AdvAnced Medicine. coMpAssionAte cAre.

St. Anthony’s Medical Center

Cancer Care CenterAnnual Report 2011 - 2012

Dr. Eric Sutphen and staff with patient after radiation therapy treatment.

Dr. Sarah Beth Snell with radiation oncology patient.

Dr. John Bechtel with staff in treatment planning and dosimetry work room.

St. Anthony’s, a Catholic medical center, has the duty and the privilege to provide the best care to every patient, every day.

To become the premier healthcare organization in the St. Louis region and the medical center of choice for people in our primary and secondary service areas. For services provided, deliver excellence in patient care, objectively measured and at a competitive price, through partnering with our physicians and other community providers.

The patient comes first in all we do n We will strive for excellence through teamwork and mutual respect n We express compassion and respect for all persons served and those serving n As a Catholic medical center we support the spiritual and physical needs of our patients and staff

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Table of contentsCancer Committee ........................................................................... 4

Messages from Leadership ................................................................ 5

Treatment of Colorectal Cancer ........................................................ 9 • Colon Cancer: Preventable • Treatable • Beatable • The Pathologist’s Role in the Diagnosis, Staging and Treatment • Radiation therapy and rectal cancer • Radiologic imaging in colorectal cancer

Cancer Treatment & Services ........................................................... 16

• Support Services • Reaching out to the community

Cancer Data ..................................................................................... 18 • Top five Cancer Sites at St. Anthony’s • Colon Cancer Staging • Colon Cancer Treatment Types • Rectal Cancer Staging • Rectal Cancer Treatment Types • Top 10 Cancer Incidence Sites, St. Louis County • Top 10 Cancer Incidence Sites, Jefferson County • Invasive Cancer Incidence Rates in Missouri

Contact Us ......................................................................................22

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Cancer committee membersCommittee LeadershipSarah Beth Snell, M.D., Breast Surgery (Chairman) John Bechtel M.D., Radiation Oncology (Physician Liaison)William Morris M.D., Medical Oncology (Medical Director Oncology Services) Brian Pence, Director of Cancer Care (Cancer Program Administrator)Eric Appelgren, M.D., Executive Vice President, Ambulatory Services, St. Anthony’s Medical Center

Physician Committee MembersMazen AbuAwad M.D., Interventional RadiologyJohn Bechtel M.D., Radiation OncologyRobert Beckman, M.D., General SurgeryEdward Burns, M.D., Palliative CareRama Devabhaktuni, M.D., Family PracticePeter Fonseca, M.D., PhD., Thoracic SurgeryEddy Hsueh, M.D., Surgical Oncology Lawrence Kriegshauser, M.D., Orthopedic SurgeryJose Lima, M.D., Otolaryngology Ronna F. Lodato, M.D., PathologyKaruna Murray, M.D., Gyn/OncologyPaul Oberle, M.D., Diagnostic RadiologyJayprakash Patel, M.D., UrologyDavid Schuval, M.D., Colorectal SurgeryEric Sutphen, M.D., Radiation Oncology Paul Young, M.D., Neuro Surgery

Non-Physician Committee MembersGail Behling, Oncology Data Services, QA of Registry DataLaura Bub,Education/Community Outreach CoordinatorKevin Dobson, Oncology Data Services, Cancer Conference CoordinatorLizzie Huger, Pastoral CareStephanie Jacobsmeyer, Quality Management Michelle Jost, Oncology Inpatient Janet Lesko, Oncology Research Lynn Stephan, American Cancer Society RepresentativeElaine Sharamitaro, OCN, RN, Infusion Services Ruth Southards, Director HospiceTerri Thompson, Nutrition ServicesRebecca Zickler, Social Worker

Cancer Oncology Program AdministrationTina Crossland

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Sarah Beth Snell, M.D.

St. Anthony’s Medical Center became an accredited community cancer program in 2010 from the Commission on Cancer of the American College of Surgeons. We area now eagerly approaching our first re-certification visit in August 2013. This will allow us to showcase the quality community cancer care we offer at St. Anthony’s Cancer Care Center.

