Cancer Treatment (Oncology)

### Cancer is a devastating affliction, the frequency of which is gradually increasing all over the world. Although it differs according to the type of cancer and where it occurs, cancer may be cured if properly intervened at the right time. The correct treatment, aided by professionals and the right technology can provide critical life support to cancer patients.

#However, this situation also means cancer patients must go through a long and complicated process. Cancer patients receive the most significant support from medical institutions. Those institutions specialized in the treatment of cancer must have experienced and specialized personnel, a wealth of medical knowledge, devices manufactured with state of the art technology, modern medical methods and infrastructure systems that will allow coordination between specialists. Adopting this approach, ACIBADEM Healthcare Group has taken big steps towards cancer treatment.

## The Multidisciplinary Approach (For effective solutions in cancer treatment)

# The most effective solutions in the treatment of cancer are obtained using a multidisciplinary approach because oncology is an area that requires the collaboration and co-decision of many branches of science. The consultation of physicians in different branches is extremely important in the diagnosis and treatment of cancer and requires close teamwork. In multidisciplinary structures, specialists in different branches come together, reach a joint decision and share the responsibility. As a result, centers working under a multidisciplinary structure obtain more successful results in the treatment and follow-up of cancer that is in the field of oncology.

The diagnosis and treatment of all cancers is evaluated using a multidisciplinary approach in ACIBADEM Cancer Centers. The services offered in the centers include scanning programs for the early diagnosis of cancer, identifying people who are healthy but at risk of cancer and informing these people and their relatives about cancer prevention.

ACIBADEM Hospitals – serving cancer patients with world class technology.

ACIBADEM Healthcare Group has brought the latest technology to Turkey. With its highly developed technology, its technological devices and wealth of knowledge and experience, ACIBADEM Hospitals offers its patients state of the art technologies used worldwide on the diagnosis and treatment of cancer.

ACIBADEM Healthcare Group offers radiation oncology treatment in 8 hospitals. These hospitals are: Maslak, Atakent and Kozyatağı Hospitals in Istanbul, Bursa, Eskisehir, Bodrum, Adana and Kayseri Hospitals outside of Istanbul.

The Gamma Knife ICON device, used for the treatment of brain tumors, offers service in ACIBADEM Altunizade Hospital and the CyberKnife device, used for the treatment of tumors in the brain and in other parts of the body, offers service in ACIBADEM Maslak Hospital. In addition, cancer patients are treated with the first and only Rapidarc device, which reduces the treatment duration to 1-2 minutes, again at ACIBADEM Maslak Hospital.

Most Common Types of Cancer

Oral Cavity Cancers
Lung Cancer
Brain Tumor
Skin Cancer
Throat ( Larynx ) Cancer
Liver Cancer
Bone Tumors
Colon and Rectal Cancer
Lymphoma
Breast Cancer

Bladder Cancer
Stomach Cancer
Pancreatic Cancer
Pediatric Oncology & Hematology
Prostate Cancer
Endometrial ( Uterus ) Cancer
Cervical ( Cervix ) Cancer
Thyroid Cancer
Ovarian Cancer

Medical oncology is a branch of science which covers not only the treatment of cancer patients, but also cancer protection, cancer scanning and early diagnostic applications. In other words, every stage of cancer is a matter of medical oncology.

Moreover, in cancer diagnosis and treatment, there is cooperation between various fields such as surgery and radiology. The approach to patients is planned as a multidiscipline in line with scientific data. Treatment is performed by means of medication administered intravenously or orally. However, this practice varies depending on the type of cancer.
Treatment planning changes based on the cell type of cancer, the organ where it first appeared and the areas to which it has spread. Treatment is performed as an adjuvant treatment to reduce recurrence risk of the disorder, as a neo-adjuvant treatment to make the bulk available for operation or to protect the organs, or as a palliative treatment to extend lifetime in disorders at later stages and to increase life quality. Treatment can be performed individually or in combination with other therapies.

