A Dedicated Multi-Disciplinary Team

Board certified medical oncologists lead the cancer care team, working with leading radiation oncologists, surgeons, radiologists and pathologists to develop and provide treatment plans with a compassionate approach to managing their patients' care.

When a diagnosis of cancer is suspected or confirmed, the patient and family are met with a bewildering, complex system of new terminology and specialists. The following is a list of cancer specialists whose services you are likely to require during your treatment:

Radiologist Oncologist - A physician trained in the administration of radiation therapy and providing highly individualized treatment programs with custom set-up, computerized treatment planning and state-of-the-art equipment.

Radiologist - A physician with advanced training in the interpretation of imaging studies, such as X-rays, CT scans, ultrasound, MRI and PET scans. The radiologist also uses imaging techniques to perform biopsies if a tumor is suspected.

Interventional Radiologist - A specially trained physician who uses X-rays, ultrasound or other imaging techniques for the diagnosis and treatment of disease. They guide small tubes called catheters and miniature tools directly to the site of the disease for diagnosing cancer without surgical biopsy, and for treatment.

Pathologist - A physician with advanced training in the evaluation of tissue samples. Biopsy specimens are evaluated under a microscope and may be tested with a variety of substances to determine the exact nature of the disease. Critical decisions regarding diagnosis, type of tumor and behavior of malignant tissue depend on this person's expertise.

Surgical Oncologist - A physician with specialized training in the surgical management of tumors. The primary treatment for many types of cancer is surgical removal. Surgical oncologists at Torrance Memorial are highly skilled at determining not only the type and extent of surgery that is optimal, but also the cosmetic outcome.

Medical Oncologist - A physician with advanced training in the medical management of patients who have cancer. The medical oncologist typically oversees the patient's care and treatment throughout the course of the disease and continues regular follow-up once the patient is cured or in remission. Types of treatments that may be used include chemotherapy, radiation therapy, hormonal therapy, therapy to stimulate the immune system and various treatments available through research protocols. The board certified medical oncologists at Torrance Memorial provide medical treatment with a compassionate approach, based on the most up-to-date medical research and tailored to meet the needs of each individual patient.

Plastic Surgeon/Reconstructive Surgeon - A physician specializing in surgery to rebuild the part of the body changed by cancer treatment. Often the specialist is a plastic surgeon who will share with you the surgical options available based on your body type, age and anticipated post-surgery treatment.

Oncology Nurse Practitioner - Through Torrance Memorial's Cancer Resource Center an oncology nurse practitioner helps patients sort through the complex terminology associated with cancer care. She provides helpful literature and connects patients and families with resources and support groups and will meet with patients to talk about their cancer diagnosis and care plan.

Nurse Navigator - Our Breast Health Navigator is an RN who is specially trained to provide breast health instruction and education on an individual basis and to community groups. The Breast Health Navigator assists patients diagnosed with breast disease to coordinate appointments, especially during the diagnostic process. She is available to answer questions about study findings, treatment options and side effects, and she serves as a liaison between patients, and various physician specialists as appropriate to ensure timely care.

A Broad Array of Physician Subspecialists

Because the South Bay is home to a select group of doctors affiliated with the Torrance Memorial Cancer Center, patients can receive care from specialists with particular expertise in cancer care. Torrance Memorial's medical staff includes board certified urologists, gastroenterologists, gynecologic oncologists, neurosurgeons, thoracic surgeons and general surgeons who perform simple to complex surgical procedures with sophisticated facilities and equipment.

If you need a referral to a medical or surgical oncologist, or any other type of physician, we can help. Our Physician Referral Service works with you to find the physician that's right for you. Our free Physician Referral Service includes vital statistics on hundreds of highly qualified doctors representing virtually every specialty and subspecialty. (The referral service is for information on physicians in California located in the South Bay Area.) And you can easily access this computerized information by accessing our on-line Email service or by calling 310/ 517-4700 between 8:30 a.m. and 4:30 p.m., Monday through Friday.

Collaboration On Care - Tumor Board

These physicians also participate in Torrance Memorial's Tumor Board, which meets weekly to provide a forum for treatment planning and consultation among surgeons, medical oncologists, radiation oncologists, diagnostic radiologists, pathologists and other cancer specialists in the community.

At the Tumor Board, physicians present cases, review the latest medical literature and research findings, and share recommendations for treatment. The American College of Surgeons' Commission on Cancer has recognized the Torrance Memorial Tumor Board Program as an excellent example of multidisciplinary cooperation that enhances patient care.