Cancer care at St. Anthony’s involves multiple specialties. This is a true team approach from all aspects. This involves not only surgery, medical oncology, and radiation oncology; but many other specialized disciplines of medicine. The spotlight cancer this year chosen by the Cancer Committee was colorectal cancer and involved the goal/use of preoperative staging of rectal cancer with rectal MRI. This is a new technology to allow for appropriate patients to receive preoperative chemotherapy with radiation to allow for better outcomes. This required the radiologist to work with the surgeons to evaluate the appropriate patients and to introduce a new standard in the preoperative work up. We also worked with pathology and surgery to make sure that an appropriate number of lymph nodes were removed in colorectal cancer patients. This allows the team to provide appropriate post operative treatment and follow up and therefore better care.

Comprehensive cancer care also involves the cancer registry that collects data on all patients to track outcomes. Since our accreditation, abstracting of all cancer patients has remained timely and accurate. Another benefit of an accredited cancer center involves access to clinical trial specialists that offer patients access to the newest treatment options close to home, as well as outreach programs that offer frequent health screenings and community education. We also provide palliative care services and both inpatient and home hospice. This is uncommon in a community cancer program and something that we are distinctly proud of. All these services allow patients first class cancer care in a comfortable community setting. The accreditation also allows St. Anthony’s to compare our outcomes to other accredited facilities. We strive to provide improved survival and quality of life and confirm this with comparing ourselves to other facilities of the same size.

St. Anthony’s provides excellent care in a convenient, community setting. With this I am proud to present the annual report spotlighting colorectal cancer.

Sarah Beth Snell M.D., FACSChairman, Cancer Committee

314-525-1545

A message from leadership

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Brian Pence

This has been my third year as Executive Director of Oncology Services at St. Anthony’s Medical Center. I have had the privilege to work for a third year with a terrific group of physicians, nurses, therapists and many other cancer care professionals as we work together to grow the program. This year we have been involved in a strategic process improvement for St. Anthony’s. The tasks forces associated have successfully met the targeted cost savings and financial improvements for the organization. This will place us in solid financial grown for future initiatives for the cancer program. An example of new initiatives has been the use of our new High Dose Rate Brachy-Therapy (HDR) unit for the treatment of lung cancers in the bronchus as well as certain esophagus tumors. In both situations we have an interdisciplinary team of physicians and staff caring for the patient with quality and efficiency. Pulmonologists and GI doctors come directly to the cancer center to work with our radiation oncologists so we do not need to transport the patient from one clinic to another. It is a terrific example of interdisciplinary care.

The outpatient infusion center cares for more and more patients each year, delivering treatments for not just cancer but many other diseases as well. Approximately 60 percent of our patients cared for in OP infusion have a cancer diagnosis. The other 40 percent have other health concerns.

Approximately 1,317 new cancers were diagnosed at St. Anthony’s Medical Center in 2011. This was a smaller number of patients diagnosed in 2012, which was 1,486. While the number of patients diagnosed declined, the number of patients who received treatment for cancer at St. Anthony’s increased. Our interdisciplinary care offers the opportunity for patients to have a streamlined and efficient access to all of the oncology therapies in order to tailor treatment to their individualized needs. The cancer center met all of its quality goals for 2011 including excellent patient satisfaction and employee satisfaction scores.

We look forward to working with our medical oncologists in 2013 to create and implement clinical pathways for the Cancer Care Center. Clinical pathways are the stepping stone for outcomes-based medicine and our team of physicians will continue to be engaged in the creation of pathways for all of the primary cancers diagnosed in our community. This approach assures not just the success of treatment delivery but measures the positive effect of an inter-disciplinary approach to cancer care. The goal will be to provide patients and the community with measured results of the quality care this is provided.

We look forward to meeting the oncology needs of our community. We are here to provide quality care in a compassionate and comfortable setting. Warmest regards.

Brian PenceExecutive Director, Cancer Care Center

314-525-4063

A Challenging and Rewarding Year

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R. William Morris, M.D., M.B.A.

A message from leadershipThe St. Anthony’s Colorectal Cancer Care Team is comprised of

a group of premier oncologic specialists with research-based expertise in colorectal cancer. Colorectal cancer is the second most common cause of death from cancer in the U.S. today. Cure rates are increasing yearly with improvements in treatment, but more Americans need to have their colonoscopies performed on a regular basis to exert a bigger impact on this disease.

90 percent of colon cancers occur after the age of 50. Most of these cancers evolve from benign polyps, which grow into benign adenomas (or gland tumors). Over time (usually 10 years or so), both raised and flat adenomas can turn into cancer. Early detection and removal of these pre-malignant tumors can prevent colon cancer and save many lives.

