Inova Schar Cancer Institute Treatment Options

Alpha interferon is a biological response modifier (a substance that stimulates or improves the ability of the body's immune system to fight disease) that interferes with the division of cancer cells and slows tumor growth. Interferons are substances normally produced by the body but can be produced in the laboratory.

Alpha interferon may be used to treat:

• Myeloma bone disease
• Multiple myeloma

Ablation is a minimally invasive technique that that destroys tumors without removing them. Ablation is often used for patients with a few small tumors when surgery is not a good option. This type of treatment may be done as an outpatient or require a brief overnight stay.  

There are several different types of ablation:

• Cryoablation

  Cryoablation (percutaneous) is a minimally invasive treatment option for patients whose tumors cannot be removed by surgery or are at high-risk for surgical complications. Cryoablation kills cancer cells by freezing them. A thin needle, called a cryoprobe, is inserted through the skin and into the tumor. The cryoprobe freezes tissue around it's tip to very cold temperatures, killing the tumor cells. The interventional radiologist uses imaging techniques such as CT or ultrasound to accurately guide the cryoprobe and spare healthy tissue. A tumor can usually be treated in one session, which usually takes a couple of hours and patients can usually go home the same day.

• Microwave Ablation

  Inova Fairfax Hospital was the first in Northern Virginia to use percutaneous microwave ablative technologies in the clinical setting. Microwave antennae are inserted into the target lesion under imaging guidance. The microwaves create a well-defined zone of thermal ablation around each antenna. Advantages of microwave ablation include less time to treat, more uniform ablation zones and less pain during and after the procedure. Most of these procedures are performed on an outpatient basis.

• Radiofrequency Ablation 

  Radiofrequency ablation is a minimally invasive treatment for cancer used when surgery is not a good option. This type of ablation kills cancer cells by heating and destroying them. Physicians insert a thin needle guided by (CT) or ultrasound through the skin and into the tumor. Energy similar to radio waves delivered through this needle heats and destroys the tumor. Patients are sedated and may go home the same day.

Conditions Treated

Ablation may be used as a treatment for cancers of the hepatobiliary system, including the liver, pancreas and gallbladder.

Partial breast irradiation is a type of internal radiation therapy known as brachytherapy. It is used for selected patients with early-stage breast cancer who have undergone a lumpectomy and is an alternative to standard radiation therapy, which is given daily over six weeks. The technique spares surrounding healthy tissue while focusing radiation in the area most likely to contain residual cancer cells.

After the breast cancer is removed, a small, soft balloon attached to a thin catheter is placed inside the lumpectomy cavity. The balloon is filled with saline solution and remains in place during the five-day treatment. The treatment is custom designed by the radiation oncologist and physicist for the patient’s specific situation and anatomy. During the twice-per-day treatments, the catheter is attached to a computer-controlled machine which inserts the radioactive sources according to the treatment plan. At the end of the five days, the treatment is complete and the catheter is removed.

Conditions Treated

Accelerated partial breast irradiation is used for selected patients with early-stage breast cancer who have undergone a lumpectomy. This treatment is an alternative to standard radiation therapy, which is given daily over six weeks.

Inova Breast Cancer Program

Apheresis is a procedure that removes substances from a patient's blood that are contributing to a condition or disease. It is also the process used in the collection of blood components from blood donors such as red cells, platelets, or plasma.

Apheresis as Treatment

Apheresis services are available from the Inova Schar Cancer Institute on the Inova Fairfax Medical Campus. The technology is used to treat blood cancers as well as autoimmune illnesses and other conditions, including:

• Leukemia
• Multiple myeloma
• Thrombotic thrombocytopenc purpura (TTP)
• Sickle cell disease
• Guillain-Barre syndrome
• Myasthenia gravis
• Chronic inflammatory demyelinating poyneuropathy (CIDP)
• Anti-glomerular basement membrane (Goodasture's syndrome)
• ANCA-associated RPGN
• Renal transplants

The Apheresis Procedure

Apheresis involves removing blood from the patient and passing the blood through an apparatus that separates the blood into components. After the blood has been separated, the remaining blood and blood components are returned to the patient. The entire procedure is typically painless and takes two to three hours.

National Accreditation

Inova's apheresis program is accredited by the Foundation for the Accreditation of Cellular therapy (FACT). FACT is the only accrediting organization that addresses all quality aspects of cellular therapy treatments and sets rigorous standards for its participating programs as defined by leading experts in the field. 

Biotherapy, also called immunotherapy, is a collection of safe, effective, nontoxic holistic methods that are used to help cancer patients fight the disease and prevent recurrences. Biological therapy uses the body's own immune system to fight cancer.

Conditions Treated

Biotherapy may be a treatment for a variety of blood cancers, as well as kidney, breast, brain, colorectal and other cancers. Your physician is your best resource when considering biotherapy as a cancer treatment.

