2015-16 Cancer Network Annual Report

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Emily Ritchie, M.D., Radiology, Sentara RMH Medical Center

Accurate Diagnosis

Imaging and Pathology

An accurate diagnosis is critical to the treatment and care of the cancer patient. At Sentara, board-certified radiologists and pathologists work together using the latest technology to confirm suspicions and accurately diagnose patients. Sub-specialization of our physicians enables the team to diagnose and treat a comprehensive array of cancers with accuracy and skill. With multiple locations throughout Virginia and North Carolina, many of which are accredited by the American College of Radiology or the College of American Pathologists, patients have access to the same high quality imaging and pathology services.

3D Mammography

Available at numerous sites throughout the network
In addition to standard mammography, 3D mammography – or tomosynthesis – has been proven to increase early detection rates by 35 percent*. Because of the groundbreaking success in early detection, Sentara invested in making the 3D technology available throughout the network to give more women access close to home.
*June 2013 issue of the American Journal of Roentgenology (AJR)

Interventional Radiology

Available at numerous sites throughout the network
Interventional Radiology (IR) is a medical specialty that performs diagnostic and therapeutic procedures utilizing minimally invasive techniques and image guidance. The following are some types of IR procedures performed across the network:

  • Image-Guided Needle Biopsies
  • Bone Marrow Biopsies
  • Fiducial Placement for Cyberknife Cancer Treatment
  • Percutaneous Drainage Procedures
  • Palliative Care: PleurX Catheters (Pleural & Peritoneal)
  • Venous Access – PICC Lines, Tunneled Central Lines and Mediport Insertions
  • Enteric Access (Feeding Tubes)
  • Image-guided cancer treatments such as: chemoembolizations, radioembolization, radiofrequency or microwave ablations, cryoablations

Navigational Bronchoscopy

Sentara CarePlex Hospital, Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara Princess Anne Hospital, Sentara RMH Medical Center, Sentara Virginia Beach General Hospital, Sentara Williamsburg Regional Medical Center
A new outpatient procedure called electromagnetic navigational bronchoscopy uses a new navigation tool (much like a GPS) to provide a road map to better find, diagnose and mark spots on the lung for precision treatment later. Using this new system Sentara pulmonologists snake a catheter through a patient’s nose and airways to reach some of the deepest tissue of the lungs. Once the questionable tissue is found in the lung, doctors rely on the fast work of specialized pathologists and within minutes, it’s known whether the spot on the lung is cancer or not.Previously, patients would have required one or more procedures to learn of their condition and treatment.

Positron Emission Tomography / Computed Tomography

Available at numerous sites throughout the network
A PET and a CT scan are performed at the same time with the same machine, providing a more comprehensive image than each could produce alone. PET scans take pictures of the function of the organs and tissues using nuclear medicine technology, while CTs create a 3D physical image using X-rays. A PET/CT scan is used often to image the heart, brain, liver or other organs. It is one of the most effective ways to study cancer. Oral contrast medium may be used to outline or highlight organs of the body so that they can be seen more easily.

Endobronchial and Endorectal Ultrasounds

Sentara CarePlex Hospital, Sentara Martha Jefferson Hospital,Sentara Norfolk General Hospital
With a minimally invasive endobronchial ultrasound procedure known as EBUS, doctors are able to diagnose patients with lung cancers before any surgery begins. This technological breakthrough is helping patients with lung and lymph node tumors to be more accurately diagnosed so treatment can begin sooner. The physician uses a bronchoscope equipped with an ultrasound device that is threaded through the patient’s nose or mouth into the airways of the lungs. The same technology is used for endorectal ultrasounds, to help diagnose pelvic and colorectal cancers. No incisions are needed and the minimally invasive procedure helps doctors see and stage cancers prior to surgery.

Breast-Specific Gamma Imaging

Dorothy G. Hoefer Comprehensive Breast Center, Sentara RMH Medical Center
While mammography remains the primary method of early detection, diagnostic challenges can occur due to the complexity of the breast tissue. Breast-specific gamma imaging (BSGI) aids in diagnosis when a mammogram is inconclusive and reveals important information that can help more accurately determine if an area of concern is cancerous. During the procedure images are taken showing the metabolic activity of breast lesions using a gamma camera. The high-resolution camera creates pictures so doctors can see cancers as small as 3 millimeters. It can detect early stage cancers, see lesions even in dense tissue, and provide multiple angle views. The result is quicker and more accurate detection of breast cancer than with mammography alone.

Molecular Testing Lab

A molecular testing lab is one of the many behind-the-scenes benefits for patients in the Sentara Cancer Network. Having an in-house molecular laboratory, staffed by a board-certified Molecular Genetic Pathologist, allows critical test results to be made available quickly.

The future of cancer medicine appears to be heavily reliant on the genetics of the person and their cancer. With so much complexity and numerous subtypes within types of cancer, having molecular information can be extremely helpful. With nearly 70 percent of medical decisions based on lab results, it’s important to have a state-of-the-art lab to assist with cancer care.

As the laboratory technology advances, other health care providers may need to send their samples to a lab out of state, across the country or many hours away, while the Sentara Lab allows for quicker, coordinated care.

The implementation of Next Generation Molecular Sequencing will allow the lab to analyze in parallel multiple genes in support of diagnosis and treatment recommendations. The technology will improve turnaround time and decrease costs compared with traditional sequencing methods.

At the tissue repository, the tissue removed for diagnosis is preserved in a block of paraffin. Should the patient ever need additional tests, the tissue is readily available. The Sentara Histology Lab has preserved the tissue of thousands of patients dating back to the 1980s. While this can benefit the patient who provided the tissue, it could also be used for research into the particular disease states in a retrospective study, preserving patient anonymity and potentially benefiting future oncology patients.

Hunt MacMillan, M.D., Pathology, Sentara Martha Jefferson Hospital

Hunt MacMillan, M.D., Pathology, Sentara Martha Jefferson Hospital