Risk factors for colorectal cancers include smoking, eating red meat, refined grains and sugar, plus alcohol and obesity. Avoidance of these lifestyle choices, plus the intake of Vitamin D, folate, and Vitamin B6 and aspirin can help prevent this cancer from occurring. The genetic risk for colorectal cancer is relatively low. However, persons with a family history of this disease should inform their primary care physician. If a colon cancer is diagnosed by colonoscopy, surgical resection is usually performed first. Surgery includes complete removal of the involved colon segment along with the local blood supply and lymph nodes. Laparoscopic (minor fiberoptic) surgery for colon cancer is frequently performed at St. Anthony’s Medical Center. Compared to open abdominal surgery, laparoscopic surgery is just as effective and often provides a shorter hospital stay with less pain and similar cure rates. Laparoscopic procedures at St. Anthony’s can be performed with the da Vinci® Surgical System.

Colorectal cancer patients at St. Anthony’s are usually seen by a multi-disciplinary care team including specialists in surgical, medical, and radiation oncology. X-rays, scans, pathology and other data are often reviewed and evaluated at a colorectal cancer conference, where a “personalized treatment plan” is created by consensus. National Cancer Institute clinical trials are sometimes available for therapy in qualifying cases. Early colorectal cancer at St. Anthony’s can often be managed with the Oncotype DX Colon Cancer (Gene) Assay, which can help predict the value of adjuvant (or preventive) chemotherapy after surgery. The K-RAS gene mutation study can also be exceptionally useful in colon cancer cases with advanced disease to determine treatment eligibility for cetuximab, a monoclonal antibody and EGFR inhibitor.

Treatment for colorectal cancer at St. Anthony’s is designed by stage, according to National Comprehensive Cancer Network (NCCN) guidelines:

Stage I: Usually treated by surgery without adjuvant chemotherapy.

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Stage II: Treated by surgical resection, plus adjuvant chemotherapy in cases eligible by the Oncotype DX Colon Cancer (Gene) Assay, plus other criteria.

Stage III: Cancers with positive metastatic lymph nodes are usually treated with adjuvant chemotherapy regimens, including 6 months of FOLFOX-6 or CAPEOX, in the out-patient setting.

Stage IV: (Including cancers metastatic to the liver, lung and lymph nodes) Is treated with multiple chemotherapy protocols, plus either Avastin or Zaltrap (monoclonal antibodies which inhibit vascular endothelial growth factor, known as VEGF ) or cetuximab (noted above).

Patients with a significant response to metastatic disease, (>50 percent tumor shrinkage from chemotherapy) can often become candidates for surgical resection of small residual tumors by our liver oncologic surgeon or for Radio-Frequency Ablation (RFA), specifically, high energy thermal treatment. Some patients who achieve a complete remission status can often enjoy long-term survival and even cure.

Stage II and III rectal cancers are treated more often with neoadjuvant (pre-surgical) combined chemo-therapy, plus radiation therapy which offers a distinct therapeutic advantage. High cure rates are expected after surgery and additional chemotherapy.

Metastatic or advanced colorectal cancer patients that do not achieve a complete remission with treatment can frequently be stabilized (in a palliative mode) for two to three or more years while enjoying good quality of life and minimal side effects from chemotherapy.

The St. Anthony’s Colorectal Cancer Care Team, including board-certified oncologic specialists is currently available for “Personalized Care Prescriptions” (“PCRx“ ) plans with an opportunity for superior outcomes and survivals.

St. Anthony’s Colorectal Cancer Care is proud of its team and its achievements and is seeking early stage and advanced colorectal cancer patients for first and second treatment opinions.

R. William Morris, M.D., M.B.A.Medical Director, Oncology Services

314-849-6066

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Treatment of colorectal cancerColon Cancer: Preventable • Treatable • BeatableColorectal cancer is the third most common cancer and the second most common cancer killer in the United States, which, in 2012, is an estimated 143,000 new colorectal cancers and 52,000 deaths. The risk of developing colorectal cancer increases with age. All men and women age 50 and older are at risk of developing colorectal cancer, and should be screened. Those with a personal history of inflammatory bowel disease or family history of colorectal cancer or polyps should be screened before age 50.

At St. Anthony’s Medical Center, rectal cancers are treated with a team approach which includes the colon and rectal surgeon, medical oncologist and radiation therapist. Radiation therapy is used in most rectal cancer cases, and in the few instances of colon cancer when it is not possible, or safe, to surgically remove all of the cancer. Surgeons working with the radiation therapists utilize different techniques to allow for the delivery of the maximum appropriate dose of radiation therapy while minimizing the adverse effects to the surrounding tissues.

