever, you must contact your general practitioner or oncologist immediately.
It could happen that your treatment is postponed or that the dose is decreased because your blood count is low. This only shows that your body is not yet ready to withstand the next chemotherapy session, and does not influence the effect of the treatment on the disease.
Before considering any form of medical treatment, it is important to understand what it entails. For this reason we would like to provide you with some background information on the following treatment modalities. In simple terms, radiotherapy means treatment with ionising rays; in this case with high-energy X-rays and electron beams which have various energy levels.
To understand how ionising rays work, you must first understand how cancer cells affect your body.Cancer starts with one cell that has lost control over it’s growth. Normal cells divide in a highly controlled manner to form new cells.
Cancer cells also divide and form new cells, but at a more rapid rate. Furthermore, cancer cells do not know when to stop dividing. They keep on dividing and multiplying until they have displaced or damaged the affected body tissue or organ. Yet these cells still continue their excessive growth and, because cancer cells do not grow within an enclosing capsule, some cells break away and are carried to the next organ by the lymph or the blood stream, and there they multiply further. This is called metastasis.
Irradiation damages and eventually destroys the cancer cells. But the rays cannot distinguish between normal and malignant cells.
The success of irradiation lies in the fact that malignant cells are more sensitive to irradiation than normal cells. The goal of irradiation is therefore to irradiate until the malignant cells have been killed or sterilised. The surrounding normal tissue is, however, still capable of complete recovery.
In certain phases of division, cells are more sensitive than in other, dormant phases. To irradiate as many of the cells as possible in the sensitive phase, the treatments are fractioned; in other words, they are spread over a period of time.
Another reason for fractionation is to give the normal cells, which recover faster than malignant cells, a chance to recuperate. (That is why you do not receive only one treatment). The sensitivity of the various types of tissue and the various organs differs, therefore the number of treatments for different diagnoses will inevitably also differ. The number of treatments prescribed bears no relation to the degree to which the cancer has advanced.
If you are to receive thirty treatments and another person only five, please do not assume that your prognosis is worse than theirs. The dose administered, the number of treatments and the specific diagnosis are very closely linked.
Irradiation is only done during the week, and may be interrupted for a day when the machine is being serviced or work is being done on the machine.
During your course of treatments you will meet other patients and you will probably compare your treatment and symptoms. It is important to understand that irradiation is used differently for the treatment of different conditions. Your irradiation and side effects may consequently differ considerably from those of another patient.
In simple terms, radiotherapy means treatment with ionizing rays; obtained from different sources. External radiation is delivered mainly by Linear accelerators (high energy X-rays). Brachytherapy (internal radiation) is obtained from radioactive substances placed inside or against the tumor area. To understand how ionizing rays work, you must understand how cancer cells affect your body.
The goal of radiation therapy is to damage and eventually destroy the cancer cells, but the rays cannot distinguish between normal and malignant cells.
The success of irradiation lies in the fact that malignant cells are more sensitive to irradiation than normal cells. The goal of irradiation is therefore to irradiate until the malignant cells have been killed or sterilized. The surrounding normal tissue is, however, still capable of complete recovery.
In certain phases of division cells are more sensitive than in other, dormant phases.
To irradiate as many of the cells as possible in the sensitive phase, the treatments are fractionated; in other words, they are spread over a period of time.
Another reason for fractionation is to give the normal cells, which recover faster than malignant cells, a chance to recuperate. This is why the total required dose is not given in one treatment. The sensitivity of the various types of tissues and the various organs differ, thus the number of treatments for different diagnoses will inevitably also differ. The number of treatments prescribed bears no relation to the degree to which the cancer has advanced, therefore, if you are to receive thirty-five treatments and another person receives only five, you cannot assume that your prognosis is worse than theirs. The dose administered, the number of treatments and the specific diagnosis are very closely linked. It is important to understand that because irradiation is used differently for the different conditions, it is not wise to compare treatments, symptoms or side effects.
Irradiation is only done during the week, and sometimes it is interrupted for a day when the machine is being serviced or work is being done on the machine.
