Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.
What does chemotherapy do?
Cure cancer – when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
Control cancer – when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
Ease cancer symptoms (also called palliative care) – when chemotherapy shrinks tumors that are causing pain or pressure.
Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy.
Since cancer is a word used to describe many different diseases, there is no one type of cancer treatment that is used universally. Our institute chemotherapy is used as a cancer treatment for a variety of purposes:
To provide cancer treatment and cure a specific cancer.
To control tumor growth when cure is not possible.
To shrink tumors before surgery or radiation therapy.
To relieve cancer symptoms (such as pain).
To destroy microscopic cancer cells that may be present after the known tumor is removed by surgery (called adjuvant therapy). Adjuvant therapy is given to prevent a possible cancer recurrence.
The Human Capacity
Specialists (Clinical & Radiation Oncologists) – 14
General Practitioners – 6
Pursuing specialization in cancer – 5
Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body. Because nuclear medicine procedures are able to pinpoint molecular activity within the body, they offer the potential to identify disease in its earliest stages as well as a patient’s immediate response to therapeutic interventions.
The division of Nuclear Medicine is responsible for all the diagnostic and in-vivo procedures with unsealed radioactive sources and therapy of benign thyroid pathology. Most of the daily workload is referral for diagnostic procedures from specialties at ocean road Hospital; which include Oncology clinics, Endocrinology, Orthopedics, and Urology As there are no Nuclear Medicine facilities available at primary and secondary level a significant number of referrals are from outside Ocean road Hospital. The referring hospitals include Muhimbili National Hospital, Lugalo military hospital, Amana, Mwananyamala and Temeke. Various community health centres, private practitioners and specialists in the private sector also refer patients.
Nuclear medicine imaging procedures are noninvasive and, with the exception of intravenous injections, are usually painless medical tests that help physicians diagnose and evaluate medical conditions. These imaging scans use radioactive materials called radiopharmaceuticals or radiotracers, our diagnostic services involves:
1. Thyroid scan using TC-99m Pertechnetate
2. Renogram using TC-99m labeled DTPA
3. Static Kidney studies using TC-99m Labeled DMSA
4. Bone scan using TC-99m labeled MDP
5. Scintimammography using TC-99 labeled MIBI
6. Radiopharmaceuticals are imported from AMESHARM SOUTH AFRICA.
Nuclear medicine also offers therapeutic procedures, such as radioactive iodine (I-131) therapy that use small amounts of radioactive material to treat cancer and other medical conditions affecting the thyroid gland, as well as treatments for other cancers and medical conditions. Non-Hodgkin’s lymphoma patients who do not respond to chemotherapy may undergo radioimmunotherapy (RIT). Radioimmunotherapy (RIT) is a personalized cancer treatment that combines radiation therapy with the targeting ability of immunotherapy, a treatment that mimics cellular activity in the body’s immune system.
Therapeutic Services are:
The use Iodine 131 for ablation cancer of the Thyroid gland, treatment of uncontrolled Toxic goiter and Graves’s diseases. I-131 is also imported from AMESHARM SOUTH AFRICA.
In average approximately 1250 cases of diagnostic and 54 cases of therapy are attended each annually.
Nuclear Medicine Imaging
Nuclear medicine imaging non-invasively provides functional information at the molecular and cellular level that contributes to the determination of health status by measuring the uptake and turnover of target-specific radiotracers in tissue. These functional processes include tissue blood flow and metabolism, protein—protein interactions, expression of cell receptors in normal and abnormal cells, cell—cell interactions, neurotransmitter activity, cell trafficking and homing, tissue invasion, and programmed cell death. By providing information on these processes, nuclear medicine imaging offers a broad array of tools for probing normal and disease-related states of tissue function and response to treatment.