Current screening methods include one or more of the following: fecal occult blood testing, flexible sigmoidoscopy, double contrast barium enema and the gold standard - colonoscopy. Colorectal cancer screening costs, including colonoscopies, are covered by Medicare and nearly all commercial health plans.

Colorectal cancer can be cured in up to 90 percent of patients when discovered in its early stages. Approximately 40,000 lives a year could be saved through widespread adoption of colon cancer screening and early treatment in men and women.

Symptoms from colorectal cancer may include any or all of the following: bleeding per rectum, dark black stools, change in stool caliber, tenesmus, lower abdominal pain, recent change in bowel habits towards diarrhea or constipation, and unintentional weight loss. However, most patients identified to have colorectal cancer have no symptoms. This is why screening is so important.

Ten percent of all colorectal cancers are identified in patients younger than age 50; therefore, when these patients do present with the symptoms associated with colorectal cancer, they should be investigated thoroughly.

Colorectal cancer, like most cancers, is staged at four different levels. Each stage carries different treatment recommendations and prognoses. Although staged the same, treatment recommendations for colon cancer and rectal cancer are different.

Stage I colorectal cancers are those where the cancer penetrates only a portion of the bowel wall. Colon resection is the main stay, without any additional therapy, and yields a five-year survival rate of 74- 93 percent. Stage II colorectal cancers invade through most, if not all, of the bowel wall or directly invade an adjacent organ. Colon resection provides a significant cure rate with five-year survival

David Schuval, M.D.

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between 59 and 85 percent. However, there is a subset of patients with stage II cancers who do benefit from adjuvant chemotherapy.Stage III colorectal cancers exist when cancer is present in one or more lymph nodes with any level of bowel wall penetration. Colon resection and, in most cases, postoperative chemotherapy yield a five-year survival rate between 44 and 84 percent depending on the subset within stage III cancers.

Stage IV colorectal cancers are present when cancer has metastasized to other locations in the body and has a five-year survival of 10 percent or less. Surgical resection of the primary cancer site is appropriate in almost all cases. When surgical or radiation therapy treatment can be used to eliminate all metastatic disease, the patient’s five-year survival may approach 25 percent. Radiation therapy is used in select cases and chemotherapy is recommended for all.

With rectal cancer, preoperative radiographic testing is critical to determine the proper treatment recommendations. Rectal ultrasound and, more recently, rectal MRI (which is available at St. Anthony’s) are used to identify whether the cancer is stage I, II or III before surgery. Stage I rectal cancers are treated with surgery alone and yield a five-year survival rate of 70-80 percent. Both stage II and stage III rectal cancers are treated most often with preoperative radiation and chemotherapy followed by an appropriate rest period before surgical resection. In nearly all cases, these patients should receive further chemotherapy after healing from their surgery. Five-year survival rates for stage II is 50-60 percent and stage III is 30-40 percent.

Stage IV rectal cancers are treated similarly to stage IV colon cancers.

All of the latest treatments for colorectal cancer are available at St. Anthony’s Medical Center. State-of-the-art surgical treatments include laparoscopic colectomy and other minimally invasive surgical techniques to remove the cancer. Transanal endoscopic microsurgery is available for select early rectal cancers. This outpatient procedure allows the patient to return to work and a normal lifestyle within a few days. Today, with rare exception, if patients have a rectal cancer that does not directly invade the anal canal, they can be reassured a permanent colostomy will not be necessary.

As described, even when colon and rectal cancers are treated with the latest and most sophisticated techniques, some patients will develop a cancer recurrence. Careful monitoring is critical after treatment for a minimum of five years with an appropriate history, physical examination, laboratory evaluations and radiographic testing. When patients have their recurrent cancer detected early, and treated with the selective use of surgery, radiation and/or chemotherapy, there is a greater probability for improved quality of life and, in some instances, cure.

David Schuval M.D. FACS FASCRS

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The Pathologist’s Role in the Diagnosis, Staging and Treatment of Colorectal Cancer Colon and rectal cancers are amongst the most frequent cancers diagnosed in Americans. These cancers, often considered together as colorectal cancer, are one of the most frequent causes of cancer deaths. Colorectal cancer rates can be decreased, and deaths from many of these cancers prevented, by screening and surveillance programs for early detection and removal of colorectal polyps. Polyps are collections of precancerous cells which represent an overgrowth in abnormal colorectal lining cells. They may be flat or raised above the surrounding tissue, and are usually visible via colonoscopy. Small polyps may be removed via colonoscopy; larger polyps may require surgery for removal. If not removed, over time colorectal polyps may undergo further changes, including genetic mutations, and become cancer (carcinoma). Colorectal carcinomas may also be detected by colonoscopy, and are usually removed (resected) by surgery.