Blood and platelet transfusion is the process of transferring blood or blood-based products, such as red blood cells, plasma, or platelets, from one person into the circulatory system of another. There are several different components of the blood that can be transfused into an adult. Red blood cells are the most common type of blood product transfusion. Human blood is made of a fluid called plasma that carries red and white blood cells and platelets. Each part of blood has special functions and can be separated from each other. The bone marrow is the soft, spongy material in the center of the bones that produces about 95 percent of the body's blood cells. Platelets help control bleeding by making clots in blood vessels opened by injury or surgery. Many medical treatments, including treatments for cancer patients, organ or bone marrow transplant patients, victims of traumatic injury, and patients undergoing open heart surgery require platelet transfusions. The body may not be able to make enough platelets because of bone marrow disorders, increased destruction of platelets, or medications such as chemotherapy.

Brachytherapy is a type of radiation treatment where the source of radiation is implanted into the patient as close to the cancer as possible. The radiation is delivered to the tumor site with radioactive isotopes contained within wires, seeds, or rods. Brachytherapy allows for a higher total dose of radiation over a shorter period of time than does external beam therapy. The radiation dose is concentrated on the cancer cells, resulting in less damage to the normal cells near the cancerous growth.

Brachytherapy implant placement may be permanent or temporary. Permanent brachytherapy, also called low dose rate brachytherapy, uses implants called pellets or seeds. These implants are very small, about the size of a grain of rice. The implants are inserted directly into a tumor through thin, hollow needles. The implants are left in place after the radiation has been used up, as their small size causes little or no discomfort.

In temporary brachytherapy, implants such as hollow needles, catheters (hollow tubes), or balloons filled with fluid, are inserted into or near the cancer for a period of time, then removed. Either high-dose or low-dose brachytherapy may be used.

Conditions Treated

Brachytherapy may be used as a treatment for these types of cancer:

• Cervical cancer
• Uterine cancer
• Vaginal cancer
• Prostate cancer
• Rectal cancer
• Head and neck cancers

Effective treatment for challenging cancers

Inova Schar Cancer Institute is the first cancer center in the Washington, DC, area to offer the sophisticated cytoreductive surgery and HIPEC treatment for advanced abdominal cancers, also known as peritoneal cancer.

Because the chemotherapy used in the treatment is heated and contained within the abdomen, HIPEC is sometimes called "hot chemotherapy" or a "chemo-bath."

The basics

Gastrointestinal and other cancers generally spread by three main routes:

• The lymphatic system
• The bloodstream
• Throughout the abdominal cavity by shedding cells that implant onto the lining of the abdominal cavity (the peritoneum)

The peritoneal route can be particularly challenging to treat because there often are multiple tumor implants that can cover large surfaces and involve several organs within the abdominal cavity. These tumor implants are also called peritoneal metastases.

Some types of cancers are particularly likely to spread in this fashion, such as appendix (appendiceal) cancer. But peritoneal metastases is also seen in stomach (gastric) cancer, colon cancer, ovarian cancer, pancreas cancer, mesothelioma and other cancers.

What is cytoreductive surgery and HIPEC

Cytoreductive surgery and HIPEC is a treatment is designed to specifically address peritoneal metastases, or peritoneal deposits on the lining of the peritoneal cavity. It consists of two main components:

• A surgical procedure that removes visible tumor deposits (cytoreductive surgery or CRS)
• A chemotherapy treatment delivered directly into the abdominal cavity during the surgical procedure

Because the chemotherapy agents are placed in the abdomen and are heated, this part of the procedure is called HIPEC (heated intraperitoneal chemotherapy). HIPEC is sometimes been referred to as "hot chemotherapy" or a "chemo-bath."

During HIPEC, the surgeon administers a chemotherapy solution into the abdomen. The solution is continuously circulated and heated by a specialized FDA-approved device for 60-90 minutes. After the 60-90 minutes, the chemotherapy solution is removed and the surgical procedure completed.

What is the rationale behind HIPEC?

HIPEC is a regional chemotherapy treatment that delivers a high concentration of chemotherapy agents within the abdominal cavity, where the cancer cells are present, while minimizing exposure to the rest of the body. Administering the chemotherapy directly into the abdominal cavity rather than intravenously helps us achieve this goal. Chemotherapy agents known to maintain a high local concentration during the 60-90 minutes of treatment are chosen for HIPEC.

Warming the chemotherapy solution achieves additional potential benefits. Laboratory studies show that cancer cells are more sensitive to heat than normal cells and may be killed more readily at an increased temperature (> 41 degrees Celsius). In addition, heating the chemotherapy solution improves the ability of the chemotherapy agents to penetrate cancer tissues and improves its ability to kill cancer cells.

What conditions can be treated with cytoreductive surgery (CRS) and HIPEC?

There is strong clinical evidence to support cytoreductive surgery and HIPEC as the treatment of choice for patients with appendix cancer and malignant peritoneal mesothelioma. Select patients with peritoneal metastases from colon cancer can also benefit from CRS and HIPEC.

HIPEC is used in other countries to treat ovarian cancer and is currently being evaluated in the United States for that use. Other types of cancers, including many rare and unusual cancers that have spread to the peritoneum, may be appropriate for this treatment.

Chemotherapy is a highly effective treatment for many types of cancer. Chemotherapy may be used alone or in combination with other treatments such as radiation therapy or surgery.

