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Oncology

Medical Oncology Department

In medical oncology department, treatment for types of cancer such as lung Cancer, Head and Neck Tumors, Brain Tumor, Kidney Cancer, Endometrium (Uterine) Cancer, Liver Cancer, Lymphomas, Malignant Melanoma, Breast Cancer, Bladder Cancer, Stomach-Intestinal Cancer, Multiple Myeloma, Osteosarcoma and Soft Tissue Sarcomas, Ovarian ( Ovarian Cancer, Pancreatic Cancer, Prostate Cancer, Gallbladder and Biliary Tract Cancer, Cervix (Cervical) Cancer, Testicular Cancer, Thyroid Cancer are administered.

Chemotherapy, Targeted Therapy, Hormone Therapy, Immune Therapy are among the methods applied.

 

What is Cancer? Is Cancer the Disease of Our Age?

Myths About Cancer

“Operating the cancer and excising it or performing a biopsy causes cancer to spread throughout the body”

WRONG. Surgery and biopsy performed correctly will not cause the cancer to spread or grow. A biopsy is the only way a person can be diagnosed with cancer.

” Diabetes feeds the cancer, person suffering from cancer should completely stop consuming sugar ”

WRONG. All cells in our body, including cancer cells, use sugar for energy. Although cancer cells consume more sugar than normal cells, no studies have shown that eating sugar makes cancer worse, or that not eating sugar reduces or destroys cancer. This does not mean that you should adopt a high sugar diet.  An excessive sugar diet can lead to obesity by causing excessive weight gain, and it is known that obesity increases the risk of developing some types of cancer. Foods containing sugar that are consumed rationally and do not cause weight gain do not increase the risk of cancer. Some patients who try to adopt an excessively restricted diet and do not consume many foods with the thought that they are carcinogenic, cannot continue their treatment due to nutritional deficiency and decrease in resistance.

“ Sweeteners Cause Cancer ”

WRONG. Sweeteners have not been shown to cause cancer in humans in any of the studies with sweeteners.

” Attitude (morale) of Cancer Patient Against Cancer Affects Recovery from Cancer ”

WRONG. Until now, no scientific data has shown that a person’s attitude towards cancer changes the probability of developing cancer or death due to cancer. After being diagnosed with cancer, it is normal to feel sad, angry, sometimes weary, or be overly optimistic. Patients with higher morale do not distance themselves from social relationships, stay more active and have better quality of life. The treatment processes of the patients who have a positive attitude towards the disease go better. However, having a depressed mood does not mean that cancer treatment will be less effective, nor does it affect the success of cancer treatment. Paying excessive attention to the patient’s attitude towards cancer (morale) may cause the patient to feel unnecessarily guilty if the treatment does not result in a good way.

” Herbal Remedies Advertised as Alternative or Supportive Treatment Cure Cancer ”

WRONG. Although some herbal remedies advertised as alternative or supportive treatments may be beneficial in some side effects associated with chemotherapy or radiotherapy, there is no scientific data to show that these drugs treat cancer. Herbal medicines, which are already understood to be effective in cancer treatment, are now becoming the standard treatment and are not called alternative or supportive therapy. It should not be forgotten that some chemotherapy drugs are also derived from plants. Patients who want to use herbal products or vitamins should discuss this with their doctor because these products can reduce the effect of chemotherapy and radiotherapy on cancer cells.

” Acidic Diets Cause Cancer, Therefore The Body Should Be Alkalized With Alkaline Foods and Sodium Bicarbonate ”

WRONG. Our body’s acid-alkali balance is very well controlled. Life would not be possible otherwise. It is not possible for a person with normally functioning lungs and kidneys to alkalize their body with what they eat. If excessive alkaline is consumed, this is excreted in the urine and the urine becomes alkaline. If the diet is too acidic, the urine becomes acidic as this will be excreted from the urine. In this way, the acid and alkali balance of the body is maintained. It is true that the tumor cannot survive in an alkaline environment, but this also applies to all cells in our body. Sodium bicarbonate should not be drunk to make the body alkaline.

” Cancer Treatments Kill Rather Than Cure ”

WRONG. It is true that cancer treatments (chemotherapy, radiotherapy and surgery) have uncomfortable side effects. However, as stated on some websites, the information that “cancer treatment is effective only in 3% of patients” is wrong. The number of patients benefiting from cancer treatment is increasing day by day in the light of new developments.

Cancer Treatment, What is HIPEC and Hot Chemotherapy Application?

Can Cancer Be Prevented?