Compassionate Inpatient Care

Patients who are undergoing active cancer treatment, experiencing negative side effects from treatment or who are in an advanced stage of illness may need inpatient hospital care. Torrance Memorial's dedicated inpatient oncology and pallative care - the Lemkin Pavilion - unit is staffed by certified oncology nurses, specifically trained to control the symptoms related to cancer and treatment side effects. These professionals play a key role in providing comfort and support to patients and their loved ones. Torrance Memorial oncology unit nurses have completed Oncology Nursing Society training on the administration of chemotherapy and biotherapy agents for treatment of cancer. The nurses administer the latest anticancer medications safely and effectively. In addition, they provide education to the patient and loved ones about the treatment regime prescribed by the physician, possible side effects of therapy, and strategies to cope with these side effects. They also educate the patient and family about the disease process, treatments, procedures and care after leaving the hospital.

Other team members who may provide care on the oncology unit include dietitians familiar with the nutritional needs and eating difficulties of cancer patients. An enterostomal therapy nurse cares for patients who have abdominal stomas. Rehabilitation therapists assist in the patient's recovery with occupational, speech and physical therapy, as needed. The wound care team develops a treatment plan and implements the latest strategies to promote tissue recovery when healing has been delayed.

Services of the dietician, enterostomal therapy nurse, Rehab Department therapists and wound care team are available to both hospitalized patients and on an outpatient basis.

The Lemkin Pavilion

The Lemkin Pavilion, a 25-bed flexible medical/surgical, oncology and palliative care unit is dedicated in memory of the late oncologist Stephen R. Lemkin, M.D.

the $12-million project was funded in part through generous donors. In addition, the project received donations from medical staff including Torrance Radiology Group, Anesthesia Medical Group and Torrance Emergency Physicians giving in memoriam of Dr. Lemkin. Corporate contributions came from donors such as The Kenneth T. and Eileen L. Norris Foundation, American Honda Motor Co., Inc. and Comerica Bank.

The 25-bed Lemkin Pavilion offers many advantages including:

• Large private patient rooms decorated in pleasing colors and attractive furnishings
• Family waiting area with amenities and conveniences
• Private consultation room
• Registered murses certified in chemotherapy, Healthcare providers wear uniforms specific to their job responsibility
• Snacks, beverages, warm blankets and more provided to patient families

Oncology Nursing Society

http://www.ons.org

Surgery

Torrance Memorial's state-of-the-art surgery facilities and highly trained surgical team offer patients a wide array of surgical options, from the simplest procedures to the most sophisticated techniques that one would expect to find only at university-affiliated hospitals From pre-operative preparation through surgery and the recovery room, patients are carefully monitored so that the optimum in safety and comfort is assured. Our highly trained recovery room nurses make sure patients are optimally recovered so the patient is ready for transfer to an inpatient unit. For patients having day procedures, our nurses provide education regarding at-home care and pain management so the family is fully prepared to care for the patient at home.

Cutting Edge Care

Torrance Memorial offers the da Vinci® Surgical System, which has been successfully used in thousands of prostate cancer procedures and hysterectomies world-wide. Click here for more information: http://torrancememorial.org/da.vinci.prostatectomy_909.tmmc

Interventional Radiology

Interventional radiologists are specially trained physicians who use X-rays, ultrasound or other imaging techniques for the diagnosis and treatment of disease. They guide small tubes called catheters and miniature tools directly to the site of the disease for diagnosing cancer without surgical biopsy, and for treatment.

In some cases, new interventional radiology procedures can be used to deliver cancer-fighting therapy directly to the site of the tumor. Using moving X-ray pictures to guide them, interventional radiologists insert miniature devices into blood vessels or other body parts and guide them to the site of the cancer. Cancer-killing therapies such as chemotherapy, radiation, heat and cold, are then delivered to the tumor. Specific treatments include:

• Transcatheter chemoembolization is used for some patients with liver cancer or other types of cancer that have spread to the liver. The procedure directs treatment to a tumor through minimally-invasive means. An angiogram--a real-time X-ray that highlights where blood flows--is performed to help the interventional radiologist look at the tumor without the need for an open incision. Although the procedure is not a cure for liver cancer, studies have shown that 70 percent or more of patients experience improvement and, depending on the type of cancer, may live longer. Chemoembolization also may relieve pain and other symptoms, make patients more comfortable and improve the quality of their lives. Another advantage is that the procedure may be repeated multiple times.