The addition of anatomic imaging provided by computed tomography (CT) to functional imaging of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has further expanded the utility and accuracy of nuclear medicine imaging. By using combined-modality PET/CT and SPECT/CT devices, functional processes can be localized within the body to an anatomically identified or, in some instances, as yet unidentifiable structural alteration. These devices have enhanced the accuracy with which disease can be detected, aided in the determination of the extent and severity of disease, enhanced the accuracy for identifying disease-related risk, and improved the ability to monitor patient response to therapy.
The Human Capacity:
Two Nuclear Medicine Physicians
One Trained Nuclear Medicin Physicist
Four Trained Nuclear Medicine Technologists
This section deals with improvement of quality of life of patients and their families facing problems associated with life threatening conditions, through prevention and relief of suffering, early identification and impeccable assessment of pain and other problems, physical, psychosocial and spiritual problems.
Palliative care started as a pain control team (PCT) in July 1994 whereby the team was dealing with mainly with physical pain. It was comprised of doctors and nurses. In early 2001 team members went to Hospice Africa Uganda for six weeks training in Palliative care. Since then the multidisciplinary team was formed. ORCI Palliative care is collaborating with different national Organizations like TPCA, PASADA, Selian Hospice, Muheza Hospice and referral hospital that deals with Palliative care. International organizations worked with are APCA, Hospice Africa Uganda, INCTR, Princess Diana of Wales, ICAP and MDH. We Have more than 20 trained personnel in palliative care. Two with post graduate diploma , 7 with Diploma,11 with certificate and 4 with Pediatric PC certificates.
Provide Hospital Based Palliative Care:
• Control of pain in totality.
• Preparing morphine and dispensing to the patients.
• Monitoring the use of morphine.
• Conducting training.
• Doing mentoring activities.
• Supervising and coaching all staffs coming from different places, government hospitals, faith based hospitals and NGO’s in morphine use.
• Supply Morphine to palliative care units in different hospitals.
• Linking and networking with other palliative care unit.
• Doing counseling services.
Provide Home Based Palliative Care:
• Provide holistic care to patients and families.
• Collaborate with Religious leader and District/Municipal Hospital volunteers.
• Networking with different support group.
The Main Goal Of Palliative Care
To improve quality of life to patients and their families suffering from CANCER and life threatening illness.
Palliative care is an urgent humanitarian need worldwide for people with life threatening/chronic fatal diseases. Palliative care is particularly needed in places where a high proportion of patients present in advanced stages and there is little chance of cure. Palliative care services should be provided from the time of diagnosis of life-threatening illness to terminal phase and also we should provide support to families in their bereavement.
There are several success achieved from implementation of Palliative Care Services at ORCI which are:
. Recognition of Palliative care in Ministry of Health in Tanzania.
. Formulation of palliative care policy guidelines.
. Availability of morphine in Palliative care centers and most referral hospitals in the country.
. Education and training to policy makers, health care workers, volunteers and public.
. Implementation of palliative care services in Pwani Region
Radiology and Imaging Section
The Radiology Section came up immediately with the establishment of ORCI in 1996. It is located on the old building close to Radiotherapy Section. The section was attached to the Allied Health Sciences Department (AHSD) together with Radiotherapy and Nuclear Medicine Sections.
In 2007, Radiology Section was separated from AHSD, became an independent department – Clinical Radiology Division (CRD) until 2013 after restructuring of the ORCI organizational structure whereby some of the divisions were removed from the list. From that time it was changed to Radiology and Imaging Section (RIS).
• To provide outstanding patient care and service
• To provide radiological & ultrasound services that are timely, cost effective, appropriate and of the highest quality.
• To educate health care professionals, medical students, residents, and secondary school students.
• To contribute to the understanding of health and disease through imaging and through imaging technology related clinical and basic science research.
• To participate in the growth and mission of the ORCI.
Conventional Radiography is the only imaging modality available at ORCI. Radiography is often the first-line test of choice in radiologic diagnosis worldwide. Despite the large amount of data in CT scans, MR scans and other digital-based imaging, there are many disease entities in which the classic diagnosis is obtained by plain radiographs. Examples include various types of arthritis and pneumonia, bone tumours, benign, malignant and metastatic bone tumours, fractures, congenital skeletal anomalies, etc.
