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Chemothearpy
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Chemotherapy
Chemotherapy is the treatment of cancer with medicines that cause damage to cancer cells, leading to cell death.

Today, many methods of chemotherapy delivery and chemotherapy medicines are used in cancer treatment. Specific chemotherapy regimens are set up individually. Cancer treatment regimens are based on cancer research and specialized training and experience of our physicians and staff.

A chemotherapy regimen includes one or more chemotherapy drugs, and specifies how often and how many treatments are given. For regimens that may cause nausea, a schedule of medicines to prevent nausea is included.

Most chemotherapy is given intravenously and may take an hour to several hours. Chemotherapy is usually given in the office and hospitalization is not necessary. The chemotherapy room nurses are experts at starting I.V.s, giving chemotherapy, and monitoring you throughout your treatment.

Before you start chemotherapy, you should be sure you understand what medicines you will be taking and what the side effects are. We provide education prior to beginning your chemotherapy treatment. These visits are designed to help you maximize your treatment course.

Methods of Chemotherapy Delivery

Implanted Venous Catheter (I.V.) - Most chemotherapy is given intravenously, which means using a needle to access your vein. Access to a good vein in the arm is important for chemotherapy. In circumstances when veins in the arm are too weak or small for a regular I.V. to be used, a semi-permanent port (tube) may be placed in a larger vein elsewhere on your body. The port should be periodically flushed (rinsed out with a syringe) with a weak concentration of Heparin, a blood thinner used to keep blood from clogging the catheter.

Implanted Port - The port has a catheter placed in a vein by ultrasound guidance and is attached to a small round device called the port. This is done in a short surgical procedure. The catheter and port are both under the skin on the upper chest. An I.V. is started by cleaning the skin and placing a needle through skin and into the port.

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Surgery

Gynecologic Surgery Procedures
Most often treatment for gynecologic cancers involves surgery. The type of surgery performed depends on the type of cancer and the stage of disease at the time of diagnosis. The choice of surgical procedure may also be based on a woman’s age and general state of health.

Total Abdominal Hysterectomy: This surgery involves removing the uterus and cervix. Lymph nodes in the pelvis and abdomen may also be removed to see if they contain cancer cells.

Bilateral Salpingo-Oophorectomy: This surgery is usually performed with a hysterec tomy and involves removing the ovaries and fallopian tubes.

Vaginal hysterectomy: This surgery involves an incision in the vagina and removal of the uterus through the vagina.

Radical hysterectomy: This surgery also removes the uterus along with the tissues next to the uterus and the upper part (about one inch) of the vagina next to the cervix. Lymph nodes may also be removed.

Tumor debulking: This procedure involves removing as much of the cancer as possible if it has spread to other parts of the pelvis or abdomen. This can improve survival and reduce the amount of cancer to be treated later with chemotherapy or radiation therapy.

Vulvectomy: This surgery involves removing all or part of the vulva. Lymph nodes near the vulva may also be removed.

Vaginectomy: This surgery involves removing all or part of the vagina and surrounding tissues. Lymph nodes in the groin area or inside the pelvis near the vagina may also be removed.

Breast Surgery Procedures

Lumpectomy: A removal of the breast tumor with approximately 1-2 centimeters of healthy tissue surrounding the tumor. Women who are interested in preserving their breast may be offered this option. One of the risks with this surgery is the possibility of needing further surgery (either a wider lumpectomy or a mastectomy if the cancer is not completely removed during the initial surgery). After you have a lumpectomy, you will need to have radiation to that side of your chest. Studies have shown that lumpectomies were equal to mastectomies in preventing cancer spread or recurrence. These studies compared lumpectomies that were followed by radiation with a mastectomy. After you have a lumpectomy, you will have an incision 2-4 inches long. (If you also have lymph nodes removed, you will have another incision in the underarm (axillary) area. You may have drains to help remove tissue fluid.

Mastectomy: A removal of the entire breast, but none of the muscle tissue under the breast. The result is a flat chest with a long horizontal incision. Women who are interested in reducing their risk of needing further surgery often pick this surgery option. Radiation is often not needed after a mastectomy, which simplifies a patient’s treatment plan.

Drains: A drain is a tube that comes out from the body to drain lymph fluid from your surgery incision into a small bulb. Many breast patients will have a drain, which is held in place with stitches. Drains should be emptied at least twice daily and your hospital nurses should show you or a caregiver how to do this.

What to Expect Prior to Surgery
Surgery will be scheduled in our office. Depending on the procedure you are having you may be scheduled for an appointment to discuss the procedure with one of our providers. You may also be asked to schedule an appointment with the hospital to discuss anesthesia and other pre-operative tests. Major abdominal surgery will require special diet restrictions and bowel preparation. These instructions will be given to you prior to surgery.

Certain medicines and supplements must be stopped two weeks prior to surgery because they may cause bleeding during surgery and/or react with anesthesia. These include: aspirin, ibuprofen, naproxen, headache powders, anti-inflammatory drugs, all herbal products and supplements, and vitamin E (more than 200 IU per day).

After Surgery
After surgery, a patient will be observed in the recovery room for several hours before moving to a room. The length of stay in the hospital varies, depending on the type of surgery and the patient’s condition after the procedure. The usual length of stay after an abdominal hysterectomy is 4-5 days, while that for a vaginal hysterectomy or vulvectomy may be 1-2 days. Lumpectomy patients often go home the same day and mastectomy patients may go home the same day or next day depending on the patient’s desires.