• Tumor Ablation enables interventional radiologists to use heat, cold or substances such as alcohol to kill cancer cells by injecting them through catheters directly at the site of the tumor. One relatively new technique called radiofrequency ablation (RFA) has good results at controlling the spread of cancer in some patients.

  RFA typically treats cancers than cannot be removed by surgeons because of their size or location, or because the patient is not healthy enough to have open surgery. RFA is primarily used to treat cancer in the liver, but it is being studied for use in the kidney, adrenal glands, lung, bone and prostate.

  During the technique, an interventional radiologist locates the tumor through ultrasound and makes a small nick in the skin, in which a needle is inserted. Through the tip of the needle, the doctor extends several prongs into the tumor that allow the specialist to deliver a precise round ball of heat that "burns" the cancerous cells - destroying the tumor. The technique kills cancerous cells with little risk to adjacent normal structures. The dead tumor tissue shrinks and slowly forms a scar. Lasers and microwave energy are other techniques that are being studied to deliver heat to tumors.

• Vertebral Body Compression Fracture Treatment

  Certain conditions, including osteoporosis, cancer and long-term use of steroids or other drugs, can make your bones fragile and more likely to break. A spinal fracture (also called a vertebral compression fracture) occurs when one of the bones of the spinal column fractures or collapses. When more than one spinal fracture occurs, loss of height or spinal deformities such as a dowager's hump may result.

  If spinal fractures are not treated properly, they can cause serious medical consequences. These include chronic back pain and fatigue, reduced mobility or lung function, loss of balance and increased risk of falls and future fracture.

  Vertebral body compression fractures may be treated Vertebral body compression fractures may be treated with medications, surgically or with minimally invasive procedures known as vertebroplasty and kyphoplasty.

  Performed approximately 75,000 times a year in the United States, vertebroplasty is designed to reinforce the fractured bone, thus eliminating the debilitating pain suffered by patients with compression fractures. Vertebroplasty is performed by first inserting a special needle into the affected vertebrae under fluoroscopic (x-ray) guidance. When the needle tip is in position, a cement mixture is injected into the affected vertebral body. When sufficient amounts of the cement are injected into the damaged bone, the needle is removed and gentle pressure is applied over the puncture site. No stitches are required and the patient is left only with a band-aid. Almost all patients experience complete and immediate relief of the severe pain caused by the compression fracture.

  Kyphoplasty is also a minimally invasive procedure kyphoplasty is conducted by inserting a balloon into the crushed vertebra via needle under X-ray guidance, expanding the balloon to create a cavity or void space within the bone tissue, and then withdrawing the balloon and inserting in its place a cement-like substance which ultimately serves to stabilize the vertebra.

  Most patients undergo both of these procedures on an outpatient basis and are allowed to leave the hospital within a few hours of the procedure.

• Vertebral Body Tumors Treatment

  Depending on the type of tumor and the symptoms it is causing, different treatments can be used to treat vertebral body tumors. If there is collapse of the bone, vertebroplasty or kyphoplasty may be performed by inserting a needle through the skin into the bone using x-ray guidance and injecting cement to strengthen the bone. If the tumor causes pressure on nerves or the spinal cord, surgery may be considered. In the event that the tumor has a large blood supply, which can complicate surgery, endovascular techniques may be employed by inserting a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the mass. This procedure, called embolization, is usually performed within a few days of the impending surgery. If surgery is not recommended or possible, embolization may be performed to shrink the tumor.

Comprehensive Outpatient Care

Torrance Memorial also offers a full array of outpatient services. In the Short Stay unit, nurses provide care during chemotherapy infusions, blood transfusions and many other procedures. The radiation oncology department offers highly individualized treatment programs with custom set-up, computerized treatment planning, and state-of-the-art equipment. Our physicians and nurses pay close attention to symptom management throughout treatment. The entire staff is attuned to making each patient's experience as favorable as possible.

The Day Surgery Center accommodates cancer patients who have been scheduled for outpatient surgery. Our on-site Blood Donor Center allows patients, friends and family members to donate blood and receive information about our designated donor and autologous blood donor programs.