There are cases in which planning for radiotherapy requires x-ray films on grid, this includes barium swallows and some metastatic bone diseases, this service is also provided by radiography unit.
Ultrasound and X-ray Unit
The section provides diagnostic imaging tests including conventional X-Rays, some few studies with contrast media and ultrasounds.
With ultrasound machines we are capable of performing various examinations such as general abdomen and pelvic ultrasound examinations, Echocardiogram, Echomammogram, Doppler and small parts examinations, On top of that, ultrasound guided biopsies are performed in collaboration with Pathology section.
The section has recommended procurement of a mammography machine so as to provide radiographic imaging services for breast cancer screening.
Knowing that CT-scanner is very important on determination the extent of cancer, that is staging of disease, the section has proposed procurement of CT-scanner for the institute.
Despite of that, the unit is capable of performing some special examinations such as Echocardiogram, Echomammogram, small parts ultrasound and Doppler ultrasound.
Mammography is the radiographic examination of the breast utilizing low energy x-rays and fine detail film-screen or digital imaging. Mammograms may be a screening examination, aimed at detecting early breast cancer or a diagnostic study, to better define abnormalities on a screening, follow-up a previously found abnormality or to evaluate a palpable mass or other symptoms. Early breast cancer may be seen as a mass, a focal asymmetric density or as clustered micro calcifications (< 1 mm).
The Human Capacity:
The section has one Medical Specialist (Radiologist), one Sonographer, one Radiographer Technologist, Six Radiographers who are capable of doing both ultrasound examinations and radiography.
There are three supporting staffs ( attendants) performing various duties.
Facilities and Equipments
Currently, there are three (3) X ray units, one Phillips system and two Siemens systems. These machines are in good condition and capable of performing a good number of examinations – conventional and some special studies with contrast media and also we have one ultrasound machine which can perform all basic ultrasound studies such as abdominal, pelvic and obstetric ultrasounds.
For many years radiotherapy department was under allied health sciences division (AHSS) which was formulated by the medical imaging section, physics section, nuclear medicine section, simulator, radiotherapy and brachytherapy units.
Fortunately in 2012 the new organization structure of the Ocean Road Cancer Institute was put into function, the new structure raised the radiotherapy unit to an independent department/section.
Radiotherapy department has been identified as the ‘heart of the institute’ for many years because it makes the Institute unique and specialized health Institute. Ocean Road Cancer Institute is the only Institute that provide radiotherapy treatment services in the country.
Promote radiotherapy services of high professional quality.
Promote integrated and holistic care of patients.
Uphold human dignity of patients including those patients who are terminally ill.
Deliver optimal radiotherapy treatment to cancer patients with available resources/modalities in order to archive cure whenever possible.
Ensure the delivery of timely radiotherapy treatment that is accurate and appropriate and is provided by competent, highly trained and friendly staff.
Promote the principles and the practice of quality improvement in all departmental units including radiotherapy machines, mould room, simulator and brachytherapy.
Ensure that our team is committed to providing a comprehensive, high quality radiotherapy service to all our patients.
Promote professional ethics relating to practice of quality radiotherapy treatment.
Ensure that the radiotherapy department meets all our patients’ expectations through dedicated professional teamwork with a caring attitude. Customer satisfaction feedback is actively sought to continuously improve our services.
Ensure that the patients’ privacy and dignity are respected and confidentiality is maintained.
Promote a working environment that is safe for staff, patients and their families.
Be a reputable center for training of oncologist, radiotherapy technologist and other allied health professionals involved in cancer care.
Being the part of promoting and giving awareness cancer management especially radiotherapy treatment to the patients and public in general.
Ensure proper patient’s documentation and dedicated team work treatment time calculation.