Because the radiation passes through normal tissue to reach the effected area the side effects must be limited. To ensure this a CT scan is done which is then transferred to a dedicated Treatment Planning System (TPS). On the TPS a 3D image of the treatment area is created using the CT slices. The oncologist delineates the area of interest (tumor) on this 3D image. MRI images where soft tissue tumours are better shown can also be used in conjunction with CT images. The 3D image is used to plan the treatment with multiple field combinations with different angles and energies, to ensure that the dose to the normal tissue and sensitive organs is limited while an optimal dose to the tumor is achieved. The combined dose of the fields where they intersect give the optimal dose required. The different tissue densities, the beam is traveling through, is also taken into account since they have different absorption properties.
To limit the dose to critical organs and normal tissue in the beam path, shielding is used to shape the radiation beam. Modern technology allows for this to be done easily with multi leaf collimators (MLC) instead of lead shielding blocks which are time consuming and labour intensive. To achieve optimum treatment planning, highly skilled and experienced planning radiographers, physicists and a specialized TPS is essential.
To ensure that the treatment is being given correctly, recording and verification systems are essential. This will prevent treatment being given unless all parameters are set-up correctly. The system also records treatment data for future reference. Anatomical verification is also required to ensure that the correct treatment position is used. This is done with a portal imager or the use of verification films.
The area to be irradiated is determined by means of a localising scan or X-rays, and then marked. This is called a simulation.
PLEASE BRING ALONG ANY PREVIOUS X-RAYS OR SCANS that may be of use. Sometimes the treatment area is decreased during the course of the treatments. This is called a booster.
It is very important that the marks that have been made on your body remain there.
YOU MAY BATH OR SHOWER, but you must make sure that these marks are not washed off. A quick bath or shower is preferable. If you do take a bath, do not soak in the water. Use a gentle soap for example Dove soap.
Irradiation is not painful and patients are not radioactive after irradiation, therefore you pose no threat to other people.
During irradiation you will be alone in the treatment room, but you will be monitored on a television screen. There is also an intercom system.
It is extremely important that you keep very still, but you may breathe normally.
It is only human to be concerned about the side effects of irradiation, especially as there are so many misconceptions about irradiation.
However, if you understand what may or may not happen, you can avoid unnecessary anxiety and fear.
The aim of the following information is to give you peace of mind.
Only patients who receive irradiation over their abdominal organs sometimes experience nausea and vomiting. If you find that this is a problem, please ask your oncologist for a prescription for medication.
If the symptoms continue in spite of the medication, inform your oncologist immediately so that other medication may be prescribed.
It is extremely important that you take your medication as prescribed to prevent nausea, and not only when you feel nauseous.
It is also important that you continue to eat enough. If you start losing weight or find that you are no longer eating regularly, consult the dietician immediately.
Patients who receive irradiation over the lower abdominal area may suffer from diarrhoea, constipation, a burning sensation when urinating and / or piles.
Please ask for medication immediately if you suffer from any of the above.
It is also important to ask the radiotherapists whether your bladder should be full or empty during irradiation.
Patients receiving irradiation over the throat area will start suffering from a sore throat after about ten treatments. Gargling with a solution of half a teaspoon of bicarbonate of soda mixed with half a teaspoon of salt in a glass of lukewarm water will help. There will also be dryness of the mouth due to the irradiation affecting the salivary glands. This condition may be permanent. You may experience a temporary loss of speech, but speech will be regained in the course of time. You might also find that you develop a double chin after irradiation.
Men who are receiving irradiation over the face must not shave the treatment area, as it would cause skin irritation.
It is important that you drink a lot of fluids.
If you experience problems with your diet due to a sore throat or mouth, please consult the dietician.
If you have three or four loose stools a day, you should drink clear fluids (soup, soft drinks, tea and ± two litres of water per day). Also consult your general practitioner or oncologist immediately.
You must prevent your body from dehydrating.
Eat a lot of bananas, carrots (cooked) and grated apple (without the skin).
The dietician can compile a special diet for you to help combat the diarrhoea. It may also be advisable to take one or more nutritional supplements. These supplements can be prescribed by the dietician. You may also take medication for the diarrhoea. Please ask the nursing staff to assist you with this.
