Oncology and Nuclear Medicine
Oncology and Nuclear Surgery in Turkey
Today, Turkey is a leader country in medical tourism for international patients who seek oncological treatment. Oncology and nuclear medicine treatment in Turkey is definitely the main focus of medical tourism also. Due to modern technologies, it possible to conduct painless and safe surgical interventions to eliminate tumors of various sizes and classes and to carry out effective treatment of cancer. All treatment methods are carried out in accordance with inter-national standards (NCCN – in the USA, ESMO – in Europe).
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Why Get Oncology Treatment in Turkey?
The prices oncology treatments are %50 - %80 lower than in the USA or Europe, but the quality is at the same level. The low cost is explained by general price policy in the country oriented on the local citizens’ income.
Turkey is convenient to reach for patients from all over Europe with less than four flying hours.
Turkey has a lot to offer in terms of history, culture, shopping and beaches, so many patients choose to extend their trip into a holiday and make the most of their time in the country. Many of the best cardiac surgery doctors in Turkey are located in Istanbul, which is a popular tourist destination in its own right.
You’ll also find that waiting times are next to none. You should be able to schedule an appointment very quickly with MTS.
Common Oncological Treatments in Turkey
The most important thing about cancer treatment the correct diagnostics. Knowing that almost %30 of patients with cancer come to Turkey with an inaccurate diagnosis, which is mistakenly made by a doctor in their home countries. This is why the diagnostic process is extremely important. In Turkey it’s conducted on the most modern equipment in the world. Hospitals are equipped with everything necessary to deter-mine areas of cancer cells. After examination is made, professors of various profiles, leading by chemotherapists, radiologists and surgeons, make common decision on treatment methods. Every case differs as well as therapy and medications.
In this type of cancer treatment, chemotherapy is used to destroy cancer cells. Treatment with chemical drugs is used both as a single method of treatment and in combination with other medicines or methods of oncological treatment such as surgery or radiotherapy. Chemotherapy is used for treatment purposes, the use of drugs before and after surgery. As a control over the disease in order to stop the growth and spread of the tumor and prolong life and as palliative care for patients with stage 4 oncological diseases.
Goals of chemotherapy treatment
Cure; if possible, chemo is used to cure cancer, meaning that the cancer is destroyed – it goes away and doesn’t come back. Most doctors don’t use the word “cure” except as a possibility or intention. So, when giving treatment that has a chance of curing a person’s cancer, the doctor may describe it as treatment with curative intent.
Control; if cure is not possible, the goal may be to control the disease. Chemo is used to shrink tumors and/or stop the cancer from growing and spreading. This can help the person with cancer feel better and live longer. In many cases, the cancer doesn’t completely go away, but is controlled and managed as a chronic disease, much like heart disease or diabetes. In other cases, the cancer may even seem to have gone away for a while, but it’s expected to come back. Then chemo can be given again.
Palliation; Chemo can also be used to ease symptoms caused by the cancer. This is called palliative chemotherapy or palliation. When the cancer is at an advanced stage, meaning it’s not under control and has spread from where it started to other parts of the body, the goal may be to improve the quality of life or help the person feel better. For instance, chemo may be used to help shrink a tumor that’s causing pain or pressure.
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.
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 radio-tracers.
Depending on the type of nuclear medicine exam, the radiotracer is either injected into the body, swallowed or inhaled as a gas and eventually accumulates in the or-gan or area of the body being examined. Radioactive emissions from the radiotracer are detected by a special camera or imaging device that produces pictures and pro-vides molecular information.
In many centers, nuclear medicine images can be superimposed with computed tomography (CT) or magnetic resonance imaging (MRI) to produce special views, a practice known as image fusion or co-registration. These views allow the information from two different exams to be correlated and interpreted on one image, leading to more precise information and accurate diagnoses. In addition, manufacturers are now making single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT) units that are able to perform both imaging exams at the same time. An emerging imaging technology, but not readily available at this time is PET/MRI.
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 under-go 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.
What are some common uses of the procedure?
Physicians use radionuclide imaging procedures to visualize the structure and function of an organ, tissue, bone or system within the body.