Chemotherapy is given:

• As a pill to swallow
• As an injection into the muscle or fat tissue
• Intravenously (directly into the bloodstream; also called IV or infusion)
• Topically (applied to the skin)
• Directly into a body cavity

Chemotherapy is a systemic treatment, meaning the cancer-fighting drugs travel to all parts of the body, not just to the cancer cells. As a result, some patients experience side effects.

• There are more than 50 chemotherapy drugs commonly used to treat cancer. Each person reacts differently to treatment, which is why side effects range from mild to severe. Some people experience no side effects at all.
• Talk with your cancer care team and learn about potential side effects before you begin treatment. Armed with this information, you and your caregivers will be better prepared to minimize, or even prevent, side effects.
• Side effects may include nausea, vomiting, confusion, headaches, sores in the mouth, redness or dryness of the mouth, diarrhea or constipation and hair loss.

Inova Schar Cancer Institute offers dedicated medical oncology units staffed by physicians and nurses with special expertise in oncology and cancer care. These professionals are highly experienced in administering chemotherapy and dealing with any side effects. Your medical oncologist also consults with other physicians involved in your treatment plan, including radiation therapists, surgeons and your primary doctor, to determine the appropriate medications and dosage for your situation.

Inova is deeply committed to finding better ways to prevent, detect, diagnose, and treat cancer.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive a standard treatment or they may be among those randomly selected to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or to reduce the side effects of cancer treatment.

Find Cancer Clinical Trials

Colonoscopy is a procedure to screen for and potentially treat colorectal cancer. During the procedure, a flexible colonoscope is inserted through the rectum into the colon to allow the physician to view the entire length of the large intestine.

Using guided imagery, the physician is able to examine the lining of the colon through the scope. At the same time, tissue can be removed for further examination. The physician may even treat problems discovered during the procedure.

Colonoscopy is usually performed by a gastroenterologist, a physician who specializes in gastrointestinal conditions and diseases. Inova Fairfax Hospital Advanced Endoscopy Center is the first of its kind in Northern Virginia to offer the most innovative endoscopic technologies available to successfully treat both cancerous and non-cancerous diseases of the digestive tract – conditions that once required traditional surgery.

Cryotherapy is a type of surgery that destroys cancer cells by freezing them. The surgeon takes care to try to keep healthy cells and tissue from being frozen along with the cancer cells.

Several different procedures can be used to freeze cancer cells. For instance, to treat skin cancer, cells are usually frozen using liquid nitrogen that may be sprayed or applied right on the skin. To treat tumors in the lung, a thin tube is put into the lung tumors. The tip of the tube applies intense cold to the tumor, destroying the cancer. This procedure is done under general anesthesia.

Cryotherapy may be used to treat cancers of the skin, liver, cervix, prostate, bone, lung and for various pediatric cancers.

CyberKnife® is cutting edge treatment without cutting. It is an exceptionally precise, non-invasive form of radiation therapy for cancer available at Inova Fairfax Hospital. 

Conditions Treated by CyberKnife

This non-surgical treatment alternative is used for many different kinds of cancer. Patients with cancer of the brain, spine, lung, prostate, liver, pancreas, head, kidney, neck and pelvis may be excellent candidates for CyberKnife radiosurgery.

The pain-free treatments are delivered on an outpatient basis with virtually no disruption to normal activities and in many fewer sessions than conventional radiation therapy.

Benefits of CyberKnife Treatment

• Pain free
• Non-invasive
• No anesthesia required
• Exceptional accuracy that spares healthy tissue and organs
• No invasive body frame or holding your breath
• Offers an excellent non-surgical option for patients with inoperable or surgically complex tumors, or who are looking for an alternative to surgery

LEARN MORE ABOUT CYBERKNIFE AND MEET OUR TEAM OF EXPERTS

The robotic-assisted da Vinci^® surgical program at Inova is the state-of-the-art alternative to both traditional open surgery and conventional minimally invasive surgery. Your surgeon's hands are at the controls of a robotic platform so refined that even the most complex, delicate procedures can be performed through very small incisions with unmatched precision.

Robotic-assisted surgery is the most recent and innovative surgical technique and became available in the late 1990s. Building on the techniques for laparoscopic surgery, the surgical tools inserted into the patient through the ports are connected to robotic arms rather than held by the surgeon. The robotic arms, however, are fully controlled by the surgeon. The level of surgical precision is unsurpassed, and there are numerous other advantages as well.

Robotic-assisted da Vinci technology is available at Inova Alexandria Hospital, Inova Fair Oaks Hospital, Inova Fairfax Hospital, Inova Loudoun Hospital and Inova Mount Vernon Hospital.

Advantages of Robotic-Assisted Surgery

The advantages for the patient are significant. The small incisions made to allow access for the surgical tools and camera mean less blood loss, lower risk of blood transfusion and infection, a shorter hospital stay, decreased need for pain medication and a quicker recovery and return to normal function. Patients also benefit from the high-tech nature of the equipment. The robotic camera provides ten-fold magnification and three-dimensional vision rather than the two-dimensional vision of a laparoscope. The robotic arms move with incredible precision, moving in, out and with a wrist-like turning motion of 360 degrees. Human tremor is filtered out completely.