Methods Used In The Application Of Medical Oncology

Chemotherapy (Medicated Therapy): Chemotherapy aims to destroy cancerous cells that grow in an uncontrolled manner due to some changes in their structures. In most cases, the aim is to kill cancerous cells by administering several medications through different mechanisms. The most recent developments in this field are monitored with effective treatments applied at ACIBADEM Oncology Centers, in line with global standards.

Hormone Therapy: Hormonal drugs are used in the treatment of tumors that are sensitive to hormones, such as prostate and breast cancers. Drugs are generally administered orally. Another application method is injection.

Immunotherapy (Treatment of the Immune System): Substances that the immune system naturally produces are used to identify and kill cancerous cells by alerting the body’s immune system.

Target-Driven Biological Therapy: One of the most important developments of the last decade in cancer treatment has been the development of highly effective biological therapies with relatively few side effects and which identify targets that are present in cancerous cells but not in normal cells. Such target-driven therapies established for cancer treatment are effective options for many types of cancer and are successfully implemented in many cancer types, especially in breast cancer, intestinal cancer and renal cancer.

Radiation oncology is the discipline that examines, through the use of ionizing radiation, the effects of radiation on the cancer, the behavior of tumors and also covers research in this field. Radiation oncology has two areas of application: Radiotherapy and Radiosurgery.

Radiotherapy (X-Ray Therapy)

Radiotherapy is defined as the treatment of the cancerous tissue or of some non-malignant tumors with radiation. It is also colloquially referred to as “radiation therapy” or “x-ray therapy”. The beams used in radiotherapy aim to stop cancerous cells from growing or to kill them. Radiotherapy is applied frequently in the treatment of cancer. As such, after being diagnosed with cancer, 60-80 % of cancer patients need at least one dose of radiotherapy.

Treatment Devices Used in the Application of Radiation Oncology:

Rapidarc

Rapidarc is a high-tech radiotherapy device that reduces the amount of time patients have to undergo radiation therapy. It provides greater comfort and ease for the patient by reducing the length of radiotherapy sessions from 15-30 minutes to as little as 2 minutes.

Trilogy

Trilogy is a type of linear accelerator, or in other words a LINAC device, used in radio therapy treatment. The Trilogy device unites the various features found in other devices, allowing accurate intervention by specialists in the shortest amount of time and to an ideal proportion. This means the patient receives the most accurate treatment in the shortest amount of time.

Brachytherapy

Brachytherapy is a method used to raise local control of the disorder by increasing the dose of radiation applied to the tumor before and after external radiotherapy. However, it may also be used on its own for curative purposes in patients whose situation is suitable for such treatment.
In brachytherapy, radioactive sources are placed in the tumor and target tissues with unique methods, thus limitation of dose around sources is provided.

Techniques Used in the Application of Radiation Oncology:

IGRT : Image Guided Radiation Therapy
IMRT : Intensity Modulated Radiation Therapy
Conformal Radiotherapy : 3D Conformal Radiotherapy
SRT / SRS : Stereotactic Radiotherapy / Stereotactic Radiosurgery

Fields of Application for Radiotherapy

It is possible to separate radiotherapy in two main groups depending on the state of the disease:

Curative Radiotherapy:
In light of available information about the disease, it is applied in cases where the disease can be completely treated. It can be applied alone or with surgery and/or chemotherapy.

Palliative Radiotherapy:

Applied in cases where it is impossible to completely destroy the disease. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. For instance, bone pain suffered by a patient can be reduced by radiotherapy. Blood loss can be brought under control with radiotherapy applied on hemorrhagic tumors. The radiation dose given in this type of radiotherapy is lesser than the dose given in curative radiotherapy. The treatment duration is also shorter.

Radiosurgery (Scalpel-Free and Bloodless Surgical Treatment Using Beams)

The fundamental aim in radiosurgery, one of the fields of application of radiation oncology, is to direct many low-energy beams to the diseased area, and by focusing on the diseased point, to direct high-energy beams only to this point.