In adults, nuclear medicine is used to:
• visualize heart blood flow and function (such as a myocardial perfusion scan)
• detect coronary artery disease and the extent of coronary stenosis
• assess damage to the heart following a heart attack
• evaluate treatment options such as bypass heart surgery and angioplasty
• evaluate the results of revascularization procedures
• detect heart transplant rejection
• evaluate heart function before and after chemotherapy (MUGA)
• scan lungs for respiratory and blood flow problems
• assess differential lung function for lung reduction or transplant surgery
• detect lung transplant rejection
• evaluate bones for fractures, infection and arthritis
• evaluate for metastatic bone disease
• evaluate painful prosthetic joints
• evaluate bone tumors
• identify sites for biopsy
• investigate abnormalities in the brain in patients with certain symptoms or dis-orders, such as seizures, memory loss and suspected abnormalities in blood flow
• detect the early onset of neurological disorders such as Alzheimer's disease
• assist in surgical planning and localize seizure foci
• evaluate for abnormalities in a chemical in the brain involved in controlling movement in patients with suspected Parkinson's disease or related movement dis-orders
• evaluation for suspected brain tumor recurrence, surgical or radiation planning or localization for biopsy
• identify inflammation or abnormal function of the gallbladder
• identify bleeding into the bowel
• assess post-operative complications of gallbladder surgery
• evaluate lymphedema
• evaluate fever of unknown origin
• locate the presence of infection
• measure thyroid function to detect an overactive or underactive thyroid
• help diagnose hyperthyroidism and blood cell disorders
• evaluate for hyperparathyroidism
• evaluate stomach emptying
• evaluate spinal fluid flow and potential spinal fluid leaks
In adults and children, nuclear medicine is also used to:
• stage cancer by determining the presence or spread of cancer in various parts of the body
• localize sentinel lymph nodes before surgery in patients with breast cancer or skin and soft tissue tumors.
• plan treatment
• evaluate response to therapy
• detect the recurrence of cancer
• detect rare tumors of the pancreas and adrenal glands
• analyze native and transplant kidney blood flow and function
• detect urinary tract obstruction
• evaluate for hypertension related to the kidney arteries
• evaluate kidneys for infection versus scar
• detect and follow-up urinary reflux
In children, nuclear medicine is also used to:
• investigate abnormalities in the esophagus, such as esophageal reflux or motility disorders
• evaluate the openness of tear ducts
• evaluate the openness of ventricular shunts in the brain
• assess congenital heart disease for shunts and pulmonary blood flow
Nuclear medicine therapies include:
• Radioactive iodine (I-131) therapy used to treat some causes of hyperthyroid-ism (overactive thyroid gland, for example, Graves' disease) and thyroid cancer
• Radioactive antibodies used to treat certain forms of lymphoma (cancer of the lymphatic system)
• Radioactive phosphorus (P-32) used to treat certain blood disorders
• Radioactive materials used to treat painful tumor metastases to the bones
• I-131 MIBG (radioactive iodine labeled with metaiodobenzylguanidine) used to treat adrenal gland tumors in adults and adrenal gland/nerve tissue tumors in children
Nuclear Medicine Examinations:
Tc-99m thyroid scintigraphy
I131 thyroid scintigraphy
For more detailed examination list and Oncology Check UP please contact MTS.
Gamma Knife Radiotherapy
The Gamma Knife is an advanced radiation treatment for adults and children with small to medium brain tumors, abnormal blood vessel formations called arteriovenous malformations, epilepsy, trigeminal neuralgia, a nerve condition that causes chronic pain, and other neurological conditions.
Gamma Knife is not a knife, but rather a sophisticated system that can be used to replace brain surgery or whole brain radiation in some situations. It uses a single, high dose of gamma radiation delivered via up to 201 individual beams which inter-sect at a single spot with the accuracy of less than one-tenth of a millimeter (about the thickness of a sheet of paper).
Gamma Knife can be used to treat an array of neurological disorders including brain metastases, arteriovenous malformations, facial nerve pain (trigeminal neuralgia), meningiomas, acoustic neuromas, recurrent gliomas and post-surgical pituitary tumors and essential tremor refactory to medication.
Gamma Knife procedure can be used to treat targets even in the most critical, difficult-to-access areas of the brain without delivering significant radiation doses to healthy normal brain tissue. Referred to as "surgery without a scalpel," the Gamma Knife procedure does not require the surgeon to open the skull.
Contact Medical Treatment Services medical adviser to find out if Gamma Knife radio surgery is the right choice for you.
TrueBeam STx is an advanced linear accelerator and radio surgery treatment system that allows doctors to target hard-to-reach tumors. The machine uses cutting-edge imaging technology — called ExacTrac® — to capture images of your tumor, even when it moves during your natural breathing patterns.
ALL ın ONE
TrueBeam STx can perform many radiation treatments.
Your doctor, with your input, will decide on a treatment plan.
Depending on your type and stage of cancer, he or she may suggest one of the following treatments on the TrueBeam STx:
Image-guided radiotherapy (IGRT)
Intensity-modulated radiotherapy (IMRT)
RapidArc® and gated RapidArc radiotherapy
Stereotactic radiosurgery (SRS), including:
Fractionated stereotactic radiation therapy
Stereotactic body radiation therapy
Types of Cancer We Treat with TrueBeam STx
At UPMC Hillman Cancer Center, we use the TrueBeam STx machine to treat the following cancers and other benign tumors:
Brain cancer (benign and malignant)
Head and neck cancer
Many recurrent and inoperable tumors
TrueBeamSTx can also treat cancer that has spread, but still remains confined to one organ (oligometastasis).