Can cervical cancer in women be prevented?

Cervical cancer is the 3rd most common cancer of the female reproductive organs and can have serious consequences when not diagnosed early. Every year, around 500,000 women die of cervical cancer worldwide, most of which are in developing countries. The most important difference of cervical cancer from other cancers is that its cause is known and can be prevented. Cervical cancer is caused by the sexually transmitted Human Papilloma virus.

Before the development of cervical cancer in women infected with Human Papilloma virus, some microscopic lesions develop in the cervix and these changes are pre-cancerous changes. These cancer precursor lesions called cervical dysplasia can be detected by pap smear examination taken from the cervix. Human Papilloma Virus (HPV) infection is the initiating factor in cervical dysplasia and carcinogenesis.

Genital HPV infection is the most common sexually transmitted disease worldwide today. It is transmitted through skin-to-skin contact during sexual intercourse.

 

Frequently Asked Questions on Breast Cancer

What is Breast Cancer?

Breast cancer occurs as a result of unlimited and uncontrolled proliferation and growth of cells. Breast cancer is the most common type of cancer in women in the world and in our country. Statistics show that 1 in 8 women face breast cancer. Although the disease is so widespread, complete cure can be achieved in over 90 percent of breast cancer detected in the early stages. While new treatment options are increasing gradually, success in breast cancer treatment requires early diagnosis. For this reason, it is extremely important to have regular screening tests in terms of early diagnosis.

 

What are the Symptoms of Breast Cancer?

The most common symptom of breast cancer is the detection of a painless mass in the breast. In addition, the presence of shrinkage in the nipple or skin, redness on the breast skin, edema or orange peel appearance, and a mass in the armpit also suggest the risk of breast cancer. When these symptoms occur, a doctor should be consulted immediately. The sooner it is diagnosed, the easier it is to treat.

 

Is Breast Cancer an Inherited Disease?

Only 10 percent of breast cancers are hereditary. Although it is not inherited in 20 percent of the patients, several family members have been diagnosed with breast cancer before. In 75 percent of the patients, there is no family member who has been diagnosed with breast cancer before. All women are at risk for breast cancer. One out of every 8 women suffer from breast cancer.

What are the Risk Factors in Breast Cancer?

Breast cancer can occur in any woman, but some factors are known to increase the risk of breast cancer. The incidence of breast cancer increases with age. The age of onset of menstruation is before 12, late menopause (after 55 years of age), never giving birth or giving birth at a late age (after 30), not breastfeeding, family history of breast cancer, alcohol and smoking, menopause post-obesity are situations that increase the risk. Although the effect of diet on increasing risk is unclear, consuming too much red meat, consuming processed meat and eating high fat can increase the risk. It has been shown that a diet rich in vegetables and fruits and excessive physical activity reduce the risk.

 

What Is Breast Cancer Screening?

Breast cancer is one of the cancers recommended for screening. After the age of 40, an annual mammogram and an annual medical examination should be performed. From the age of 25, women are recommended to have their breasts examined and between the ages of 25-40 to have a medical examination every 1-3 years.

 

Who Should Be Screened for Hereditary Breast Cancer?

  • Those who are considered to be at high risk for hereditary breast cancer,
  • Breast cancer in both breasts,
  • Having a relative in the family diagnosed with both breast and ovarian cancer,
  • Having a family history of male breast cancer,
  • Having breast cancer in 2 or more people on the same side of the family (father or mother’s side),
  • The presence of ovarian cancer in 1 or more people on the same side of the family, and a person diagnosed with breast cancer younger than 45 in first or second degree relatives suggest that there may be hereditary breast cancer.

The most common genetic disorder in hereditary breast cancers is a mutation in the BRCA-1 or BRCA-2 gene. 85% of people with this mutation develop breast cancer and 45% develop ovarian cancer. Therefore, if a mutation is detected in the BRCA-1 or BRCA-2 gene, preventive approaches are recommended.

 

What Should People at Risk of Hereditary Breast Cancer Do?

Preventive surgeries, drug protection and close follow-up are recommended for these people. The most effective method is to reduce the risk with preventive surgery. These are bilateral mastectomy, that is, removal of the breast and removal of the ovaries against ovarian cancer. Since the skin and nipple are protected in mastectomy and silicone implants are placed during surgery, there is no aesthetic problem.

Removal of the ovaries is recommended after 35-40 years of age or after the desired number of children have been made.

 

What are the Treatment Methods of Breast Cancer?