The aim is to shrink or kill the cancerous cells with intense beams while the surrounding healthy tissues are protected from the harmful effects of radiation.

Techniques Used in the Application of Radiation Oncology

SRS / SRT:
Stereotactic Radiosurgery (SRS), which can be explained as the treatment of a specific target by means of coordinates, refers to the complete destruction of the tumor in one single session through high doses of radiation after 3-D coordinates of the target are determined. When this therapy is applied in more than one session (generally 3-5 session), it is named as Stereotactic Radiotherapy (SRT).

MRIdian® Linac is the world’s first radiotherapy device, with an integratedonboard MRI, for image guidance. This device can provide continuous and real time based imaging before and during the treatment.

What is Viewray? MRIDian® is the world’s first MRI-Guided Radiation Therapy System that can image and treat cancer patients simultaneously. It’s a radiotherapy solution that integrates a Linac with MRI technology in a compact design, together with software to locate, target and track the position and shape of tumors while radiation is delivered.

Viewray Process

As conventionel radiotherapy, patient is placed on table. MRI is performed for targeted tissues. Tumoral region and surrounding healty tissues can be detected and visualized clearly with the aid of MRI. If targeted tissues and surrounding hey tissues are radiated with precise dose then treatment begins. Real time based imaging helps physicians to control the treatment process during irradiation. In case of detecting a clinical important movement of targets or healty tissues, physicians recontours the patient target and critical structures and re-plan the new treatment while patients are on treatment couch.

What are the differencess between MRIdian Linac and the conventional Linac-based treatments? Integrated MRI system provide the continuous and real time based imaging. Precise soft tissue imaging Less radiation to surrounding healthy tissues Fast online adaptive treatment planning Enables high dose and precise irradiation Less treatment session Avoidance 4of invasive and costly markers, tissue expanders What are the advantages of Viewray Viewray is the newset technology that combines Linac and MRI in the same device. The advantages of Viewray treatment are as follows:

Improves tumor visibility and patient alignment, tracks tumors and manages tumor and normal organ motions. Provides real time – on table adaptive radiotherapy planning Accurately records delivered radiation dose Enables continuous and real time soft tissue imaging during the treatment Provides recording video during the treatment and enables to see all treatment process and progress

Which Diseases Can be Treated With Viewray? Breast, Periaortic LN, Lung, Kidney, Bladder, Pelvic LN, Head/Neck, Bile Duct, Stomach, Cervix, Adrenal Gland, Orbit, Bone, Spleen, GYN Pelvis, Thorax, Aortic Arch, Pancreas, Heart, Prostate, Mesenteric, Abdomen (Soft tissue), Neck LN, Rectum, Parotid Gland, Pelvis, Spine, Esophagus, Thyroid, Colon, Liver, Extremity, Mediastinal LN, Pelvis, Soft Tissue Pelvis, Superclav, Brain, Uterus, Flank, Gall Bladder, Lingual LN, NAsopharynx, Ovaries, Rib, Thymus.

Facilities equipped with the technology: Acıbadem Maslak Hospital

Robotic Radiosurgery System

CyberKnife® Robotic Radiosurgery System

WHAT IS CYBERKNIFE

CyberKnife® system is a non-invasive radiosurgery device for treatment of tumors where radiotherapy is indicated.

It’s a robotic radiosurgery system that can treat with highly sensitive precision, even to within a millimeter. With this system cancerous region in the brain or in the body can be treated with high doses by using radiation beams focally. In this procedure the healthy tissues can be protected at maximum levels against side effects of radiation.

DEVICE FEATURES

CyberKnife® is constituted of a linear accelerator producing x-rays, which is placed on a 6-joint industrial robot. The device using computer controlled robot technology turns around the patient and performs the treatment by applying radiation from hundreds of angles.

Differently from standard stereotactic radiosurgery methods, CyberKnife® determines the precise location of the target with its imaging system and radiates precisely by combining the guidance system with computer-controlled robot system.