The surgeon and surgical team work from a comfortable, ergonomic position, resulting in less fatigue during long complex cases. Is everyone a candidate for robotic surgery? Robotic-assisted surgery is appropriate for many different types of conditions, including cancer and non-cancerous procedures, and is available for adults and for children.

Conditions Treated

Inova's surgical teams use robotic-assisted da Vinci surgery to treat many different kinds of cancer, including:

• Colon cancer
• Kidney cancer
• Laryngeal cancer
• Liver cancer
• Lung cancer
• Pharyngeal cancer
• Prostate cancer
• Tongue cancer
• Tonsil cancer
• Uterine cancer

LEARN MORE ABOUT DA VINCI

Embolization is a minimally invasive therapy to block a blood vessel. It is commonly used to stop bleeding as well as to stop blood flow to a tumor in order to shrink it or in preparation for removal.

Different types of embolization are used for tumors in specific areas of the body. The following are most often used on tumors affecting the liver, bile duct, pancreas and liver.

• Bland embolization – a treatment option for liver cancer patients where the tumors cannot be removed by surgery because of their location or number of tumors. This can treat tumors that have originated in the liver and tumors that spread from other sites (colon or breast). Through a catheter, small particles are injected to prevent blood flow to the tumor. This is an outpatient procedure.
• Chemoembolization (LC Beads^®) – beads are injected into the vessels to block the blood flow to the tumor, causing it to shrink over time.
• Portal vein embolization – a procedure that blocks the flow of blood to an area of the liver. Tiny particles are injected into the vein and this blockage redirects the blood flow to the side of the liver that is not being embolized allowing for surgery to be possible.
• Radioembolization and selective internal radiation therapy (SIRT) – SIRT delivers radiation directly to the tumor through millions of microscopic radioactive spheres, called SIR-Spheres®,  where they destroy the tumor by depositing millions of tiny radioactive emitters around the tumor nodules in the liver. These particles act like local radiation therapy directly to the tumors, with very few side effects. The radiation is contained within the patient's body, and continually delivers the radiation over a few days. The microspheres are then no longer radioactive. Patients usually spend four to six hours at the hospital. Learn more about SIRT and watch patient videos.

The Interventional Oncology Program at Inova Fairfax Hospital and Inova Alexandria Hospital draws together a multidisciplinary team of specialists to deliver the best possible outcomes to adults and children with tumors of the liver, bile duct and pancreas. The program is the only one of its kind in Northern Virginia.

For more information, call 703-776-3832.

Endoscopic retrograde cholangiopancreatography (ERCP) combines combines X-ray imaging and the use of an endoscope (a long, flexible, lighted tube) to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas.

The endoscope is carefully guided through the mouth and esophagus, into the stomach and duodenum. The physician can examine the inside of these organs and detect any abnormalities. Dye injected through a tube in the scope highlights the internal organs and makes them more clearly visible on an X-ray.

Conditions Treated

ERCP may be used to help diagnose these types of cancer:

• Liver cancer
• Gallbladder cancer
• Bile duct cancer
• Pancreatic cancer

The Inova Fairfax Hospital Advanced Endoscopy Center is the first of its kind in Northern Virginia. Our physicians utilize some of the most innovative endoscopic technologies available to successfully treat both cancerous and non-cancerous diseases of the digestive tract – conditions that once required traditional surgery.

Enterostomal therapy focuses on the acute and rehabilitative care of patients with:

• Abdominal stomas
• Bladder and colorectal cancer
• Draining wounds
• Fistulae
• Dermal tissue trauma
• Urinary incontinence

Inova Fairfax Hospital is the only hospital in Northern Virginia offering a dedicated outpatient ostomy care program for both pediatric and adult ostomy patients. Our patients receive specialized care from a team of registered nurses with advanced training in wound, ostomy, and continence (WOC) disorders.

We understand that patients need both medical care and educational support after intestinal or urinary diversion surgery and offer the following ostomy services:

• Pre-surgical ostomy site marking (for patients having surgery at an Inova hospital)
• Pre-surgical education
  Patients will be given a pouching system to take home, informational brochures on the type of ostomy they will have (ileostomy, urostomy, or colostomy) and how to care for their ostomy. Nurses will discuss clothing, lifestyle, exercise and dietary needs, as well as potential benefits and complications, both short- and long-term
• Post-surgical care and education
  Patients receive written home instructions, videos, pamphlets, information on how to obtain supplies and a description of the various pouching systems currently available. Patients with a colostomy may return, if necessary, to learn about irrigations (a bowel management program).
• Appliance fitting and adjustments
  We offer problem-solving assistance for stomas that are poorly placed or constructed, flushed or retracted, as well as help with irregular abdominal contures. The goal is to obtain a minimal three-day wearing time.
• Ostomy and peristomal skin assessments and treatments
• One-on-one education for family and friends

Effective treatment for challenging cancers

Inova Schar Cancer Institute is the first cancer center in the Washington, DC, area to offer the sophisticated cytoreductive surgery and HIPEC treatment for advanced abdominal cancers, also known as peritoneal cancer.