In the first days after abdominal or vaginal surgery the patient can expect:

• The abdominal incision may be closed with stitches or staples and covered with a gauze dressing. Staples are usually removed one to two weeks after surgery by a nurse in our office.

• Patients may have pain in the lower abdomen after surgery. The surgeon will order medication to control pain and send you home with a prescription for pain medicine. The pain medicine can cause constipation, so it may be necessary to use a stool softener after surgery.

• Urination may be aided by a tube or catheter, which is put in the bladder during surgery. In most cases, it is removed a day or two after surgery. After certain surgeries, like a radical hysterectomy, the catheter may not be removed until two weeks after surgery. This allows for healing after surgery.

• Some women may have a drain in the lower abdomen or groin after surgery to help remove tissue fluid. This is most often removed before discharge. Certain surgeries, such as a vulvectomy with lymph node removal, may require that the drain be left in from one week to a month. The hospital nurses will give instructions on how to care for the drain at home. The drain will need to be emptied at least twice a day and a record kept of the drainage amount.

• After most abdominal surgeries, eating and drinking are prohibited until the doctor determines that the digestive system can safely process food and drink. The diet usually starts with light liquids, and then slowly progresses to soft food prior to discharge from the hospital.

• A patient’s lungs need to be kept clear of excess fluid to prevent problems such as pneumonia. The hospital nurses will teach patients how to use a breathing apparatus called an incentive spirometer for this purpose.

• Walking soon after surgery helps with recovery. Walking lowers the risk of blood clots and breathing problems and helps the bowels recover from anesthesia.

• After a hysterectomy, women may experience gas pains and bloating. Walking is helpful as well as an over-the-counter medication for gas relief.

In the first days after a lumpectomy or mastectomy:

• After your tumor is removed, your surgeon will send it to the pathologist who will examine the tumor and perform some tests that will help your doctor determine what further treatment you may require.

• When you wake up from surgery, you will have a thick gauze dressing over the incision and likely an Ace bandage wrapped around your chest. The gauze will be removed before you go home. You can wear your bra home from the hospital, or you may want to wear the Ace bandage.

• You will be given a prescription for pain pills when you go home, although often pain with breast surgery is generally mild.

• Patients should keep arm and upper body movements to a minimum. You will be able to eat and write, but you should not lift anything heavier than a half-gallon of milk. Do not raise your arms on the surgery side above your shoulders for the first 5 to 7 days after surgery.

• DO NOT DRIVE FOR ONE WEEK.

• After a mastectomy, you may want to wear a breast prosthesis. Ask the nurse to show you some prosthesis samples when you come for your postoperative visit. You will be ready to be fitted for a prosthesis seven weeks from the date of your mastectomy. Your insurance usually will pay for a prosthesis and 2 mastectomy bras.

• During the 7-week post-operative period, patients often were a Soft-Tee. This is a t-shirt that has pockets for fiberfill padding. Your insurance may help with the cost of a Sof-Tee. Please let our office know if you are interested (this has to be arranged at Park Ridge.)

• Mastectomy patients always have the option of having breast reconstruction. Enough skin is left in place after the surgery to make this possible. Our surgeons usually prefer that you wait at least six months after having a mastectomy, before making a decision about breast reconstructive surgery. A plastic surgeon would perform this surgery, and New Horizons is happy to make a referral.

Recovery Period
Recovery after surgery may take 2 to 8 weeks depending on the type of surgery. During that time, it is important to rest and increase activity gradually. We recommend not driving for two weeks after abdominal surgery. Avoid tasks or movements that can strain the incision, such as lifting or bending. To allow the body to heal, it is best to take showers instead of baths, to not use tampons or douches, and to not have intercourse for the length of time your surgeon suggests, usually 6-8 weeks.

Usually one to two weeks after surgery, a patient will have a post-op appointment in the office to check the incision and remove any staples or drains if needed. At that time, the doctor will review the pathology report of the surgery with the patient. The pathology report is an important tool in helping to determine whether any further treatment is necessary.

When to Call Your Doctor
It is important to call the office, even after office hours, if a patient develops any of the following symptoms: fever or chills; heavy vaginal bleeding or a smelly discharge; redness, bleeding, or discharge at the incision site; pain or swelling in the legs; shortness of breath or chest pain; or severe abdominal pain or pelvic pain.

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Consultations and Second Opinions

Consultations
Many of our patients are first referred by family doctors or gynecologists who suspect or have diagnosed some form of cancer. Because we understand that recommendations and specialized care are important to your future treatment, we attempt to schedule a consultation for you with one of our doctors as soon as possible. Following this consultation, many of our patients are able to return to their doctors for continued care.

Some of the reasons you might be coming to see us include:

• Abnormal pap smears
• Abnormal mammograms
• Vulvar disease
• Endometrial hyperplasia
• Vaginal bleeding
• Breast Cysts or Lumps
• Ovarian cysts
• Uterine fibroids
• Breast changes
• Family history of cancer
• Breast cancer
• Ovarian cancer
• Endometrial cancer
• Cervical cancer
• Vaginal cancer
• Vulvar Cancer
• Gestational Trophoblastic Disease
• Chemotherapy

Second Opinions
Occasionally patients would like a second opinion regarding their diagnosis. Second opinions can convey new information or a new perspective. When considering having a second opinion, it is best to be open and truthful with your doctor so he or she can recommend the best possible specialist in regards to your condition. Your doctor shares your concerns and wants what is best for you.

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20 Medical Park Drive Asheville, NC 28803 | ph. (828) 274-7502 | fax. (828) 271-6599