CyberKnife® offers safe and millimetric radiotherapy with robotic radiosurgery.

INDICATIONS

The tumors of any size in the brain and head-neck area can be treated with CyberKnife®. It can be used in the treatment of malign and benign brain tumors and metastases. CyberKnife® can be used to treat conditions throughout the body, including tumors of the prostate, lung, brain, spine, head and neck, liver, pancreas, kidney, and certain gynecologic indications, arteriovenous malformations and some functional diseases. Liver and lung cancers in which the tumor is moved with respiration can be safely treated with CyberKnife®.

CyberKnife® system can deliver a maximum dose of radiation directly to the tumor with maximum precision while minimizing radiation exposure of healthy tissues.

ADVANTAGES

CyberKnife® is an alternative method to surgery, there is no surgical operation needed. It provides patients with an a highly precise treatment alternative for the treatment of the tumors that require a complicated operation or are inoperable. While CyberKnife® is able to treat the cancerous areas in the brain or body, especially those that are not easy to reach with high doses, by using radiation beams focally, it is also a stereotactic surgery (SRS) device which provides maximum protection for the healthy tissues.

CyberKnife® offers a short treatment option with only 1-5 sessions. It’s a painless therapy; no anesthesia is required for the therapy. It can treat multiple tumors simultaneously. By real-time monitoring of patient movements, spontaneous changes that occur during the therapy can be identified and fixed. That multiple tumors can be treated simultaneously is another advantage of CyberKnife®.

TREATMENT PROCESS

During the treatment with CyberKnife® a water-soluble plastic mask will be placed on the face of the patient. The mask and special beds are used instead of the methods used to immobilize the head or the body. The patient rests on a robot-controlled bed that can move on six directions. The image capture system of CyberKnife® determines and monitors the location of the tumor and changes the patient’s position if necessary. The patient doesn’t have to hold the breath and can breath normally during the treatment. The patient does not feel anything during treatment and its acute side effects are almost none. The system compares computed tomography (CT) or magnetic resonance (MR) images of the patient taken before the therapy with the spontaneous images during the treatment. Radiation dose is adjusted after the determination of tumor coordinates.

CyberKnife® system in Acıbadem is equipped with an iris collimator which dramatically reduces the treatment period. This system is technologically most advanced form of the similar devices.

Gamma Knife Icon is the sixth generation of the Leksell Gamma Knife technology, which has involved over more than 60 years. It is the most accurate, most flexible and the safest of the Leksell Gamma Knife family.

What is Gamma Knife? Gamma knife is a one of the stereotactic intracranial radiosurgery technique that treating the brain tumors and other brain abnormalities as part of radiation therapy. In gamma knife radiosurgery, the targeted tissues receive a very high dose of radiation in a single session, while the adjacent brain tissues are exposed only to a negligible dose of radiation. The aim of this procedure is to stop the growth of the tumor.

The Gamma Knife Process Treatment is planned according to the specific needs of individual patients and this customized process is very easy, fast, reliable, safe, and straightforward. The computer software of Gamma Knife reduces the treatment plan to a list of simple instructions to guide the gamma rays to the target.

The treatment begins by fitting the stereotactic frame to the patient’s head. This is easily done within minutes and requires only local anesthesia. Once the frame has been fitted, an imaging procedure suitable for the patient’s pathology (i.e. MRI, CT, angiography) is performed. These studies create a very detailed and precise map of the brain. Then the treatment is planned with exact precision using a special computerized planning program. The treatment is fitted to cover the target with an accuracy of less than a millimeter, while protecting the surrounding brain and nerve tissues with exquisite safety. Then the treatment is administered usually over a period of 30 minutes to one and a half hours. These treatment times are longer for only a very few medical conditions. While the treatment is administered, the patient peacefully rests on the treatment couch and listens to music. Following treatment, the frame is removed and most patients are discharged from hospital on the same day. There is no need to return to hospital again after Gamma Knife procedures unlike most other surgical procedures. The patients continue with their routine life the way they did one day before the procedure.