Because the chemotherapy used in the treatment is heated and contained within the abdomen, HIPEC is sometimes called "hot chemotherapy" or a "chemo-bath."

The basics

Gastrointestinal and other cancers generally spread by three main routes:

• The lymphatic system
• The bloodstream
• Throughout the abdominal cavity by shedding cells that implant onto the lining of the abdominal cavity (the peritoneum)

The peritoneal route can be particularly challenging to treat because there often are multiple tumor implants that can cover large surfaces and involve several organs within the abdominal cavity. These tumor implants are also called peritoneal metastases.

Some types of cancers are particularly likely to spread in this fashion, such as appendix (appendiceal) cancer. But peritoneal metastases is also seen in stomach (gastric) cancer, colon cancer, ovarian cancer, pancreas cancer, mesothelioma and other cancers.

What is cytoreductive surgery and HIPEC

Cytoreductive surgery and HIPEC is a treatment is designed to specifically address peritoneal metastases, or peritoneal deposits on the lining of the peritoneal cavity. It consists of two main components:

• A surgical procedure that removes visible tumor deposits (cytoreductive surgery or CRS)
• A chemotherapy treatment delivered directly into the abdominal cavity during the surgical procedure

Because the chemotherapy agents are placed in the abdomen and are heated, this part of the procedure is called HIPEC (heated intraperitoneal chemotherapy). HIPEC is sometimes been referred to as "hot chemotherapy" or a "chemo-bath."

During HIPEC, the surgeon administers a chemotherapy solution into the abdomen. The solution is continuously circulated and heated by a specialized FDA-approved device for 60-90 minutes. After the 60-90 minutes, the chemotherapy solution is removed and the surgical procedure completed.

What is the rationale behind HIPEC?

HIPEC is a regional chemotherapy treatment that delivers a high concentration of chemotherapy agents within the abdominal cavity, where the cancer cells are present, while minimizing exposure to the rest of the body. Administering the chemotherapy directly into the abdominal cavity rather than intravenously helps us achieve this goal. Chemotherapy agents known to maintain a high local concentration during the 60-90 minutes of treatment are chosen for HIPEC.

Warming the chemotherapy solution achieves additional potential benefits. Laboratory studies show that cancer cells are more sensitive to heat than normal cells and may be killed more readily at an increased temperature (> 41 degrees Celsius). In addition, heating the chemotherapy solution improves the ability of the chemotherapy agents to penetrate cancer tissues and improves its ability to kill cancer cells.

What conditions can be treated with cytoreductive surgery (CRS) and HIPEC?

There is strong clinical evidence to support cytoreductive surgery and HIPEC as the treatment of choice for patients with appendix cancer and malignant peritoneal mesothelioma. Select patients with peritoneal metastases from colon cancer can also benefit from CRS and HIPEC.

HIPEC is used in other countries to treat ovarian cancer and is currently being evaluated in the United States for that use. Other types of cancers, including many rare and unusual cancers that have spread to the peritoneum, may be appropriate for this treatment.

Hormone therapy adds, blocks or removes hormones from the body. To slow or stop the growth of certain cancers such as prostate cancer and breast cancer, synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that produces a particular hormone.

Image-guided radiation therapy (IGRT) is a process of using various imaging technologies to locate a tumor prior to turning the radiation beam on. Radiation oncologists use image-guided radiation therapy, or IGRT, to help better deliver the radiation to the cancer since tumors can move between treatments due to differences in organ filling or movements while breathing. All patients first undergo a CT scan as part of the planning process. The imaging information from the CT scan is then transmitted to a computer in the treatment room to allow doctors to compare the earlier image with the images taken just before treatment. During IGRT, your treatment team can compare these images to see if the treatment needs to be adjusted. This allows us to better target the cancer while avoiding nearby healthy tissue. IGRT is complementary to IMRT. IMRT is used to improve the radiation delivery precision and IGRT is used to improve the radiation delivery accuracy.

Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional external radiation therapy that uses that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation have different intensities and are precisely aimed at the tumor from many angles. IMRT is often used to treat head and neck cancers.

IMRT can cause less damage to healthy tissue near the tumor. Dry mouth, a commonly reported side effect of traditional radiation therapy, can be less of an issue with IMRT patients.

Minimally invasive laparoscopic surgery allows a surgeon to remove cancerous tissue through a very small incision. Advantages include reduced scarring and quicker recovery time.

Laparoscopic surgery was the first available form of "minimally invasive" surgery and is still frequently performed today. When it first came on the scene in the 1980s, laparoscopic surgery was sometimes referred to as "keyhole" surgery. Small half-inch incisions are made and access ports are placed in the body. A camera is inserted in one port to look inside the body. The camera is connected to a monitor that displays the body's interior to the surgeon and the surgical team. Surgical tools on long thin instruments are placed inside the body through the ports and surgery is performed.

Laparoscopy requires smaller incisions and results in less blood loss, lower risk of transfusion, a shorter hospital stay, less need for pain medication, and a quicker recovery.