CAUTION: Please do not use any ointment, powder or deodorant spray on the irradiation area. These will make any skin irritations worse. You may use a roll-on deodorant (like Dove). If the skin feels tender, you could use Aqueous water-soluble cream. If necessary your doctor will prescribe a special cream.
Do not expose the treatment area to direct sunlight. Wear a hat and suitable clothes in the sun. If a skin reaction is to be expected, the oncologist or radiotherapist will tell you. A reddening of the skin will become visible after about fifteen treatments.
Your hair will only fall out if you receive irradiation over the scalp. Irradiation of other parts of the body will not cause hair loss on the head.
The hair will only start falling out after about fifteen treatments, and in most cases will start growing again after about three months.
White blood cells are the body's protective mechanism against infections.
The white blood cell count of patients receiving irradiation over large areas of bone may decrease, therefore regular blood counts will be taken if you are such a patient.
When smaller areas of the body are irradiated, the loss of white blood cells is so small that regular blood counts are not necessary.
Before considering any form of medical treatment, it is important for you to understand what the procedure and side effects of each treatment entail. There are a variety of drugs and treatments for cancer, these drugs include chemotherapy drugs, hormonal therapy drugs, biotherapy drugs, targeted therapy and gene therapy.
The information contained within this website will help to form a basic knowledge of each treatment, however it may not necessarily answer all the questions you have. Please feel free to discuss any questions, side effects or problems with your nurse or radiographer when you visit your Oncology Centre or alternatively with your doctor.
New treatments for cancer are continually being developed and the Alberts, Bouwer & Jordaan Inc. are involved with a large number of clinical trials which assess the effectiveness of these treatments. Research is conducted in collaboration with international pharmaceutical companies and recognised cancer research groups from both Europe and the United States of America.
All advances in Chemotherapy in the past decade are as a direct result of clinical research. We offer our patients the opportunity to participate in these clinical trials if they are relevant for the treatment of their specific cancer. This gives our patients access to new and exciting drugs that are still in development, at greatly reduced costs.
All our research is conducted in accordance with ICH (International Committee for Harmonisation) and GCP (Good Clinical Practice) guidelines. These are international guidelines, which rigorously govern the conduct of clinical research and ensure the delivery of the highest quality of patient care.
Compliance with these global standards provides the public with the assurance that the rights, safety and well being of our patients are protected and are consistent with the principles that have their origin in the Declaration of Helsinki.
This added facet of our practice helps to ensure that the standard of care delivered to our patients is comparable to that of the finest cancer institutions in the world.
The concept of immunotherapy is based on the body's natural defence system, which protects us against a variety of diseases. Although we are less aware of it, the immune system also works to aid our recovery from many illnesses and there is evidence that in many cancer patients the immune system slows down the growth and spread of tumors.Biotherapy drugs harness or mimic the body’s immune system, to fight cancer cells.
Certain hormones in the body assist hormone sensitive cancer cells to grow. Hormone therapy blocks the effect of natural hormones on cancer cells i.e. it prevents the cancer cells from getting the hormones they need to grow.When choosing a hormonal therapy, you and your doctor will weigh the benefits and possible side effects before deciding on a hormonal therapy treatment plan that suits your needs.
Targeted therapy utilises drugs or other substances that block the growth of cancer by targeting and interfering with the tumor growth and progression by attacking specific targets in cancer cells. They induce the death of the cancer cells by destroying those targets.
Examples of Targeted Therapies include Angiogenesis Inhibitors, EGFR Inhibitors and TKI blockers. Angiogenesis inhibitors block the formation of new blood vessels in cancer cells. New blood vessels form naturally in tumors, because they grow rapidly, and require new blood vessels for nutrition and oxygen. By preventing the formation of these blood vessels, the growth of the cancer can be slowed or inhibited.
Heamatology includes bone marrow transplant, stem cell transplant, pheresis or chemotherapy and is used to treat cancers that are treated with non surgical therapy such as leukemia, lymphomas, Hodgkin's, non-Hodgkin's, multiple myelomas and immunological disorders.
Brachytherapy is radiation performed by placing radioactive isotopes inside tissues, which are targeted to receive a high dose, thus giving high doses of radiation over short distances, with little radiation to surrounding normal tissues. There are permanent implants and interstitial implants.