Radiotherapy Section has following Units:
1. Treatment Planning unit
2. Brachytherapy unit
3. Simulator and quality control unit
4. Mould room unit
5. Customer care unit
Treatment Planning Unit
The Unit is responsible for planning the appropriate external beam radiotherapy or internal brachytherapy treatment techniques for a patient with cancer.
ORCI Treatment planning usually takes place on a CT scanner or simulator. Images are taken in the exact (mock-up) treatment position. This is documented so that it can be consistently repeated for treatment. We may also need to take a photograph of patient position. Patient may already have had a lot of imaging done, including a CT scan, this is necessary to diagnose the patient condition. Patient planning scan will give us a 3D/4D model of you, positioned as you will be treated. Together with the diagnostic imaging they will allow our medical staff to define exactly how to treat Patient. When we plan patient treatment, we may need to make some tiny, permanent, marks on the patient skin. This will be done by putting a pinprick of ink under the surface of the skin. From all the information gathered, the patient treatment plan will be created. Some treatments require complex computer planning. The amount of time necessary to prepare a treatment plan will vary from patient to patient, depending on what is required to deliver the best treatment.
Treatment simulations are used to plan the geometric, radiological, and dosimetric aspects of the therapy using radiation transport simulations and optimization. For brachytherapy, involves selecting the appropriate catheter positions and source dwell times (in HDR brachytherapy) or seeds positions (in LDR brachytherapy).
Plans are often assessed with the aid of dose-volume histograms, allowing the clinician to evaluate the uniformity of the dose to the diseased tissue (tumor) and sparing of healthy structures.
Brachytherapy unit is responsible for taking care patients who requires an advanced cancer treatment.
Brachytherapy is radiation therapy given at a short distance: localized, precise, and high-tech. ORCI provides brachytherapy for many types of cancer. Some of the tumors ORCI experts treat with brachytherapy are:
Head and neck cancers
Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues.
Ocean Road Cancer Institute is the only cancer center in Tanzania. For many years ocean road cancer institute were treating cervical cancer by using low dose rate brachytherapy (LDR) whereby patient spent more than 15hrs for single fraction. Early this year 2011 ocean road cancer institute managed to have two HDRs, one donated by international atomic energy agency (IAEA) and the other one bought by the Ocean road cancer institute through Medical Store Department (MSD)-Tanzania.
Simulator and quality control unit
Simulation is a process carried out by radiation therapist under the supervision of radiation oncologist. It is a mockup procedure of patient treatment with radiographic documentation of the treatment portals.
Simulator Is a radiographic x-ray unit that mimics all the movements and parameters of the treatment units. They are used for imaging the target volume during treatment planning.
Mould Room Unit
The mould room is where individual immobilisation devices hold you still during treatment. This is necessary particularly when treating the head or neck. The mould room will produce an array of different apparatus before radiotherapy commences, your clinician will decide which is best for your treatment, this could include a thermoplastic mask for positioning, a lead mask or lead cut out shapes for shielding.
As part of pre-treatment planning, some patients may require a mould to be made, for example, patients requiring treatment to the head and neck region.
Moulds are also known as BDS (Beam directional shells) or thermoplastic shells and they can be referred to as a mask. The mould ensures the patient is in the correct position to allow accurate delivery of radiation to the correct area every day.
For a mould to be useful it must be a good fit. If a patient has a moustache, beard or long hair this may be difficult, so they may be asked to tie back long hair and shave facial hair before the mould is made. The process of making a mould can take about 15-20 minutes. The materials used will feel warm and a little damp on the skin, but most people do not find it unpleasant. Patients wearing moulds can breathe normally and the mould room staff will be present at all times. Fitting a mould may take more than one appointment
Customer Care Unit
The main reception of radiotherapy department is the customer care unit, where by all the patients going for radiotherapy have to be seen by customer care unit staffs. The unit consist of nurses who are trained internally on how to handle patients in a good manner, support and giving them direction about radiotherapy treatment.