Conditions Treated

Laparoscopic surgery is a minimally invasive option that can be used to treat many different types of cancer, including:

• Gynecologic cancers
• Urologic cancers
• Colorectal cancer
• Lung and other thoracic cancers

Laser surgery uses a focused, high-powered beam of light to destroy cancer cells. It's often used to control tumors that are causing certain symptoms because of their size or location. Lasers may also be used to activate a cancer-killing chemotherapy agent.

Laser surgery can be very precise and as a result, patients often have less bleeding and scarring and recover sooner. However, the results of the surgery may not last as long, often making repeat procedures necessary.

Conditions Treated

Laser surgery is used for many types of cancer, including:

• Cervical cancer
• Esophageal cancer
• Stomach cancer
• Vaginal cancer
• Vulvar cancer
• Colorectal cancer
• Lung cancer
• Head and neck cancers

Medical oncology is the specialty associated with administering chemotherapy, or cancer-fighting drugs, to treat cancerous cells. Chemotherapy is a very effective treatment has been used for many years. The number and types of chemotherapy medications increase each year as research continues to find new and better ways to fight cancer and lessen the side effects associated with treatment.

Inova Cancer Institute offers dedicated medical oncology units staffed by physicians and nurses with special expertise in oncology and cancer care. These professionals are highly experienced in chemotherapy and its side effects, pain management and cancer education. Your medical oncologist consults with radiation therapists and surgeons about your overall treatment plan and determines the proper medications and dosage.

Inova Fairfax Hospital and Inova Fair Oaks Hospital offer comprehensive ostomy care services to both pediatric and adult ostomy patients.

Our patients receive specialized care from a team of registered nurses with advanced training in wound, ostomy and continence (WOC) disorders.

Our nurses are part of a prestigious group of medical professionals who have graduated from an accredited program to earn their advanced certification in WOC. In keeping with their commitment to patient care and education, they are re-certified every five years. 

Inova offers treatment for colon cancer at all of its hospitals and is home to the largest number of board-certified and board-eligible colorectal surgeons in the Washington, DC, region. Minimally invasive robotic-assisted surgery is available to treat colon and rectal cancer at Inova Fairfax Hospital, Inova Fair Oaks Hospital and Inova Loudoun Hospital.

Enterostomal therapy is available to patients who may require this care after colon cancer surgery as a temporary or permanent measure. 

This program offers new options and hope for people with complex cancers and those who haven’t had success with standard therapies.

Learn more

Photodynamic therapy (PDT) is a type of laser treatment may be an alternative to invasive traditional surgery for lung or esophageal cancer.

With PDT, photosensitizing chemicals are injected into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells.

For lung cancer, the light is delivered through a bronchoscope (a small, flexible tube with a light on the end) that is inserted through the mouth or nose. In the case of esophageal cancer, patients in the past often required surgery to remove the esophagus. Today PDT combines endoscopy with modern laser technology to destroy the cancer, often without need for further surgery.

Inova Fairfax Hospital Advanced Endoscopy Center, the first of its kind in Northern Virginia, performs photodynamic therapy.

You may have heard of robotic surgery for prostate cancer, also known as robotic prostatectomy.

More accurately, the da Vinci^® prostatectomy is a robot-assisted, minimally invasive surgery that has become the preferred treatment for removal of the prostate following early diagnosis of prostate cancer.

With da Vinci prostatectomy, the likelihood of a complete recovery from early stage prostate cancer without long-term side effects is, for most patients, better than ever.

The da Vinci Surgical System at Inova enables surgeons to operate with unmatched precision and control, using only a few small incisions.

Benefits of the da Vinci prostatectomy include:

• Significantly less pain
• Less blood loss
• Fewer complications
• Less scarring
• A shorter hospital stay
• A faster return to normal daily activities

Inova has the longest-running da Vinci prostatectomy program in the Washington, DC, metro area. And we continue to perform an increasing number of da Vinci procedures every year. This translates to unparalleled experience and expertise at work for you.

If you are a candidate for prostate surgery, talk to your surgeon about whether da Vinci robotic surgery is an option for you. Or call 1-855-MY-INOVA (1-855-694-6682) for a referral to one of our da Vinci robotic surgical specialists.

Prostate seed implants, also known as brachytherapy, is a cancer treatment where radioactive seeds are implanted directly near the tumor to kill cancer cells. The technique spares surrounding healthy tissue from more of the side effects associated with standard therapies. Prostate seed implants are performed on an outpatient basis by a radiation oncologist, urologist and diagnostic technician.

Prior to surgery, patients undergo a prostate volume study which generates a 3-D computerized plan of the implant. Later, during surgery, the surgeon places the small radioactive seeds – about the size of a grain of rice – into the prostate via small needles and guided by ultrasound imaging. The seeds remain permanently in the prostate and deliver targeted, low-dose radiation for several months.

The surgery is performed under general anesthesia and takes about an hour to complete. The final step for the patient involves a CT scan of the pelvic region one to two months after surgery.

Inova Schar Cancer Institute offers state-of-the-art radiation oncology and proton therapy services for all types of cancers and benign conditions.