Breast cancer is a treatable disease when it is diagnosed early and when modern treatments are used. A successful treatment cannot be done by a single branch. For success, a multidisciplinary approach, that is, many branches such as General Surgery, Medical Oncology, Radiation Oncology, Pathology, Radiology, Nuclear Medicine, must act by making a joint decision. For this purpose, patients should be discussed in the tumor council and treatment plans should be made.

In early stage breast cancer, the main treatment is surgery. In order to prevent recurrence after surgery, radiotherapy, chemotherapy and hormonal treatment are applied according to the characteristics of the tumor. Surgical treatment is not initiated in tumors that have spread to other organs (metastasized). First of all, chemotherapy and / or radiotherapy is applied.

Are All Cancer Cases Fatal?

Myths About Breast Cancer

·       If there are no symptoms related to breast cancer, there is no need for mammography.

Actually; As with many types of cancer, breast cancer usually does not show any symptoms in the early stage. For this reason, it is vital that women have regular breast examinations and periodic mammographic examinations.

·       Mammography is a painful method.

Actually; During mammography examination, the breast is slightly compressed between two plates in order to obtain better quality imaging by giving less radiation. According to the pain threshold, some women may feel discomfort during the scan. Most of the women who have mammography with new generation digital mammographies and tomosynthesis devices state that they do not feel pain during the procedure and that what they heard about the procedure was very exaggerated

·       Women with small breasts are less likely to develop breast cancer.

Actually; Breast size has no effect on cancer development. The amount of milk glands and ducts in the breast in cancer development is shown as a more effective factor than size.

·       Breast cancer always manifests symptoms with masses in the breast.

Actually; As with many benign breast diseases, a mass in the breast can be a symptom of cancer. However, breast cancer does not always show symptoms as a palpable mass in the breast. It is also necessary to be careful against other symptoms such as nipple withdrawal, nipple discharge, skin redness, thickening.

You can get detailed information about Breast Cancer from the Breast Diseases Diagnosis and Treatment Unit.

How Is Cancer Diagnosed?

3D Diagnosis Method in Breast Tumors: TOMOSYHTHESIS

Mammography is a method of imaging breast tissue using low energy x-rays. It is also used for screening purposes in the early diagnosis of breast cancer. Since early diagnosis affects the success of the treatment, it is recommended that women aged 40 and over should have mammography and breast ultrasound every year.

How is Tomosynthesis Mammography Performed and Analyzed?

In tomosynthesis  mammography, cross-sectional images are obtained using low-dose X-rays while the X-ray tube moves in a certain angle arc. The resulting raw (projection) images appear in a series of thin sections such as 0.5 mm, 1 mm. Thanks to these thin sections, breast tumors can be detected with higher accuracy and at an earlier stage.

What are the Advantages of Tomosynthesis Mammography?

It provides 3-dimensional, cross-sectional scanning of the breast tissue. The density of the breast tissue and the prominence of fibrocystic structures in women who are note menopausal or are under the age of 40 can cause difficulties in mammography evaluation. Cancer images can be hidden among healthy breast tissue. With Tomosynthesis Mammography, this problem is prevented and it is possible to detect masses in the early period, especially in young women. Since false positive images that overlapping breast tissue can create are eliminated, it reduces the number of repeat radiograms taken in specific positions. Thus, unnecessary radiation exposure is prevented and it increases the rate of correct diagnosis and reduces the rate of biopsy and surgery.

What is Tomosynthesis Mammography?

Tomosynthesis Mammography is accepted as the advanced technology used in breast imaging. Until today, overlapping of images in two-dimensional (2D) mammograms could lead to failure to obtain images with the desired detail. This could make it difficult to evaluate the masses. Today, it is possible to view breast tissue in three dimensions (3D) with Tomosynthesis Mammography technology. In this way, tissue overlap is prevented and the possibility of missing tumors is significantly reduced.

What You Want to Know Before Tomosynthesis Mammography

  • Our radiology counter offers you service regarding your registration and insurance processes before mammography.
  • Products such as powder, cream, deodorant should not be applied to the armpit or breast area before the mammography examination.

Large Intestine Cancer Treatment

Surgical Factor in Large Intestine Cancer

What are the Symptoms of Esophageal Cancer? How is It Treated?

What are the Symptoms of Stomach Cancer? How is It Treated?

What is Pancreatic Cancer? What Are The Symptoms? How is It Treated?