CAR T-cell therapy
CAR T-cell therapy is a type of immunotherapy. You might also hear it called a type of adoptive cell transfer. CAR T-cell therapy is a very complex and specialist treatment. With this treatment, a specialist collects and makes a small change to your T cells. These then target the cancer cells.
It is available as a possible treatment for some children with leukaemia and some adults with lymphoma. People with other types of cancer might have it as part of a clinical trial.
To understand CAR T-cell therapy more, it helps to understand what T cells do.
White blood cells called lymphocytes play an important part in fighting infection and diseases, including cancer. There are different types of lymphocytes. T cells are one type.
T cells move around the body to find and destroy defective cells. When you come in-to contact with a new infection or disease, the body makes T cells to fight that specific infection or disease. It then keeps some in reserve so that if you come across the infection again your body can recognise it and attack it immediately.
With this treatment, you have a sample of T cells taken from your blood. Your medical team do this through a process called apheresis.
First you have a tube put into a vein in each arm. One tube removes the blood and passes it into an apheresis machine. The machine separates the different parts of the blood. For CAR T-cell therapy, the machine takes out your T cells. The rest of your blood cells and normal blood fluid go back into your body through the tube in your other arm. In the lab, they change the T cells. You might hear this called genetically engineering the T cell.
The T cell is now a CAR T-cell. CAR stands for chimeric antigen receptor. These CAR T-cells are designed to recognize and target a specific protein on the cancer cells. Those changed T cells grow and multiply in the lab. Once there are enough cells you have a drip containing these cells back into your bloodstream.
The aim is for the CAR T-cells to then recognize and attack the cancer cells. The changes they make in the lab mean that they can stay in your body for long periods of time, recognizing and attacking the specific cancer cells. Researchers are still looking into how long they might stay in the body.
There are different types of CAR T-cell therapy made by different companies.
• tisagenlecleucel (Kymriah)
• axicabtagene ciloleucel (Yescarta)
Which cancer types?
CAR T-cell therapy is available for some children with leukemia and some adults with lymphoma.
Children and young people:
CAR T-cell is recommended for those up to the age of 25 who have a type of leukemia called B cell ALL. It will be used in one of the following situations:
• newly diagnosed children or young people whose leukemia hasn’t gone away with 2 cycles of treatment
• their disease has come back (relapsed) following a stem cell or bone marrow transplant
• their disease has relapsed twice or more
• children and young people whose leukemia had gone away with treatment, but it’s come back, and chemotherapy isn’t working now
• their disease has come back once but they can’t have a stem cell transplant because either they aren’t well enough, or they don’t have a donor
For adults, it will also be available for some people with one of the following types of lymphoma:
• diffuse large B cell lymphoma
• primary mediastinal B cell lymphoma
It is for those adults whose lymphoma has continued to grow or relapsed following at least 2 treatments.
So this treatment is only suitable for a small number of children and young people, and around 200 adults each year. It is not used as a treatment outside of clinical trials for other types of cancer in children or adults.
Genetic Approach to Cancer Treatment
Cancer is a disease that begins with gnomic mutations. Classical cancer treatment, which is carried out only by establishing the stage and type of cancer is outdated. The protocols that are used depending on the site of the cancer are blinded treatments that are verified by routine MRI screenings.
Today we live in a world where, after the completion of the human genome project, we manage to obtain a profile of genetic mutations for which we clearly understand which treatment will best suit the patient. We work with a council of experienced oncologists who evaluate the results of the genetic studies performed. We have all the possibilities to apply the latest technologies in radiotherapy and proton therapy when needed. IMRT, ARC, Radiosurgery is successfully applied to patients. In addition to these types of treatment, hyperthermia is used, which improves the effect of radiotherapy, immunotherapy and other types of oncology treatment. At the same time, doctors strengthen the patient's body with a high dose of vitamin C and improve treatment tolerance.
Not only the method of treatment, doubts, type of diet, habits, the patient's spiritual state are important, all together, a comprehensive method of treatment with a suitable diet, psychological support, physiotherapy and by support of team of oncologist team make success in patient’s health. Doctors do not treat the cause of the disease, they treat the component that was disturbed in the body and led to cell mutation as only a small percentage of cancers are hereditary.
Oncologists, after carrying out complex treatment, to minimize recurrence, draw up a new map of life with the improvement of those mistakes that were made before. This program is compiled individually for each patient. Genetic approaches to individualized treatment are not standard treatments for cancer. Together with a genetic test, this is the selection of the correct lifestyle and diet. We provide personalized treatment based on the latest technology, modern drugs and an individualized course of treatment with supportive therapy.
If surgery is necessary, our team of oncologists includes leading specialists. Each patient undergo treatment based on evaluation of their medical examination and test results.