Radiation therapy is a unique treatment that uses different forms of radiation to target cancer cells. Many cancer patients will undergo some form of radiation either as a stand-alone treatment or in combination with surgery and chemotherapy.

Learn about the Center for Advanced Radiation Oncology and Proton Therapy

Cancer rehabilitation services are available at Inova Alexandria Hospital, Inova Fairfax Hospital, Inova Fair Oaks Hospital, Inova Mount Vernon Hospital and Inova Loudoun Hospital. 

See all locations 

All Cancer Patients

The physical, occupational and speech therapists at Inova offer comprehensive and compassionate care to people dealing with the potential debilitating complications of cancer and cancer treatment. Our therapists are able to address problems that interfere with your ability to move and/or care for yourself such as pain, fatigue, weakness, poor balance, difficulty swallowing or cognitive deficits.

Rehabilitation for Breast Cancer Patients

Our physical and occupational therapists are specially trained to meet the needs of women who are undergoing treatment for breast cancer. We offer both pre- and post-surgical education and treatment to aid in optimal recovery.

Lymphedema Therapy

Certified lymphedema specialists provide complete decongestive therapy at the rehabilitation centers at Inova Alexandria Hospital, Inova Fairfax Hospital and Inova Loudoun Hospital.

Learn more about lymphedema treatment

Lung, Head and Neck Cancer

Our speech therapists are specially trained to meet the unique needs of patients who are undergoing treatment for head, neck or lung cancer. We focus on recovery of swallowing function, breath and voice, including alternative communication.

Pediatric Rehabilitation

Pediatric rehabilitation is available at Inova Children's Hospital and Inova Loudoun Hospital. 

Learn more about pediatric rehabilitation at these locations. 

Home Care, Assisted Living and Long Term Care

Inova offers a full range of home care services through Inova Home Health. Other options include individually tailored short- and long-term rehabilitation programs at our nursing and rehabilitation center. 

Inova Home Health
Inova Loudoun Nursing and Rehabilitation Center

SIRT is a specialized internal radiation therapy for liver cancer during which a dose of SIR-Spheres® microspheres are delivered up to 40 times higher than conventional external beam therapy while sparing healthy tissue. This maximizes the treatment’s effectiveness and reduces the risk of injury to the liver. The treatment is typically administered as an outpatient procedure.

Who is a candidate for the treatment?

This treatment is indicated for patients with colorectal liver cancer whose liver metastases cannot be surgically removed. As with any treatment, your physician can help you decide if this treatment is best suited for your condition.

How are SIR-Spheres microspheres administered?

During the SIRT procedure, an interventional radiologist makes a small puncture, usually into the femoral artery near the groin. A small flexible tube called a catheter is then guided through the artery into the liver and millions of microscopic spheres (about a third of the width of a human hair), are delivered directly into the tumor. The entire procedure takes about 90 minutes. Patients will be sleepy during the procedure but able to communicate with the doctor and the team. Most patients return home four to six hours following treatment.

How do SIR-Spheres microspheres work?

The SIRT procedure delivers radiation, which is often used to treat cancer, directly into the liver tumors by using the tumor’s own blood supply. Normal liver tissue takes about 90 percent of its blood supply from the veins, while liver tumors receive about 90 percent of their blood supply from arteries. This allows SIR-Spheres microspheres to target the liver tumors with a tumor-killing dose of radiation via the hepatic artery, while sparing surrounding healthy liver tissue. This typically isn’t possible with conventional external beam radiation.

How are SIR-Spheres microspheres different from other radiation treatments for cancers of the liver?

SIR-Spheres microspheres usually reduce liver tumors after just one treatment. The targeted nature of SIR-Spheres microspheres therapy enables doctors to deliver more radiation to the liver tumors than would be possible using conventional radiotherapy. Also, because traditional radiation is delivered to a general area of the body where cancer exists, it is less exact than SIR-Spheres microspheres. Another limitation of conventional radiotherapy is that it can only be applied to certain areas of the body, often excluding the liver. SIR-Spheres microspheres, however, are designed specifically for delivery directly to the liver.

What side effects and complications can I expect?

When properly administered, most side effects are typically mild and subside within several days. Post treatment side effects can include abdominal pain and/or nausea which normally subside after a short time and/or with routine medication. Patients may also develop a mild fever that may last up to a week and fatigue which may last for several weeks. As a precaution, we may recommend additional medications with the aim of preventing or minimizing these side effects.

In rare instances there is a possibility that a small number of microspheres may inadvertently reach other organs in the body, such as the gall bladder, stomach, intestine or pancreas. If SIR-Spheres microspheres reach these organs, they may cause inflammation of the gall bladder (cholecystitis), stomach (gastritis) or intestine (duodenitis). These complications are rare, but if one of these occurs, they will require additional treatment. Your treatment team will have received special training to minimize these risks and to prevent them from happening.

Inova Fairfax Hospital Stem Cell Transplant Program is the region's expert provider of bone marrow or stem cell transplant for patients with certain cancers such as lymphoma, leukemia or multiple myeloma.

Inova pioneered the first autologous bone marrow transplant in the area in 1989 and continues as a leader in transplant procedures.

Stereotactic radiosurgery is a form of radiation therapy that delivers a high dose radiation to a small, specific area. The treatment is also known as stereotactic radiation therapy.

Stereotactic radiosurgery uses high energy X-ray beams to shrink or manage the tumor by destroying the cells or by disrupting the cells from growing. This therapy is different from traditional radiation therapy as stereotactic radiation therapy more effectively excludes the surrounding healthy tissues and organs so that side effects are minimized.

Stereotactic radiosurgery is available at Inova Alexandria Hospital Cancer Center and Inova Fairfax Hospital Cancer Center.

Conditions Treated

Stereotactic radiosurgery can be used to treat:

• Brain cancer
• Lung cancer
• Liver cancer

Surgery encompasses an ever-growing list of procedures, many of them minimally invasive, to diagnose, remove or treat cancer in nearly every part of the body.

Surgery is both a common and effective treatment for many types of cancer, especially those that are detected early and have not spread. In more advanced cases, surgery is often combined with chemotherapy, radiation therapy or hormone therapy.

Surgeons at Inova utilize some of the most advanced technologies available, including:

• CyberKnife® 
• da Vinci® robotic-assisted surgery 
• Laparoscopic surgery 
• NanoKnife™ 
• TomoTherapy™  
• Trilogy™  
• Video assisted thoracic surgery (VATS)

See also, surgical options for breast cancer

All anticancer drugs target tumors in some way. Most conventional treatments, however, attack healthy cells as well as cancer cells. As a result, there can be serious side effects from the treatment.

A newer approach to cancer treatment, molecularly targeted therapy, may help reduce side effects. The medication takes a more direct aim at cancer cells, and that means less damage to healthy cells.

Targeted therapies are designed to recognize a specific molecular change in a cancer cell that drives the growth and spread of a tumor. By zeroing in on its molecular target, these new medications destroy or slow the growth of cancer cells while avoiding normal, healthy cells. And because healthy tissues are spared, targeted therapies tend to bring about fewer and less severe side effects than conventional treatments.

Some targeted therapies home in on tumors by seeking out molecules found only in cancer cells. Other targeted agents seek out molecules that are more abundant in cancer cells than in healthy cells. And still other treatments are focused on processes that are more important to the growth of cancer cells than normal cells.

Conditions Treated

Targeted therapy can be an effective treatment strategy for:

• Breast cancer
• Colorectal cancer
• Skin cancer
• Stomach cancer
• Leukemia
• Lung cancer
• Lymphoma
• Pancreatic cancer
• Thyroid cancer

Transcatheter chemoembolization is used for the treatment of hepatocellular carcinoma, the most common liver cancer. Interventional radiologists insert drug-eluting beads containing chemotherapy directly into the tumor. While the patient is under sedation, a small catheter is guided using imaging from the entry site in the groin to the blood vessels supplying the tumor.

The interventional radiologist will use contrast dye and X-ray imaging to find the branches of the hepatic artery that are supplying blood to the tumor. Once this vessel is found, smaller catheters are inserted into the branches of the artery that are directly supplying blood to the tumor. Chemotherapy beads will then be inserted directly into the tumor. Patients usually spend one or two nights in the hospital.

Trilogy™ is a state-of-the-art radiation therapy that treats cancer conditions more quickly and with unprecedented precision, reduces treatment times and side effects, and improves outcomes. The Trilogy system's linear accelerator rotates around the patient to precisely target tumors from nearly any angle and reduces radiation exposure to healthy tissues. The system shapes the radiation beam to match the three-dimensional form of the tumor and an On-Board Imager™ device delivers real-time tumor tracking and automated patient positioning.

A set of optical guidance cameras monitor and correct for a patient’s slight movements on the treatment table. Trilogy even adjusts to the subtle motion of breathing. An infrared monitoring device turns the radiation beam on and off during treatment to compensate for respiratory motion. This feature is especially useful for treating lung cancer, but it is also effective on several other types of cancer as well.

Conditions Treated

The advanced features of Trilogy™ make it an effective form of radiation therapy for these types of cancer:

• Breast cancer
• Lung cancer
• Prostate cancer
• Kidney cancer
• Liver cancer
• Colon cancer

Video-assisted thoracic surgery (VATS ) is a newer, and less invasive procedure for treating early stage lung cancer, especially tumors smaller than 3 to 4 centimeters. Instead of making a large incision, specially trained surgeons place a thin tube with a small video camera on the end through a small opening in the side of the chest. The camera transmits images of the inside of the body onto a high definition flat screen monitor. The surgeon watches the screen while inserting instruments through a second small incision to perform the surgery and remove the tumor.

This procedure usually involves less pain after surgery and a shorter hospital stay. The cure rate after VATS appears to be similar to other surgical methods.

The specialists and staff at Inova Thoracic Oncology Program know that people facing lung cancer, esophageal cancer and other complex thoracic conditions benefit most from an integrated, coordinated approach to care. State-of-the-art diagnostic services and the latest treatments, including minimally invasive options, are offered by a team of expert specialists unparalleled in the Washington, DC, region. Call for more information.

703-776-3777.