3D Diagnosis Method in Breast Tumors: TOMOSYHTHESIS

A disease where early diagnosis saves lives is lymphoma, lymphoma. This cancer manifests itself with the rapid growth of lymph nodes in areas such as the head, neck, armpit and groin. Lymph cancer, which causes various symptoms, most often occurs with general symptoms such as fever, sweating, weakness and itching. So what is lymphatic cancer? What are the symptoms of lymph cancer? What are the causes of lymph cancer? Is there a cure for lymph cancer? To which patients is bone marrow transplant performed? What is the success rate in the treatment of lymph cancer in the last stage? Is it possible to reduce the side effects of chemotherapy?

Lymphoma is one of the treatable diseases. Experts state that early-stage lymphomas can be treated in a shorter time and with a greater success rate. In order for the disease to be detected at an early stage, it is useful to consider the symptoms of the disease.

Blood consists mainly of red blood cells, platelets and white cells. As a result of the increase in the growth rate of a subgroup of white cells called lymphocytes, and the prolongation and immortality of those formed, lymphoma, in other words lymph cancer occurs. In short, it is a type of tumor originating from lymph cells. Lymphomas are examined in two main groups as Hodgkin and non-Hodgkin lymphomas. Hodgkin lymphoma has a better course than another and is also called Hodgkin’s disease. Both groups have many subgroups.

What are the Symptoms of Lymph Cancer?

Noting that lymph cancer is manifested by the rapid growth of lymph nodes in areas such as head, neck, armpit and groin, Prof. Okan Kuzhan, ‘It can enlarge the liver and spleen, which sometimes leads to early satiety. Most of the time, the patient cannot understand this, and it is revealed by imaging methods. If lymphoma cells uptake the bone marrow, it can disrupt the white blood cell, red cell and blood platelet formation there. Anemia, easily occurring bleeding in the body, frequent and severe infectious diseases may be encountered. General symptoms such as fever, sweating, weakness, itching can also be seen in lymphomas.

How is the Staging of the Disease Done?

When lymphoma is diagnosed, the whole body is scanned with various imaging tests. It is determined which lymph node regions the disease affects. Apart from lymph nodes, it is checked whether it is involved in organs such as liver, lungs and brain. A bone marrow biopsy is performed and the presence of lymphoma cell accumulation in the bone marrow is evaluated. The cases with organ and bone marrow involvement are stage IV cases. However, Prof. Okan Kuzhan, warning that some of his patients think that death in the fourth stage is inevitable and there is no cure. It is true that early stage lymphomas can be treated with shorter treatments with a greater success rate. However, stage 4 lymphoma can also be completely cured. Among general cancers, the highest success rates are provided in lymphomas. Sometimes an early stage lymphoma is resistant to treatment due to tumor-related factors, while a fourth stage lymphoma can rapidly heal.

What Causes Lymph Cancer?      

The causes of lymph cancers are roughly similar to those in other organ cancers. It is known that an average of 120000 errors occur in the bases in our chromosome sequence during each cell proliferation. DNA repair enzymes correct some of these errors, but some avoid repair mechanisms. We call these errors mutations. Physical reasons such as some chemicals and radiation increase the number of errors. However, errors can occur during cell proliferation even for no reason. In short, it is not very difficult to understand the causes of lymphoma and other organ cancers. The real question is why not everyone has cancer. If so many errors occur in every cell proliferation, and since we have a quadrillion cells in our body, the number of cancer patients we see is below what we expect. Mutations are a mechanism for living things to keep up with the changing world and survive by evolving. Cancer is a price for this advantage.

What Are the Lymph Cancer Treatment Options? For Which Patients Is Bone Marrow Transplant Suitable For?

Treatment of lymphomas depends on the stage. However, the basis of treatment is intravenous chemotherapy. According to the properties of the tumor that can be detected under the microscope, some drugs known as smart drugs are also used. We try to reduce the number of chemotherapy sessions and reduce the side effects of chemotherapy by applying radiotherapy to the disease area for lymphomas limited to an area. Surgery is not applied in the treatment of lymphoma, except for very special emergencies. If a patient doesn’t respond to a chemotherapy plan, we move on to another plan. The treatment plan given first is called the first line and the other is called the second line. When lymphoma cells develop resistance to standard chemotherapy doses, we can break this resistance and heal by increasing the dose of chemotherapy. Therefore, patients whose lymphoma relapses after first line therapy are as disease free as possible after second line chemotherapy and we apply high-dose chemotherapy and autologous peripheral blood stem cell transplantation. The bone marrow transplant procedure here is done as follows: First, the patient’s blood stem cells are extracted into the peripheral blood by a method called mobilization, then collected by a process called apheresis and stored by cooling. Then we give the patient the chemotherapy doses above the doses we normally give. High-dose plans use drugs that have been researched for side effects other than bone marrow damage in previous studies and have been proven safe for patients. Such high doses of chemotherapy can completely eradicate the tumor.      However, in the meantime, healthy blood stem cells in the bone marrow are also damaged. When the blood stem cells that were previously taken from our patient and stored are given back to the patient, the given stem cells settle in the bone marrow and begin to produce white blood cells, red blood cells and blood flakes. In fact, bone marrow transplantation is a procedure developed to repair bone marrow damage caused by high-dose chemotherapy. In some types of lymphoma, such as lymphoblastic lymphoma, whose clinical course we know will be more difficult, patients whose disease disappeared after first-line chemotherapy are administered high-dose chemotherapy and autologous peripheral blood stem cell transplantation to reinforce without waiting for the relapsing of the disease.

