Penn Medicine specializes in innovative approaches that use chemotherapy and biologic therapies to target tumors prior to and after surgery.
- Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through an IV, or orally by pill. Chemotherapy can also be delivered to potentially enhance the effectiveness of radiation therapy.
- Biologic therapy, also called targeted therapy, uses the patients' own immune system to target cancer cells. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer, and are delivered intravenously through an IV, or orally by pill. This type of cancer treatment is also called immunotherapy.
Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:
- Diagnosing cancer has become more precise.
- Radiation and surgical techniques have advanced.
- Medications are more successful.
- Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
- Strategies to address the late effects of cancer and its treatment are improving quality of life.
Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.
Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.
Types of radiation therapy include:
3-D Conformal Radiation Therapy
This imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Conformal radiation therapy gives doctors more control when treating tumors. Special computers use CT imaging scans to create 3-D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.
Intensity-Modulated Radiation Therapy (IMRT)
IMRT is an advanced type of radiation therapy that uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, may stop cancer cells from dividing and growing, thus slowing or stopping tumor growth.
Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.
Volumetric-Modulated Arc Therapy (VMAT)
VMAT is a type of specialized IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.
VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patients more comfort because it does not require them to lie completely still for long periods of time.
Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.
Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors and tumors in the upper digestive tract in clinical trials.
Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.
The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.
Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.
Radiation oncologists at Penn Medicine use both internal and external forms of radiation therapy to treat cancer. Brachytherapy is an internal therapy in which the radiation source is placed inside the body.
Brachytherapy for bile duct cancer involves placing radioactive wires inside tubes in small sealed holders in the body. The implants are left in the body for only a short time. This allows the doctor to give a high dose of radiation to a smaller area than is possible with external radiation treatment.
Some patients with bile duct cancer may be good candidates for bile duct cancer surgery.
Surgeries for bile duct cancer include:
Bile Duct Resection
In a bile duct resection, some or all of the bile duct may be removed if the tumor is small. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes may be removed to check for cancer.
A partial hepatectomy removes the part of the liver near the bile duct where cancer is present. The part may be a wedge, an entire lobe, or a larger part of the liver along with some surrounding tissue.
A Whipple procedure, or pancreaticoduodenectomy, is a complex procedure in which the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas are removed. Enough of the pancreas is left to continue to produce digestive enzymes. Studies have confirmed that the success of the procedure is linked to the experience of the surgeon performing the procedure.
Surgical Biliary Bypass
If a tumor is blocking the small intestine and bile is building up in the liver, a biliary bypass may be performed. The gallbladder or bile duct is cut and sewn directly to the small intestine to create a new pathway around the blockage. This procedure is not designed to cure bile duct cancer, only relieve symptoms.
Endoscopic Stent Placement
If the tumor is blocking the bile duct, a stent may be placed via an endoscopic retrograde cholangiopancreatography (ERCP) or interventional radiology to drain bile that builds up in the area. This procedure is not designed to cure bile duct cancer, only to relieve symptoms.