Palliative Care

Palliative care at Torrance Memorial is focused on providing relief from pain and symptoms that result from advancing illness. It is available to patients at any stage of a condition that cannot be cured, such as advanced cancer. The goal is to ensure patients have peace, dignity and relief of suffering in the face of debilitating illness.

The palliative care team consists of a physician skilled in treating pain, a palliative care nurse trained in understanding the needs of seriously ill patients and their families, and a social services professional who assists in meeting the social and emotional needs of those coping with a life-threatening illness. Other professionals, such as a pharmacist, chaplain and dietitian, are available as needed. For more information, click here: http://torrancememorial.org/palliative.care_677.tmmc

Leading the Way Through Clinical Research

We believe that being the leader in cancer care for the South Bay community means staying on the cutting edge of research and the latest treatment approaches. Through Torrance Memorial's Cancer Center, patients have access to clinical trials and treatment protocols, including the latest cancer-fighting medications. The Medical Center participates in private pharmaceutical research, as well as research studies sponsored by the National Cancer Institute (NCI). Torrance Memorial is proud to be a member of two NCI-supported clinical trials cooperative groups - the Radiation Therapy Oncology Group (RTOG) and, as a subsite of UCLA, the National Surgical Breast and Bowel Project (NSABP). These types of affiliations provide residents of the South Bay convenient access to the latest clinical trials.

Working with the Vasek Polak Institute, the Cancer Center participates in high quality clinical and health services research with the Vasek Polak Research Program. The Vasek Polak Research Program serves the public interest by:

• Developing and conducting meaningful clinical and health care services research aimed at improving the health and/or quality of life of members of the community.
• Providing administrative and technical support to investigators as they identify and develop research proposals.
• Assisting researchers to find the clinical resources and funding necessary for proposed studies.
• Educating the community regarding the research findings, and whenever possible working with the community to implement changes based on new information.

Participation in clinical trials is purely voluntary and may benefit the patient as well as others who eventually face the same disease.

While many trials focus on curing cancer, some investigate ways to better manage cancer pain and improve the quality of life for cancer patients. Patients do not have to travel to hospitals outside the community to participate in clinical trials. They have the opportunity to take part in nationwide studies in their own backyard, as well as an extensive network of support services at Torrance Memorial.

Although great strides have been made in the treatment of cancer, we still have far to go in finding the cause - and ultimately the cure - for cancer. Research is an essential ingredient in this quest. Click here to see current cancer research and clinical trials

Radiation Oncology

Radiation therapy is used to treat many kinds of cancer. Approximately half of all cancer patients will benefit from radiation therapy at some point during their care. Radiation therapy uses high energy X-rays to treat cancer. Treatments are given in a very precise manner so that the radiation beam is directed to the cancerous tissue only, limiting the amount of radiation delivered to the surrounding tissue.

Torrance Memorial has the latest in radiation technology, coupled with sophisticated planning and imaging equipment, to develop an individualized treatment plan and pinpoint the most effective location and dosage. Specific treatments include:

• Intensity modulated radiation therapy (IMRT) - A highly advanced technique regarded as the "gold standard" in radiation treatment, IMRT delivers high doses of radiation to tumors while substantially reducing the risk to normal tissue. IMRT is a form of three-dimensional conformal radiation therapy and one of the most precise and sophisticated treatment techniques currently available. This relatively new technology is used effectively to treat prostate cancer and cancers of the head and neck.
• ACCULOC image-guided patient localization system -The higher doses and tighter margins associated with IMRT require highly accurate tumor localization. ACCULOC-- an image-guided patient localization system--provides high-precision delivery for every IMRT dose.
• 3-D Conformal Radiation Therapy - 3-D conformal radiation therapy uses CT based treatment planning with three dimensional rendering of the tumor and surrounding structures. This allows for very precise delivery of radiation doses and better avoidance of normal tissues. This technique can be applied to prostate cancer limited to the prostate gland, as well as other localized cancers.
• Conventional External Beam Radiation Therapy - This radiation therapy technique uses a medical linear accelerator to deliver radiation treatments to somewhat larger treatment areas. CT based treatment planning is often used and every effort is made to exclude as much of the normal tissues from the treatment area as possible.
• Intracavitary Therapy - Intracavitary therapy is a form of internal radiation therapy. It is often used for cervical or uterine cancer. It involves the placement of a special intrauterine or intravaginal applicator under anesthesia. This applicator then holds the radiation sources for delivering treatment. This type of internal treatment allows the placement of the radiation close to the tumor so that higher doses of radiation can be given.
• Brachytherapy - Interstitial therapy is another form of internal radiation therapy. It involves the placement of radioactive sources (seeds) directly into involved tissues. Interstitial therapy has been successfully used to treat prostate cancer and other cancers. We have used prostate seed implants at Torrance Memorial Medical Center for over eight years.