What is the Success Rate in the Treatment of Lymph Cancer Diagnosed in the Last Stage?

Stating that patients with lymphoma and their relatives may want to know the treatment success rates, Prof. Okan Kuzhan stated that it is better for them to directly ask their doctors about this information. When lymphoma patients are divided into good, moderate and bad risk groups according to their stages, some blood parameters and whether they have complaints such as fever, sweating and weight loss, which we call B symptom, 80-90% in good risk groups; In bad risk groups, 45-50% complete healing can be achieved. It is possible to keep patients who cannot be fully cured alive for many years with increasing and varying treatments. As can be seen, contrary to what is known in the society, the cure rate in lymphomas and cancer in general is higher than many other chronic diseases.

What Should a Person Diagnosed with Lymphoma Cancer Pay Attention to?

Prof. Dr. Okan Kuzhan advised that patients diagnosed with lymphoma should ask their questions primarily to their doctors; he thinks that applying to knowledge of a neighbor, healed or not healed another patient, newspapers and internet may be harmful, today the information gets spread and become manipulated very easily, even for a doctor, it is hard for him/her to decide on matters out of his/her specialty. He said he saw that being over-informed led to confusion, anxiety, insecurity, and non-compliance with treatment.

What Should Be Considered In The Nutrition Of Cancer Patients? 

There is no specific diet that is good for lymphoma or any cancer. Consuming sugar does not feed lymphoma. All cancer patients must comply with the general healthy living rules that apply to each individual. These include not smoking, not consuming alcohol, living active, not getting fat, and eating a balanced diet. If excessive sugar consumption causes obesity, it can trigger chronic diseases such as diabetes, hypertension and cancer. However, it is not correct to ban sugar for cancer patients. The most common problem encountered in advanced stage cancer patients is anorexia and wasting (cachexia). It is unethical to condemn patients in this period to dietary programs that are difficult to follow, even though they do not have scientific data.

What Can Be Done Against Common Side Effects of Chemotherapy?

Of course, chemotherapy has some side effects. Some appear immediately during medication, some appear days or weeks later. Nausea, vomiting, mouth sores and hair loss are common. All cancer patients are informed about the side effects before the treatment and their signature and approval are obtained for this notification. In many centers, booklets describing what to do in which side effects are distributed. I think it would not be useful to explain the management of all side effects here. The specialist doctor, who plans the chemotherapy, prepares a prescription describing the drugs to be used at home and the way of use according to the most common side effects of the treatment he gives. These prescriptions include anti-nausea, anti-constipation, diarrhea, heartburn, appetite suppressants, or drugs that prevent uric acid from rising in the blood. Thanks to these supportive drugs, whose subgroups I mentioned, many patients can complete their treatment with no or mild side effects. In short, patients should follow the recommendations of their doctors and nurses. Patients whose complaints continue despite these measures should be checked by their doctors. For these complaints, traditional, alternative or complementary methods applied without the knowledge of the doctor may be harmful. You should get the correct information from your treating doctor.

What is the Role of Alternative Medicine in Lymph Cancer? 

Patients frequently ask questions about alternative treatment methods they have heard from their neighbors, television and the internet. Like donkey milk, breast milk, turtle blood or a random herb. Cancer studies continue rapidly. Treatments that have proven to be effective and harmless are offered to you. You must be sure of that. Patients who still want to use such methods should inform their physicians and chemotherapy nurses. Because these methods can interact with chemotherapy drugs, causing interactions and side effects that can be fatal. It saddens me as a person to see that patients waste time with alternative methods while there are proven treatments.

How Is Cancer Staging Done?

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