The process involves:
These are done by placing radioactive seeds or wires into the tumour or tumour bed to give a high local dose of radiation with rapid fall off and minimal damage to surrounding tissues. It is commonly used for head and neck cancers, sarcomas or skin cancers.
The process involves:
The practice of stem cell transplantation can be autologous (where the patient is their own donor) or allogeneic (where someone else is the donor – either a sibling or a registry, unrelated donor). Stem cell transplants are mostly performed for malignant blood conditions (e.g. Leukemia, Myeloma, Lymphoma etc) or for bone marrow failure syndromes. The transplant of marrow stem cells allows higher (myeloablative) doses of chemotherapy to be given and in some transplants (from an allogeneic donor) allows a "clean" marrow and new immune system to replace the diseased marrow.
Stereotactic Radiosurgery (SRS) and Stereotactic Irradiation refer to radiation treatment in which a large radiation dose is delivered very precisely to a lesion in anything from one to 25 treatment fractions. Stereotactic irradiation is performed worldwide as an alternative to surgical removal of brain lesions such as arteriovenous malformations (AVM’s), acoustic neuromas, solitary or multiple brain metastases, gliomas, pituitary microadenomas, astrocytomas and others. Stereotactic irradiation treatment is specifically indicated when lesions are near critical brain structures, making them difficult to reach with invasive surgery techniques without damaging normal, healthy brain structures. The treatment procedure is typically performed on an out-patient basis. No surgical incision is required and therefore radiosurgery and stereotactic radiotherapy (irradiation) avoids the complications, substantial recovery times, and costs associated with open brain surgery.
Stereotactic irradiation is a very attractive alternative to the emotional and physical trauma associated with major, high-risk surgery.
Stereotactic irradiation is a very attractive alternative to the emotional and physical trauma associated with major, high-risk surgery.
Radiation beams in conventional external radiation therapy and three dimensional conformal radiotherapy (3D-CRT) can be shaped by customised blocks or multileaf collimators, but the intensity or fluency of the radiation beam has traditionally been uniform within the treated region. By adjusting the beam-intensity across the field, another dimension to treatment delivery can be provided to permit even more conformal dose distributions.
This treatment delivery is known as intensity-modulated radiation therapy, or IMRT. In IMRT, the intensity of the radiation exposure in one portion of the field is modified depending on whether tumor or critical normal structures are present in the beam pathway. Hence, the beam is divided into multiple beamlets, which are the essence of IMRT.
When the beamlet hits sensitive normal tissues such as the spinal cord or parotid glands, the intensity is lowered, and when the beamlet hits tumor, the intensity is higher. By dividing the radiation beam into multiple slices, the beam-intensity in any slice can be varied either by computer-controlled multileaf collimation or physical compensators during the radiation exposure. While the radiation source, or linear accelerator gantry head, moves around the patient, both the shape of the beam and the intensity of the beam slices (lighter shades representing higher radiation intensity) are varied to avoid the organ at risk while treating the tumor. This results in highly conformal distributions of radiation dose, even around concave tumor volumes.
Image-guided radiation therapy is conformal radiation treatment guided by imaging equipment, such as CT, ultrasound or stereoscopic X-rays, taken in the treatment room just before the patient is given the radiation treatment. IGRT allows radiation to be delivered to tumors with more precision than was traditionally possible. One of the challenges encountered when radiation is delivered to a tumor is that the tumor can move based on the patient's day-to-day position on the treatment table (as well as from breathing). IGRT allows the physician to better deliver the radiation dose directly to the cancer by using a variety of automated and tracking systems.
Clinicians obtain daily high-resolution imagery to pinpoint tumor sites, adjust patient positioning when necessary, and complete a treatment, all within the standard treatment time period. By Imaging the tumor daily, we can detect movement in normal structures or changes in tumor location or size which permits the physician to precisely locate the tumor while the patient is in the treatment position. This minimizes the volume of healthy tissue exposed to radiation during treatment, yet allows the delivery of higher doses of radiation to the tumor volume.
We offer specialist advice and support both on symptom control and total patient care. We concentrate on working with the patient to achieve the very best quality of life and to support them and their family. We provide support in: