Central Maine Healthcare

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About Us: Cancer Care

Head and Neck Cancer

At Central Maine Healthcare, we’re committed to bringing the most effective treatments for this cancer to our communities in central Maine.

About Head and Neck Cancer

Each year, about 110,000 people in the U.S. are diagnosed with head and neck cancer, a group of cancers that starts in or near your mouth, throat, larynx, nose or sinuses. Most begin in the cells that line the surfaces of these areas. Head and neck cancer may also be called oral cavity cancer or oropharyngeal cancer.

There are five main types of the disease, collectively called head and neck squamous cell carcinoma (HNSCC), and named for the area they affect:

  • Oral cavity: Lips, gums, inside lining of the cheeks and other areas inside of your mouth
  • Pharynx (throat): Includes your tonsils, back of your tongue and your soft palate
  • Larynx (voice box): Holds your vocal cords and your epiglottis, a flap of cartilage at the base of the tongue
  • Nasal cavity and paranasal sinuses: Hollow area inside your nose and small spaces in the bones of your head around your nose
  • Salivary glands: In the lower part of your mouth near your jawbone

Each of these types has its own set of cancer symptoms.  Though head and neck cancers can affect anyone, major risk factors include heavy tobacco and alcohol use, as well as the human papillomavirus (HPV), a type of sexually transmitted disease.

Prevention

Cancer can’t be prevented in all cases, but your risk of cancer can be reduced if you have a healthy lifestyle. Nearly 85 percent of all head and neck cancers are linked to tobacco use, so don’t start smoking. If you already smoke, quit. Learn how by calling the Maine Tobacco Helpline at 1-800-207-1230.

Other things that increase your risk include:

  • Exposure to human papillomavirus (HPV), a sexually transmitted disease
  • Drinking alcohol
  • Exposure to sun without protection increases risk of lip cancer
  • A diet that’s high in processed meat and low in fruit and vegetables
  • Not treating pre-cancerous growths like leukoplakia or erythroplakia

Detection

The key to treating—and beating—cancer is to catch it early. But like many cancers, cancer of the head and neck may not produce signs or symptoms until it’s already grown and spread to other tissues, making it harder to treat. That’s why some providers recommend that you examine the inside of your mouth in a mirror once a month. If you notice any white patches, sores, or lumps, see your provider. This kind of self-exam is especially important if you smoke – or used to smoke – and routinely drink alcohol.

Screening and Diagnosis

If you’re concerned you may have head and neck cancer, you want answers quickly. At Central Maine Healthcare, we understand not knowing can be the most difficult experience. That’s why we’re focused on providing the expert medical attention you need to get a diagnosis as quickly and accurately as possible.

Screening for Head and Neck Cancer

A screening test is developed to help your provider see if you have cancer before you have any symptoms. Early detection is an important part of treatment and recovery. Unfortunately, for head and neck cancer, there is no routine screening test. The good news is that many pre-cancers and cancers in these areas can be found early (when they’re small) during routine exams by a provider, dentist, dental hygienist, or by self-exam.

Especially if you smoke and regularly consume alcohol, you should do a self-exam once per month to check for any changes inside your mouth. If you notice any lumps, white patches, or sores, see your provider.

At your regular dental check- up, your dentist may use special dyes and/or lights to look for abnormal areas, especially if you are at higher risk for head and neck cancer. If anything looks abnormal, another test will help your dentist decide if these areas might be cancer. They may take a biopsy, which is the process of removing a small bit of the suspicious tissue for further testing.

It’s very important to be aware of the signs and symptoms of head and neck cancer, especially if you are at higher risk for the disease:

  • Swelling or a sore that does not heal
  • Pain in the mouth that doesn’t go away
  • A white or red patch on the gums, tongue, tonsil, or lining of the mouth
  • Lump, bump, or mass in the head or neck area, with or without pain
  • Bad breath that’s not explained by hygiene
  • Hoarseness or change in voice
  • Pain or difficulty chewing, swallowing, or moving the jaw or tongue
  • A lump or thickening in the cheek
  • Jaw pain
  • Weight loss

Diagnosis of Head and Neck Cancer

During your check-up, your provider will look inside your mouth, nose and throat, and check for lumps in your neck. That’s especially important if you use tobacco or have in the past, or drink regularly.

If your provider finds anything suspicious, you may need additional tests. Common options include:

  • Biopsy: A small piece of tissue is removed and checked for cancer cells.
  • Panendoscopy: A complete exam done in the operating room under anesthesia. The surgeon looks inside your nose, mouth and throat through thin tubes called scopes and may perform biopsies of abnormal tissue.
  • CT scan: A special kind of X-ray that takes detailed pictures to see if the cancer has spread to the lymph nodes, lungs or other organs.
  • MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors.
  • Barium swallow: X-rays are taken while you swallow a liquid with barium in it. Barium coats the inside surface of the throat and helps get a good picture to see how you swallow.
  • Chest X-rays: Used to see if the cancer has spread to the lungs.
  • PET scan: You are given a special type of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found.

If cancer is detected, know that you have Central Maine Healthcare’s most experienced care team in your corner. These specialists will discuss all cancer treatment options with you and create a personalized plan. And you’ll have your own nurse navigator to guide and support you throughout the journey.

Treatment

If you’ve been diagnosed with head and neck cancer, we know how overwhelming that can be. That’s why at Central Maine Healthcare, we combine compassionate care with the most advanced technology available to help you fight cancer with confidence.

Full Range of Head and Neck Cancer Treatments

Central Maine Comprehensive Cancer Center (CMCCC) offers a comprehensive spectrum of cancer care for patients with cancers of the head and neck. This includes thyroid, salivary glands, nose, mouth, facial, skin and neck tumors or lesions.

Providers at our Ear, Nose and Throat (ENT) or Head and Neck Otolaryngology practice specialize in state-of-the-art medical care and surgical options. Our team includes some of the region’s leading cancer specialists: medical and radiation oncologists, surgeons, highly trained nurses, dietitians, social workers and more. Together they will work with you to create the best possible treatment plan.

Your Personalized Treatment Plan

Treatment of head and neck cancer depends on many factors, including the type and stage of the cancer (early or advanced), how treatment will affect the way you talk, breathe or eat, your overall health and your personal feelings about certain treatments and possible side effects.

Your personal treatment plan may include one or a combination of:

Surgery

Surgery may be used to take out the cancer and a margin of healthy tissue around it. In some cases, all or part of the tongue, throat, voice box wind pipe, or jaw bone may need to be removed. Surgery may also be used to take out lymph nodes in the neck which may harbor metastatic cancer. Our team includes a plastic surgeon who offers reconstructive and plastic surgery, following surgical procedures.

Radiation

Radiation therapy uses high-energy rays (like x-rays) to shrink or kill cancer cells and help prevent recurrence of the disease. CMCCC uses the most advanced radiation technology available to treat head and neck cancer. Options include:

External beam radiation therapy (EBRT): In EBRT, beams of radiation are focused on the tumor from a machine outside the body called a linear accelerator.

Because head and neck cancers are close to other critical body structures, getting a clear view of the areas during radiation therapy is critical. CMCCC uses the groundbreaking Versa HD accelerator to plan and deliver high-dose radiation with unmatched precision. The result is faster, more effective treatments that minimize the impact on healthy, surrounding areas.

Internal radiation therapy: Also called brachytherapy, this minor outpatient procedure involves implanting tiny radioactive seeds close to the tumor. These seeds, about the size of a grain of rice, remain in place and give off radiation to the tumor site for weeks or months.

Chemotherapy

Chemotherapy is used to kill cancer cells with powerful medicines delivered in varied cycles through either an IV or a pill. It may be used to shrink a tumor before surgery, to kill cancer cells that remain in the body after surgery or radiation, to treat tumors that have developed in other areas or to relieve symptoms when the cancer cannot be cured. Whenever possible, Central Maine Comprehensive Cancer Center uses newer medications that help maximize results and minimize side effects.

Immunotherapy

Recent FDA-approved drug therapies give people the ability to fight head and neck cancer using the body’s natural defense mechanism: the immune system. Immunotherapy works by making hidden cancer calls visible to the immune system, allowing white blood cells to fight and kill the cancer.

Colorectal Cancer

Colorectal cancer is a dangerous disease partly because patients rarely show symptoms before their cancer is too advanced to cure. Fortunately though, if it’s caught early, patients usually go on to full recovery. Central Maine Healthcare wants our entire community over the age of 45 to have colonoscopies so we can help stop this disease.

About Colorectal Cancer

Colorectal cancer refers to cancer that begins in the colon or in the rectum. Colon and rectum cancer are grouped together because they have many features in common, like all cancers, colorectal cancer begins when cells in the body begin to grow out of control.

Prevention

While no cancer can truly be prevented, there are important steps you can take to significantly reduce your risk. It’s likely the best way to do this is getting your colonoscopy as soon as you turn 45. This test allows your gastroenterologist to detect pre-cancerous growths early, before they become cancer. These lifestyle changes are also associated with lower risk of colorectal cancer:

  • Maintaining a healthy weight
  • Increasing your physical activity
  • Reducing alcohol intake
  • Quitting cigarettes if you smoke
  • Increasing the amount of fruits and vegetables in your diet

Detection

Detecting colorectal cancer early is possible through a variety of screening tests. These include visual exams, like a colonoscopy, and stool-based tests, in which a provider checks the stool (feces) for signs of cancer. Stool-based tests are less invasive but must be done more often, usually once a year. A colonoscopy on the other hand is usually needed only once every 10 years.

Treatment

Most polyps do not become cancer, but if you’re diagnosed, rest assured you’re in skilled and caring hands. Our multi-skilled team of gastroenterologists, colorectal surgeon, oncologists, specially trained nurses and support staff will work with you to create a personalized cancer treatment plan.

Extra Support in Your Fight Against Colorectal Cancer

Central Maine Healthcare is devoted to providing the best care for all our cancer patients. In addition to our highly skilled specialists, we offer features designed to give you full support during treatment and recovery. These include navigator nurses specifically dedicated to guiding you to resources that will support you and your family and oncology social workers who offer counseling.

Screening and Diagnosis

We understand no one is eager to get a colonoscopy, but it could save your life! Colorectal cancer is 90% preventable which is why, at Central Maine Healthcare, we’re committed to making the process as easy and convenient as possible so more people will get tested.

What is a Colonoscopy?

A colonoscopy is a test to view the inside of the rectum and colon, all of the large bowel and the lower part of the small intestine. This routine exam is usually done as an outpatient procedure and is administered by a trained gastroenterologist or surgeon using a colonoscope. A colonoscope is a long, thin, flexible tube with tiny camera and light on one end that relays information to a video monitor.

Why Get a Colonoscopy?

A colonoscopy is a safe and effective way to monitor gastrointestinal (GI) health and to check for diseases of the colon. Currently, a colonoscopy is the best defense against colorectal cancer as the most helpful tool in early detection. Colorectal cancer is the second leading cause of cancer deaths in the U.S. and is the third most common cancer in both men and women. Early detection through a colonoscopy could save your life.

Polyps are small growths on the inside wall of the rectum or colon that may become cancerous, removal of these during colonoscopy can actually prevent the polyps from becoming cancer. A colonoscopy is also done to find irregularities in the intestines, or to further look for microscopic evidence of disease through a biopsy taken during the procedure or to treat GI issues.

When Should I Get a Colonoscopy?

The American Cancer Society recommends that people at average risk for colorectal cancer begin regular screening at age 45. If you have a family history of colon cancer, screenings should start earlier. Talk to your provider about when to start regular screenings if you have a family history of colon cancer.

Colorectal Cancer Symptoms

You should also ask your provider about a colonoscopy if you’ve experienced any of the following:

  • Blood present in stool
  • Change in bowel habits
  • Prolonged rectal pain
  • Prolonged stomach pain
  • Inflamed colon as determined by a CT (computerized tomography) scan

Additional Colorectal Cancer Screenings 

Colonoscopy is considered the gold standard in colorectal cancer screening, but we also perform other standard tests to help detect polyps and signs of cancer:

  • Fecal Occult Blood Test: This test, recommended annually, looks for blood in the stool. Polyps bleed more than normal tissue and these tiny amounts of blood can be detected by a test called hemocult.
  • Flexible Sigmoidoscopy: This exam, recommended every five years, evaluates the lower section of the colon and rectum, where most polyps and cancers are located.

Treatment

If you’ve been diagnosed with colorectal cancer, we know how worrisome it can be. But the good news is that colorectal cancer is one of the most treatable cancers. Central Maine Healthcare wants to help you by providing all the compassionate care and support you need to fight this disease.

Treatments We Offer

The type of treatment your provider recommends depends largely on the size and stage of the cancer (early or advanced), as well as your overall health, personal preferences and potential side effects. Our team will work with you to create a plan that you’re completely comfortable with and will focus on keeping you feeling well at every step. Your personal treatment plan may include one or a combination of:

Surgery

Surgery to remove the tumor is the most common treatment for colorectal cancer, especially the early stages. Part of the healthy colon or rectum and nearby lymph nodes may also be removed. If the cancer is small and completely contained within a polyp, your provider may be able to completely remove it during the screening colonoscopy which has less complications and faster recovery, with a minimally invasive laparoscopic procedure, using just a few small incisions in the abdomen.

If the cancer has grown into or through your colon, you may need a procedure called a colectomy, in which the part of your colon that contains the cancer is removed, along with a margin of normal tissue on either side of the cancer.

Many colostomy can be less often, some people may need a temporary or permanent colostomy after surgery. This is a surgical opening through which the colon is connected to the abdominal surface to allow waste to exit the body. This waste is collected in a pouch worn by the patient. Our specially trained ostomy nurses can help learn how to manage the pouch and make any lifestyle adjustments.

Radiation Therapy

Radiation therapy uses high-energy rays (like X-rays) to shrink or kill cancer cells and help prevent recurrence of the disease. The rays can be specifically directed at the part of the body where the cancer is located, and are commonly used to treat colorectal cancer because the tumor tends to recur near where it originally started. It can also be combined with chemotherapy to increase effectiveness.

External-beam radiation therapy is another therapy we use at Central Maine Healthcare to fight colorectal cancer. With this treatment, a machine is used to precisely deliver a high dose of radiation to a small area.

For some people, internal radiation therapy may help get rid of areas that have spread to the liver when surgery is not an option. Brachytherapy is an example of this sort of radiation therapy. It uses radioactive “seeds” placed inside the body to treat the cancer.

Chemotherapy

Chemotherapy is used to kill cancer cells with medicines delivered in varied cycles through either an IV or a pill. It may be used to shrink a tumor before surgery, to kill cancer cells that remain in the body after surgery or radiation or to treat tumors that have developed in other areas of the body. Chemotherapy for colorectal cancer is usually given after surgery if the cancer has spread to lymph nodes, which may reduce the risk of a cancer recurrence. For advanced cancer that is no longer curable, chemo be used to help shrink tumors and relieve symptoms.

Targeted Therapy

Typically used for people with advanced colorectal cancer, targeted drug therapy works to block specific genes and proteins that allow cancer cells to grow, while limiting damage to healthy cells.

Immunotherapy

Some patients with advanced colorectal cancer may benefit from immunotherapy, which uses medicines to help a person’s own immune system find and destroy cancer cells.

Central Maine Healthcare Treats the Whole You

We help you in your battle against cancer by providing extra support along the way. Our nurse navigators, for example, guide all our cancer patients through their treatments and direct them to a variety of supportive resources including:

The Arbor House, a hospitality house near the Central Maine Medical Center campus, provides free accommodations for patients traveling a long distance for medical treatments, and for families visiting loved ones who are hospitalized.

Find a Colorectal Specialist Near You

Breast Cancer

One in eight women will develop breast cancer in her lifetime. But with increased awareness, early detection and innovative new treatments, survival rates continue to rise.

About Breast Cancer

Breast cancer is the uncontrolled growth of abnormal cells within the breast. Breast cancer begins in the breast tissue, which is comprised of glands used for milk production (called lobules) and ducts that connect these lobules to the nipple. The remainder of the breast is made up of fatty, connective and lymphatic tissue.

With the exception of skin cancer, breast cancer is the most commonly diagnosed cancer among women, and the second leading cause of cancer death, second only to lung cancer. Many breast lumps turn out to be non-cancerous, though a malignant lump can mean that the cancer has already spread beyond the breast. That’s why it’s crucial to get regular breast screenings, so your provider can catch and treat any concerns before they become serious.

Prevention

Whether you have a family history of breast cancer or just want to stay on top of your health, Central Maine Healthcare offers the preventive services and support you need for your peace of mind. Start by understanding your personal breast cancer risk factors, and how you can take control right away. If you have a family history of breast cancer, or other factors that may increase your risk, talk to your provider about further ways to prevent the disease.

Detection

If you’re over 40, getting an annual mammogram is your best weapon against breast cancer. Mammography has proven to be the most effective tool for detecting breast cancer early, when it’s most treatable. Central Maine Healthcare offers all-digital mammography, with crystal-clear images that can be magnified to pinpoint any suspicious areas.

Not all breast problems are cancer, but if you’re diagnosed, our breast cancer experts will be by your side. Our dedicated care team—including gynecologic and radiation oncologists, breast surgeons, specially trained nurses, physical therapists and more—work closely to create a personalized cancer treatment plan. Should you need surgery, we offer a full range of breast procedures, including mastectomy, lumpectomy, breast reconstruction and more to help return you to good health. And you have access to leading breast cancer clinical trials, right here at home.

Screening and Diagnosis

One in eight women will develop breast cancer in her lifetime. But with increased awareness, early detection and innovative new treatments, survival rates continue to rise.

Treatment

Not all breast problems are cancer, but if you’re diagnosed, our breast cancer experts will be by your side. Our dedicated care team—including gynecologic and radiation oncologists, breast surgeons, specially trained nurses, physical therapists and more—work closely to create a personalized cancer treatment plan. Should you need surgery, we offer a full range of breast procedures, including mastectomy, lumpectomy, breast reconstruction and more to help return you to good health. And you have access to leading breast cancer clinical trials, right here at home.

The Cancer Care Center includes The Sam and Jennie Bennett Breast Care Center, which is a nationally accredited Breast Center of Excellence, in addition to being accredited by several renowned professional healthcare organizations that supervise the quality of cancer care. That means you can find peace of mind, knowing that you’re getting excellent care, without having to travel far from home.

Treatment of breast cancer depends on many factors, including your overall health and wellness, the stage of the cancer (early or advanced), hormone sensitivity of the tumor and your personal feelings around certain treatments and possible side effects. Our goal is to keep you feeling well throughout treatment without major changes to your usual routine.

Your personal treatment plan may include one or a combination of:

Breast Cancer Surgery

Surgery is the most common treatment for early breast cancer. Depending on the stage of the cancer, there are different types of surgery available:

  • Lumpectomy: Removal of the just tumor and some surrounding tissues.
  • Total mastectomy: Removal of the entire affected breast, but no lymph nodes or muscle.
  • Modified radical mastectomy: Removal of the affected breast as well as any lymph nodes under the arm where the cancer has spread.
  • Radical mastectomy: Removal of the affected breast, lymph nodes and the muscle under the breast.
  • Breast reconstruction: One of our skilled plastic surgeons can restore the breast mounds using your own tissue or from other areas of the body, either at the same time or following a mastectomy.

Chemotherapy

Chemotherapy is used to kill cancer cells with medicines delivered in varied cycles through either an IV or a pill. It may be used to shrink a tumor before surgery, to kill cancer cells that remain in the body after surgery or radiation or to treat tumors that have developed in other areas. Whenever possible, Central Maine Healthcare uses newer medications that help minimize the side effects of chemotherapy.

Radiation Therapy

Radiation therapy uses high-energy rays (like X-rays) to shrink or kill cancer cells and help prevent recurrence of the disease. The rays can be specifically directed at the part of the body where the cancer is located. Treatments are delivered by linear accelerator, where patients lie on a table in a specially designed room.

Hormone Therapy 

Hormone therapy uses medication to block the use of estrogen by the cancer cells, as some types of breast cancer rely on estrogen and/or progesterone to grow. These cells are referred to as “hormone receptor positive” cancer cells. If a tumor is not deemed hormone receptor positive, then hormone therapy is not usually used.

Biological Therapy

Biological therapy works in with the body’s own immune system to help destroy cancer cells or to assist in controlling side effects resulting from other cancer treatments.

Support

Throughout your journey, you’ll find a variety of cancer support services to meet your physical, emotional, spiritual and financial needs. That includes your very own breast cancer nurse navigator to coordinate all of your care, connect you to valuable resources and provide extra comfort and support at every step.

Your Breast Cancer Team

The Cancer Care Center provides a team of support for patients diagnosed with breast cancer. You’ll meet with breast cancer surgeons to discuss the best treatment plans. Our surgeons are one part of your team that also includes radiologists, pathologists, and medical and radiation oncologists. If you choose to have reconstructive surgery following breast surgery, your team will also include CMMC’s plastic surgeons.

All these providers work together, communicating with each other as needed to give you individualized, focused care. Our nurse navigators serve as your advocate and can help you with other parts of the process, like understanding financial and health insurance requirements, the day-to-day impact of treatments, and other needs as they arise.

Brain and Spinal Cancer

At Central Maine Healthcare we understand that a brain or spinal tumor diagnosis can be alarming. That’s why we offer the services of the cancer care team at Central Maine Comprehensive Cancer Center, an exceptionally skilled neurological oncology group to design your treatment plan and give you the best possible care, including the most effective approaches to combatting these diseases.

Brain and Spinal Tumors

A tumor is a mass of abnormal cells. These can be benign (non-cancerous) or malignant (cancerous). With most cancers, benign tumors are much less of a concern than malignant ones. Benign tumors in the brain or spine are riskier to remove, and as they grow they may begin to press on and damage normal brain tissue or spinal nerves.

Prognosis will depend on your age, the type of tumor, and its location, not by how early it is discovered. As with any disease, early detection and treatment is likely to be helpful.

Prevention

Thanks to the blood-brain barrier, our bodies protect our brains from toxins that may affect other areas, so unlike many cancers, lifestyle choices like diet and exercise appear to have little impact on prevention of brain or spinal tumors. If you’ve been exposed to radiation, this may increase your chances of contracting the disease. According to the American Cancer Society, there is no known way to protect against these tumors. The good news is that they are not common.

Detection and Diagnosis

Brain tumors are often discovered when a patient begins to have headaches, seizures or other symptoms of pressure inside the skull (also known as intracranial pressure). It’s important to note however that the majority of headaches and seizures are not caused by a brain tumor.

If you have a spinal cord tumor, symptoms may include numbness, weakness, or lack of coordination in the arms and/or legs (usually on both sides of the body), as well as bladder or bowel problems. Again, these symptoms don’t mean you have spinal cancer but if you have any of these symptoms, see your provider promptly.

The process for detecting brain or spinal cancer starts with your provider getting your medical history and completing a physical exam. If they discover anything abnormal, they may refer you to a neurologist or neurosurgeon who will do a more detailed neurologic exam or other tests, which may include imaging tests like magnetic resonance imaging (MRI), computed tomography (CT) scan, positron emission tomography (PET) scan, or x-ray. These tests may show an abnormality but often they can’t tell the type of tumor. To make this determination, the provider may recommend a biopsy, which involves removing a bit of the tumor to further test it.

Treatment

CMH is committed to providing compassionate, high-quality brain and spine care. If you are in the process of being evaluated for or have received a brain or spinal cancer diagnosis, your provider will refer you to the appropriate specialist.

Our health system offers experienced providers who specialize in treating cancer of the brain and spine, including:

  • Radiation oncologists, who use high-energy beams or small particles to kill cancer cells
  • Medical oncologists, who administer anti-cancer drugs, usually given into a vein or taken by mouth
  • Neurosurgeons, who remove cancerous tumors, lesions and tissues

Support

Fighting cancer is a tough job and we’re here to take it on with you. Our oncology nurses and oncology social workers know your treatment plan and help you get the support you need, whether it’s educational, emotionally supportive and wellness programs or a place for your loved ones to rest at the Arbor House, a free residential space on the CMMC campus.

Screenings and Diagnosis

If you’re concerned you may have brain or spinal cancer, you want to know your diagnosis as soon as possible. Central Maine Healthcare understands that knowing the first step, so we strive to provide the most accurate diagnoses as quickly as possible. Our pathologists and radiologists use state-of-the-art assessments to determine the cause of your symptoms and provide the best treatment.

Screening for Brain or Spinal Cancer

Brain or spinal cancer is usually detected by the symptoms it causes, which include headaches, seizures, back pain and numbness in the limbs. While patients with these symptoms usually don’t have brain or spinal cancer, talk to your provider promptly if you are experiencing any of them.

There are no widely recommended tests at this time that can detect brain or spinal cancer before symptoms appear. (“Screening” is the term for these types of tests.) But as with any cancer, early detection puts you at an advantage so be sure to share any and all symptoms you have with your provider.

Diagnosis of Brain and Spinal Cancer

A number of technologies and sciences are used to help your provider determine whether you have a tumor, whether it is benign (non-cancerous) or malignant (cancerous) and, if it is malignant, the type of cancer it may be.

A neurological exam may be ordered if you’re experiencing problems with your strength, reflexes, vision, coordination, hearing, or balance. Checking these areas helps your provider understand more about what areas of your brain or spine may be affected.

Pathology is another tool used to understand diseases, including brain and spinal tumors. If your provider suspects you may have one of these tumors, they may order pathology tests to examine the cells, tissues and/or fluids of your body. These samples are captured using the following techniques:

  • Blood tests
  • Resection, a technique for surgically removing areas suspected to be cancerous
  • Biopsies, which involve removing cells and tissue

Any of these tests are available onsite at Central Maine Medical Center (CMMC) although some samples are sent to an outside testing lab. Your provider can answer any questions you have about the process and will let you know when you can expect results.

Radiology uses pain-free X-rays and other high-energy radiation to produce accurate images of internal body structures, allowing radiologists to detect the presence or absence of most tumors. CMMC’s Cynthia A. Rydholm Cancer Treatment Center is staffed with experienced radiologists who use a number of radiology scans to help providers find the cause of your symptoms, and if it’s a tumor, determine its type and best possible treatments. Radiology testing includes:

  • X-rays
  • Computed Tomography (CT) Scans
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET)

Treatment

If you or a loved one has received a brain or spinal tumor diagnosis, we understand it can be upsetting and even frightening news. At Central Maine Healthcare (CMH), we want to provide everything we possibly can to make the treatment process reassuring. The information below is a general overview of the types of treatments your provider may recommend, but we hope you’ll do further research, including asking your care providers any questions you have.

Surgical Oncology

A surgeon who has expertise in removing cancerous tumors, lesions and tissues from the body is known as a surgical oncologist. This is often the first step in the treatment of brain or spinal cancer and in some cases will involve removing as much of the tumor as possible without affecting normal function and then following up with radiation treatments. Used together, these treatments may control or cure many tumors.

Radiation Oncology at the Cancer Care Cancer Center

A provider who specializes in using radiation to treat cancer is called a radiation oncologist. They use high energy rays or small particles to kill cancer cells. When a tumor is on or near your spinal cord or brain, the radiation needs to be aimed very precisely to avoid damaging these important organs.

The radiation team at Central Maine Medical Center’s Cancer Care Center, will determine the best angle and the lowest possible dose of radiation, with the goal of damaging the tumor while minimizing harm to your healthy tissue. Providers at the Cancer Care Center have advanced training and years of experience using radiation to help patients fight brain and spinal cancer.

One or more of the techniques below may be used to focus the radiation in the most therapeutic way possible:

  • IMRT (intensity-modulated radiation therapy)
  • IGRT (image-guided radiation therapy)
  • Rapid arc / VMAT (Volumetric-modulated arc therapy)
  • Hexapod table movement
  • CT simulation
  • SBRT (stereotactic body radiation therapy)
  • 3D-conformal radiation therapy

Medical Oncology

A medical oncologist treats cancer using chemotherapy, hormonal therapy and biological therapy to weaken the brain or spinal tumor. These drugs are delivered either intravenously (through a needle in the vein) or via a pill and are used to reduce a tumor’s size before surgery, to kill cancer cells remaining after surgery or radiation, or to treat tumors that have developed in other areas.

Medical oncologists undergo advanced training in the use of these drugs and create a plan to guide treatment. Patients at Central Maine Healthcare have peace of mind thanks to our relationship with the Hematology-Oncology Associates practice, which offers medical oncology specialists and a commitment to compassionate care. The practice features a state-of-the-art infusion center, as well as hydration, antibiotic, therapy and blood product transfusion services.

Bile Duct Cancer

What is Bile Duct Cancer? Your bile ducts are thin tubes that carry bile from the liver, gallbladder, and pancreas into your small intestine to help digest the fats in food. Bile duct cancer happens when cells in the bile ducts divide without stopping and spread into surrounding tissue. Because bile duct cancer occurs deep in the body, it is difficult to detect and there are no screening tests that can find it before it produces symptoms. The good news is that it is very rare, with only 8,000 people per year diagnosed with the disease.

Detection and Diagnosis: Symptoms of bile cancer can include pain in the belly, nausea and vomiting, fever, weakness and dark urine. But experiencing these symptoms does not mean you have the disease – it is quite rare. If you’re concerned about your risk of bile duct cancer, you want a diagnosis or to know the disease has been ruled out quickly. Central Maine Healthcare’s cancer care team is focused on providing fast, accurate testing, along with compassionate care. 

Treatment: Bile duct cancer is usually treated with either surgery or radiation and often with a combination of the two. With surgery, your provider removes as much of the cancer as possible. Sometimes all of it can be removed, curing the cancer. In other cases, the cancer is too advanced, but surgery can be done to remove as much as possible in order to relieve symptoms or treat complications.

The other form of treatment is radiation, which uses high-energy rays or particles to kill cancer cells. This approach allows your provider to try to eliminate cancer that could not be safely removed during surgery. If the cancer can’t be operated on but hasn’t spread to other parts of the body, radiation helps control the disease.

Support: Central Maine Healthcare’s cancer care team includes nurses specially trained for treating cancer patients, nurse navigators who guide patients and their loved ones to a variety of supportive resources, and oncology social workers who help you balance the demands of battling cancer with the rest of your life. Our residential facility, Arbor House, offers patients and families bedrooms, apartments, laundry facilities and a dining room all on the Central Maine Medical Center campus.