What are the differencess between Gamma Knife Icon and Gamma Knife Perfexion? In the Icon version, patient could be treated with frame or with frameless (mask). Integrated stereotactic cone-beam CT helps physicians to determine the stereotactic coordinates in 3D. Patient could be treated in single session or more fractions. Icon is the most sensitive radiosurgery device comparing with the other radiosurgery devices. What are the advantages of Gamma Knife treatment? Gamma Knife is a painless and bloodless treatment method for brain tumors and other brain abnormalities. The advantages of Gamma Knife treatment are as follows:

It can eliminate the need for open surgery for many types of brain tumors. It does not require general anesthesia It does not require going to operating theatre. There are no incisions on the scalp or head. Normal brain tissues are exposed to very little radiation. Hair does not have to be cut and does not fall out. Patients return to their homes or work on the day of treatment. There is no recovery period. Which Diseases Can Be Treated with Gamma Knife? Patients with benign brain tumors:

Vestibular schwannomas (formerly known as acoustic neuromas) Meningiomas Pituitary adenomas Skull base tumors Chordomas All other intracranial schwannomas Glomus jugulare tumors Craniopharyngiomas Hemangioblastomas Tumors of the pineal region Patients with blood vessel anomalies:

Arteriovenous malformation ( AVM) Cerebral cavernous malformations Cavernomas Dural arteriovenous fistulas Patients with malignant tumors:

Malignant melanoma Uveal melanoma Certain glial tumors Hemangiopericytoma Nasopharyngeal carcinomas Patients with functional diseases:

Trigeminal nuralgia Patients with movement disorders:

Tremor associated with Parkinson’s disease. Patients who refuse open surgery

Patients unable to tolerate surgical procedures for reasons such as age or associated medical conditions. Facilities Equipped with the Technology: Acıbadem Altunizade Hospital

The era of single-dose radiotherapy during surgery begins… What is Single-Dose Radiation Therapy? In patients with breast cancer, radiation therapy can be completed with a single-dose application done using the Intra Operative Radiotherapy (IORT) method during surgery. Once the tumor in the breast is removed in an operation, the special applicator in the tool is placed in the tumor area. Following the necessary calculations, high-dose radiation is given only to this area, completing all local treatments and protecting healthy tissue.

How is Traditional Radiotherapy Applied? Radiation therapy is carried out with “linear accelerators” that produce photons and electrons, in specially protected rooms in hospitals’ Radiation Oncology departments. In almost all cases that have been diagnosed with breast cancer and treated with “protective surgery” (in which only the portion of the breast with the tumor is removed and the rest of the breast is left intact), radiotherapy is needed following the operation.

single-dose-app1Radiotherapy begins preferably after chemotherapy in patients who require it or at least 3 weeks after surgery in patients who are only treated with hormone therapy. In patients who’ll receive radiotherapy for the breast, tomography cross-sections with 2-mm increments are first taken using a computer for planning purposes. Later, arrangements are made to apply the necessary dose to the areas under risk in the breast that’ll receive radiotherapy while protecting the healthy organs (the heart, main arteries of the heart, lungs, other breast, etc. where the illness hasn’t spread). Once the plan is approved, the patient receives radiation treatment for 5 to 7 weeks, dependent on the condition of the illness and determined by the radiation oncology doctor. Other patients still receive a short-term treatment called hypofraction, which lasts 3 weeks.

Advantages of Single-Dose Application single-dose-app2 The single-dose application done with the Intraoperative Radiation Therapy (IORT) tool utilizes a linear accelerator in very much the same way that traditional radiotherapy does. This method is used in an operating room using a safe and portable tool that operates in a linear and accelerated manner, only producing electron energy but not requiring too much protection for the personnel like traditional linear accelerators do. In addition to the surgical team carrying out the operation, a radiation oncology specialist and a medical physicist are also present in the operating room. This way, radiotherapy is completed at the same time as the surgery. A significant advantage for the patient is that there is no need to wait for the wound to heal following surgery, or to plan radiotherapy and visit the hospital each day for treatment. This way, the total duration of the treatment is also cut down.