To better pinpoint a tumor's volume and surrounding structures, the hospital offers the capability to merge a patient's CT, MR and PET images. This allows for a more accurate dose delivery.

For more information, log onto: http://torrancememorial.org/radiationonc.htm

Rehabilitation

The hospital's Rehabilitation Department staff members play an active role in cancer patients' recovery. Licensed specialists in speech, physical and occupational therapy are available for rehabilitation and exercise planning during and after cancer treatment. Therapists can provide exercises for strengthening, stretching and balance improvement after chemotherapy or radiation therapy. Range of motion can also be improved through therapy. Speech pathologists can assist patients with swallowing or communication difficulties. Wound care is provided for patients with sores that will not heal.

A comprehensive Lymphedema program is available for patients requiring preventive education and assistance with limb swelling problems. Lymphedema can be congenital, or occur as a result of injury, cancer, other disease, or treatment. Our therapists are certified by the Lymphology Association of North America and provide the latest techniques to alleviate swelling and dysfunction. Comprehensive education also enables patients to manage lymphedema at home.

Cancer Survival Rates

Five-year survival rates for patients with breast, prostate and colorectal cancers treated at Torrance Memorial compares favorably with National Cancer Data Base (NCDB) 5-year survival statistics for these tumor types.1"

1Source: NCDB, Commission on Cancer, ACoS/ACS Survival Reports.

Survivorship Program

Cancer Survivorship Program - a partner of UCLA-LIVESTRONG™ Survivorship Center of Excellence

The Torrance Memorial Medical Center Cancer Program, in partnership with UCLA-LIVESTRONG™ Survivorship Center of Excellence, presents a comprehensive resource program for cancer survivors.

The National Cancer Institute estimates that as of January 2004 there were 10.8 million cancer survivors in the U.S. This number is expected to steadily grow.

To each person with a history of cancer surviving has a unique and very personal meaning. Surviving cancer can be a mixed bag of blessings, questions and uncertainty. "Where have I been?" and "Where am I going?" are very common questions. Surviving can be a reason for celebration and a reason to move forward.

Survivors include family caregivers, friends and relatives alike who have been touched by loved ones surviving cancer.

To help cancer survivors in our community along this journey Torrance Memorial provides follow up care at the completion of the active phase of treatment.

Working in concert with the entire medical team is one component of the transition to survivorship. Attaining information from medical professionals about tests and treatments in planning for the future can be challenging. Navigating the healthcare system to gather information is one way the Cancer Survivorship Program can be of help.

Out goal is to help you successfully embark on your future.

Contact the Torrance Memorial Cancer Survivorship Program by calling 310-517-4665 or by e-mailing us at CancerSurvivor@tmmc.com

SUPPORT Torrance Memorial Healthcare Professionals/Loved Ones/ Community Resources/Torrance Memorial Cancer Resource Center
DIAGNOSIS Imaging Biopsy Pathology Clinical Examination	TREATMENT Torrance Memorial Medical Center Physicians and Office Staff Surgery Medical Oncology Radiation Oncology	SURVIVORSHIP Cancer Survivorship Program R.N. Follow-up Plan Resource Program

What is the Torrance Memorial Cancer Survivorship Progam?

An integral part of the Torrance Memorial Medical Center Cancer Resource Center, your survivorship program can include:

• Completion of an individualized cancer treatment summary and follow up plan of care together with a list of your physicians and possible tests for ongoing monitoring
• Copies of the National Cancer Institute's brochure Facing Forward: Life After Cancer Treatment, The Lance Armstrong Foundation's brochure, The Road to Survivorship and a medication record for your use
• Your survivor wellness plan agreed on by you and developed through assessment of you current status of well-being. This personalized plan can include written and web-based resources which will address areas of concern for you
• Navigation services to appropriate resources and care providers to assist recovery and survivorship. Connection within the community to support groups, exercise programs and volunteer opportunities
• Advanced notification of survivorship functions, such as education programs and guest lectures
• An experienced oncology nurse to answer your questions and help you transition beyond your diagnosis