Screening for Bile Duct Cancer: Your bile ducts are deep inside your liver and gall bladder so detecting cancer in these areas during a physical exam is very difficult. And so far there are no reliable blood tests or other tests that can help providers discover the disease in its early stages. Usually, bile duct cancer is discovered after tumors have grown large enough to create symptoms. One of the most common is jaundice, a yellowing of the eyes and skin, that’s caused by a blocked duct. Other symptoms of bile duct cancer include:

  • Pain in your belly or sides, which can come from fluid buildup
  • Nausea and vomiting
  • Fever
  • Loss of appetite/weight loss
  • Weakness
  • Itching
  • Light-colored stools
  • Dark urine

It’s important to note that bile duct cancer is quite rare – only about 8,000 people per year are diagnosed with the disease – so if you’re experiencing any of these symptoms, it’s not likely you have bile duct cancer.

Diagnosis of Bile Duct Cancer: Your provider will use a combination of methods to diagnose your condition, including:

  • Physical exam
  • Blood tests – blood is drawn from your body with a needle and examined in a lab
  • Endoscope ERCP spy glass cholangioscopy
  • Ultrasound – a pain-free imaging tool that uses soundwaves
  • CT scan – which uses powerful x-rays to make an image of the inside of your abdomen
  • MRI – image created by high powered magnets that a radiologist uses to detect tumors
  • Endoscopy – endoscope cable with a camera lets your provider see inside your body without surgery or be used to inject dye into bile ducts, which are x-rayed in a test referred to as ERCP (endoscopic retrograde cholangiopancreatography).
  • Laparoscopy – once sedated, your provider inserts a thin tube through an incision with a small video camera so they can see if – and how far – the cancer has spread.

Treating Bile Duct Cancer: Bile duct cancer is usually treated with surgery, radiation or some mix of the two. Your cancer care team will develop a treatment plan based on how advanced the cancer is, whether tests indicate it can be surgically removed, how well your liver is functioning, your age and general health condition, and a host of other factors.

Surgery for Bile Duct Cancer: Because bile duct cancer is difficult to detect, it’s usually only discovered after surgery could cure the cancer. If imaging tests or surgeries indicate the cancer has been caught early, a surgeon may be able to remove all the cancer, plus a margin of healthy tissue around it. This is referred to as curative surgery because it usually cures the cancer.

In most other cases, the cancer is too advanced or is in a spot where surgery to completely remove the cancer would be very risky for the patient. In these situations, your provider may consider palliative surgery, which means the procedure is done to relieve symptoms or treat complications, rather than cure the disease. Both curative and palliative surgeries are major operations that can require long recovery times, so you should be sure you’re well informed about the goals of the surgery, its risks and potential side effects.

Palliative endoscopy is often done to unblock a bile duct which can relieve jaundice or itching that is common with bile duct cancer. While it can help the patient feel better, it is not done to eliminate or cure the cancer. In some cases, a surgeon will rely on the best information available – which may come from imaging tests and/or exploratory surgeries like laparoscopy – to plan a curative surgery but realize when the surgery begins that the cancer is too advanced or widespread to be cured. At this point, they may decide to take palliative measures.

Radiation therapy for bile duct cancer isn’t common and providers disagree about how helpful it is. But your provider may decide in your case that its benefits outweigh its costs, which can include side effects like skin redness and blistering, nausea, vomiting, diarrhea and fatigue. There are two main types of radiation therapy for bile duct cancer:

External beam radiation therapy (EBRT) – uses high-energy rays aimed directly at the tumor to kill cancer cells. EBRT is the most commonly used radiation therapy for bile duct cancer

Brachytherapy – is also known as “internal radiation therapy.” A radiologist places small pellets of radioactive material next to or into the tumor. Since the source of the radiation is so close, it affects the cancer without causing much harm to nearby healthy tissue.

RFA Endoscopic Treatment – CMMC offers these treatments at the Cancer Care Center, which has state-of-the-art radiation therapy services, including EBRT and brachytherapy.

Chemotherapy for Bile Duct Cancer: the use of medical drugs to treat cancer. Also known as medical oncology, it involves giving these drugs in the vein (IV) or taking them by mouth. Since they go directly into the bloodstream, they reach all areas of the body. Like radiation therapy, providers may not agree on whether chemotherapy is helpful for bile duct cancer. Still, your provider may decide it is useful for your case. Chemotherapy may be used in one or a combination of several ways to treat bile duct cancer:

  • To shrink tumors before surgery to make them smaller and easier to remove
  • To lessen the odds that cancer will return after surgery has removed the tumors
  • To help people whose cancer can’t be operated on to live longer
  • To slow the growth of or reduce the size of tumors that are creating painful symptoms by pressing on nerves.

The Cancer Care Center at Central Maine Medical Center offers our cancer patients who need medical oncologists the services of Hematology-Oncology Associates practice, which is committed to offering the most current, individualized, compassionate and convenient care for cancer patients and their families.