During the operation, once the tumor in the breast is removed, the special applicator within the tool is placed in the area where the tumor is. Following necessary calculations, the high-dose radiation is given only to this area, completely protecting healthy tissue. Although single-dose application or using different methods to apply radiation only to the tumor area as opposed to the entire breast are methods that have become more globally accepted in recent years, single-dose application isn’t for every patient. The decision whether a patient is suited to receive this treatment must be made collectively by the radiation oncologist, the surgeon and the pathologist dealing directly with the patient. The patient’s age, the size of the tumor and other pathological qualities of the tumor play an important role in this decision.

Who Receives the Radiation Boost? single-dose-app3 Patients under the age of 50-60 are not considered to be ideal candidates for single-dose application. In these patients, it is necessary to apply radiation to the tumor area following radiation application to the entire breast in the traditional method. Once the treatment of the entire breast area is completed within 25 to 28 work days, excluding weekends, instead of the entire breast, only the area where the tumor was removed is treated with radiation, which takes around 5 to 8 work days depending on the patient and the patient’s circumstances. Applying radiation to the area with the tumor is called a radiation boost. Thanks to the IORT method, the radiation boost is delivered as a single dose during the operation, after which the entire breast is subjected to radiation and the total treatment duration is cut down.

Applying Radiotherapy to the Nipple Complex Breast-protective surgical treatment may not be suitable for some patients. In patients where the entire breast needs to be removed, the nipple and its surrounding area are left intact for a better cosmetic result. This is called nipple-sparing mastectomy. A single dose of radiation is applied to the nipple and the tissue right underneath using the IORT method to lower the risk of recurrence here. The radiation boost is offered for the first time in Turkey at ACIBADEM Maslak Hospital Breast Health Center.

TRUEBEAM® RADIOTHERAPY SYSTEM

High-Precision Radiotherapy Treatment

TrueBeam® Radiotherapy System

WHAT IS TRUEBEAM

TrueBeam® is an advanced radiotherapy system combining advanced treatment options, such as image-guided radiation therapy (IGRT), stereotactic radiosurgery (SRS), stereotactic body radiation therapy (SBRT), intensity-modulated radiotherapy (IMRT), RapidArc (a volume based intensity adjustable treatment that shortens the patient’s treatment period) and Gated RT in a single device.

Integrating respiratory gating, real-time tracking, imaging and treatment in a streamlined system, the TrueBeam® can deliver more powerful cancer treatments with accuracy and precision.

From fast imaging to accurate dose delivery, TrueBeam® helps clinicians navigate the complexities of cancer care with confidence.

DEVICE FEATURES

TrueBeam® can deliver any type of radiation, and it also can shape radiation according to the tumor structure, with IMRT and IGRT techniques as well as RapidArc and radiosurgery methods with the most sensitive imaging and application abilities.

Radiosurgery involves application of a dose that is as effective as a knife while minimizing the damage to the area surrounding application and destroying the target completely. The SRS technique, which focuses on a target in three dimensions with a high dose and is therefore able to achieve the same results as removing the target with surgery, can also be done with TrueBeam® STx. The SBRT technique in which tumors with a small volume in any part of the body are safely treated in fewer sessions (3-5) is also possible with this device.

INDICATIONS

All tumors that require radiotherapy can be treated safely with TrueBeam®.

TrueBeam® offers new possibilities for the treatment of cancer of the lung, breast, stomach, liver, prostate, brain, head and neck. Bone tumors and soft tissue sarcomas in any part of the body can also be treated with radiotherapy via TrueBeam®.

It is especially useful for tumors located in the head and small volume tumors in the body and next to risky organs. It provides a suitable method for treating lung and spinal tumors and for second series radiation therapy.

ADVANTAGES

TrueBeam® is a system to treat cancer with speed and accuracy while avoiding healthy tissues and organs. The most important feature of TrueBeam® is that it can provide faster, safer and more effective treatment. The carefully guided, automated workflow on the TrueBeam® system uses precise visual cues to enhance safety and reduce treatment period.

TrueBeam® makes it possible for radiotherapy to be applied to cancerous tumors without harming the surrounding tissues.

With TrueBeam® it’s possible to treat the tumor with a high dose in a very short time, while monitoring and compensating for tumor motion. The radiation therapy period that is reduced increases the accuracy of the treatment and the comfort of the patient. A conventional intensity-modulated treatment would typically take 10 minutes; with TrueBeam® it takes less than two minutes. Complex radiosurgery typically takes 40 minutes to an hour; but it can be completed in 5-20 minutes using TrueBeam®. And with TrueBeam® the added radiation given to patients is 25% less than other imaging systems.

Streamlined imaging and patient positioning tools enable more flexibility to treat clinical cases throughout the body. Mechanical accuracy being under a millimeter is vital in terms of focusing rays on the target accurately. This is what makes it possible for the treatment of the patient to be done according to plan.

The image quality of TrueBeam® is very high. Thus radiologists are able to see small details better.

The power to not only treat quickly, but to deliver high, accurate dose rates are hallmarks of the TrueBeam® system.

TREATMENT PROCESS

TrueBeam® has been designed with patient comfort in mind. It rotates around the body of the patient to deliver radiation therapy from nearly any angle. It is quiet during operation and has communication technology that enables interaction between the patient and the clinicians operating the equipment. Most treatments take just a few minutes a day, which means less time on the treatment couch and reduced motion during treatment.

TrueBeam® device has been used in Acıbadem with great succes in cancer treatment for the last few years.

Application Fields of Surgical Treatment

Curative surgery is also applied within the scope of surgical oncology. However, the preliminary condition for applying curative surgery is that the disorder is limited to the organ or lymph nodes where it first appeared. In these patients, no remote metastasis should be present and, pathologically, no tumors must be present in the cross section obtained through surgical resection.

Tumors may be completely removed from patients, provided that their boundaries are well determined. However, there are cases where the tumor cannot be completely removed. In such cases, debulking surgery may be applied to minimize the bulk. Moreover, removal of metastases which are low in number improves the patient’s chances of a sound recovery.

Robotic Surgery with “da Vinci”

Laparoscopic operations that are performed with “da Vinci” surgical robot are defined as Robotic Surgery. These operations provide a great deal of advantages to the patient. In addition to the common advantages of all laparoscopic operations such as less pain, minimized scars on the skin, shorter stay in the hospital; there occurs less bleeding and the success rate of the operation is higher. “da Vinci” robotic surgery is performed especially in these major areas; Gynecology, Gynecologic Oncology, Urology, Cardiac and Vascular Surgery, General Surgery and Ear-Nose-Throat surgery.

Radiological Diagnostic Methods (The First Step Towards Accurate Treatment)

Accurate radiological diagnosis is an essential part of deciding how treatment should be performed. Modern techniques and advanced technology are of paramount importance when performing radiological diagnosis, as well as an experienced radiology staff.

Accurate radiological diagnosis is crucial in deciding whether the cancer needs treatment or not. As well as qualified radiology staff, it is essential that techniques applied with advanced technology are used in accurate diagnosis. ACIBADEM Healthcare Group, working according to this principle and closely following developments in medical science, is constantly changing its diagnostic equipment in all ACIBADEM hospitals and outpatient centers with new high-tech equipment. ACIBADEM Hospitals Group offers diagnosis and treatment services to patients using latest technology equipment, and radiology specialists work together with well-trained and experienced radiology technicians and nurses.

Cutting-Edge Technology in Diagnostics:

PET/CT

For rapid and reliable diagnosis

The PET/CT device is used to identify tumors in their early stages, particularly for cancer treatment, and to determine whether these tumors are malign or benign. The device is also used in the diagnosis and treatment of neurological and cardiological disorders.

Pet/CT In Early Diagnosis

PET/CT offers many significant advantages in early diagnosis. It offers the opportunity to identify many disorders at the beginning phase. In pre-PET/CT periods, it was determined only by biopsy whether nodules in the body are cancerous or not, whereas now it is determined at a high rate of precision with PET/CT.

In PET/CT imaging, it is possible to visualize tumors as small as 5 mm in diameter, as information taken from the patient’s body images is obtained through advanced computer systems. PET/CT, by taking advantage of increased glucose metabolism, a feature of cancerous cells, facilitates establishment of fast and reliable diagnosis without taking any samples.

PET/CT In Metastasis

PET/CT also offers a significant advantage for the determination of whether the disease spread to adjacent tissues or lymph nodes in many cancer types, i.e. whether there is metastasis or not. Since the entire body is visualized at the same time thanks to the images taken via PET/CT, it is also possible to evaluate whether the cancer has spread to another organ. Thus, PET/CT is highly advantageous in determining, for instance, whether a tumor in the lung has spread to other internal organs, the adrenal glands or the lymph nodes (whether there is metastasis or not), in other words for determining the extensity of the disorder which is known as staging.

PET/CT Is Performed At 6 ACIBADEM Hospitals

ACIBADEM Maslak ACIBADEM Kozyatağı ACIBADEM Kadıköy, International Hospital ACIBADEM , Adana ACIBADEM , Bursa ACIBADEM Kocaeli.

An imaging technology which is only used at ACIBADEM Kozyatağı Hospital in Turkey, Intraoperative MR facilitates the complete removal of the tumor by providing images during brain surgery. It thus eliminates the risk of a second operation that would be required, due to tumor residues.

Advantages of 3-Tesla MRI:

Generates more robust information than low-Tesla systems

The 3-Tesla MRI device generates faster data with higher resolution during and after the operation, and provides physicians with more reliable information than that obtained from low-Tesla MRI systems. The device achieves this thanks to its strong magnetic field. By generating a magnetic field twice as strong as the magnetic field of the 1.5-Tesla MRI device, which had been used previously, it receives more signals from tissues.

Works more rapidly

The 3-Tesla MRI device works much quicker than other devices. This is especially important during brain surgery. The system allows the surgeon to take images during the operation at any required moment without waking the patient and without closing the surgical area. In particular, it addresses surgeons’ concerns about obtaining correct information on the size and direction of the tumor if it is in a place difficult to reach. The chances of operational success improve as images may be evaluated during the operation.

Eliminates the risk of a second operation

Various risks may arise in operations in which intraoperative MRI is not used. In these operations, residues cannot be identified due to the fact that they are so small that they cannot be seen with a microscope, or they are of the same color as the brain tissue. As such, there is a 30-40% probability of residues being left over in brain tumor operations. The patient is taken into intensive care after the operation. Whether or not residues are present may be determined based on MRI images taken 24 hours after the period of intensive care. In the event that any residues are identified in the MRI, a second operation will take place. Here, thanks to its intraoperative feature a second operation is not required as residues may be fully identified and removed during the operation.

Zero probability of residues

Thanks to the 3-Tesla MRI device, there is no chance of residues being left in the brain after the operation. All residues that may be omitted are identified with the images the device takes. Thus, the surgeon has reliable information when it comes to removing these residues as well. One of the worst results of leaving residues is that the tumor may grow again from these residues. The growing tumor may compromise the patient’s quality of life or even threaten the patient’s life again. Another satisfactory result of the complete removal of the tumor is that it further delays the recurrence of malign brain tumors.

Accurate identification of operation area

Operation-related side effects are eliminated.

A mammography device which delivers excellent two- and three-dimensional image quality at the lowest required dose. With its two dimensional and multi slice three dimensional tomosynthetic imaging capacity, it offers groundbreaking possibilities in the early diagnosis of cancer.