Pathologists are physicians who specialize in the diagnosis of human diseases (pathology) by examination of tissue. Pathologists encounter colorectal polyps and cancers in both endoscopic biopsies and surgically removed segments of colon and rectum. These tissues are placed in formalin, a fixative which helps preserve cellular detail, and then examined by the pathologist.

Small biopsy specimens are used in their entirety to produce slides for microscopic examination. Larger specimens, including colon and rectum removed surgically, are grossly (with the naked eye) examined and dissected by the pathologist to select the areas of most significance for microscopic examination. These areas include the tumor or polyp itself and its relationship to the edges of surgical resection (margins of the specimen). For the polyp or cancer, size, shape, color, consistency, and distance from the margins are noted and documented in the pathology report. The presence or absence of invasion into the bowel wall is also noted. Additional characteristics of any invasion and the status of the margins are further classified upon microscopic exam (see below).

An important feature in the staging of colorectal cancers is the status of the lymph nodes. These are normal structures in the fat surrounding the colon and rectum, where lymphocytes and inflammatory cells cluster, and where lymphatic channels drain. These are typically the sites where colorectal cancers first metastasize, and are therefore important to examine to assess for metastatic colorectal cancer. These lymph nodes must be dissected, or teased out of their surrounding fat, by the pathologist. Often lymph nodes are quite obvious, and may even be enlarged, up to several centimeters (1-2 inches), due to inflammation or metastatic cancer. However these lymph nodes may also be quite small or few in number in some cases (eg, smaller specimens, after radiation or chemotherapy, elderly

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patients, rectal site). Tiny nodes may measure only 1-2 millimeters, and these pinpoint structures are challenging for the pathologist to see and feel in what may be an abundance of fat attached to the colorectal specimen. It’s important to find all of the lymph nodes and examine them microscopically for the presence of absence of metastatic cancer. The goal for the surgeon and pathologist for accurate staging is to retrieve at least 12 lymph nodes from all colorectal surgical resections.

Once the areas of interest of the colorectal polyp or tumor are selected during gross examination and dissection by the pathologist, the tissue is processed overnight by progressive dehydration, and then embedded in paraffin wax by histotechnologists in our laboratory. These formalin-fixed, paraffin-embedded tissues are then cut in approximately 4-5 micron slices and mounted on slides which are then stained, and examined by the pathologist using a microscope.

Polyps are of many types, the two most common of which are completely benign hyperplastic polyps, and precancerous adenomatous polyps. All are examined carefully to exclude the presence of carcinoma. Biopsies of carcinomas are also performed endoscopically, and are likewise carefully examined to confirm the endoscopist’s impression of cancer and provide details about the microscopic appearance in the pathology report.

Microscopic examination of the resected colorectal cancer specimen is a detailed process, and includes creating a report which clarifies the characteristics of the cancer. These include:

• type of cancer (the vast majority of colorectal cancers are adenocarcinomas)• grade or degree of differentiation (how closely the tumor resembles normal colorectal glands)• depth of invasion by the cancer into the colorectal wall (the “T” stage)• presence or absence of lymphatic or vascular invasion• presence or absence of lymph node metastases, their number and size (the “N” stage)• status of the margins (whether the cancer was completely removed)• any other polyps or abnormalities in the specimenIn addition, in patients who have undergone pre-operative

chemotherapy and /or radiation therapy, the pathologist assesses for treatment effect, which provides information on how well the tumor has responded to the treatment. If there is clinical evidence of metastatic carcinoma beyond the colorectal lymph nodes, those sites (the most common is the liver) are typically biopsied and the pathologist examines the tumor to ensure it is similar in microscopic appearance to the colorectal cancer. All of this detailed information is included in a comprehensive pathology report and to provide details for the treating physicians (surgeon, oncologist, radiation oncologist)

Ronna F. Lodato, M.D.

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who use it to craft the appropriate treatment plan for a given individual. The pathologic stage of the cancer (I-IV) is a combination of details about the size and depth of the tumor invasion (ranging from T1-4), lymph node metastases (N0-2), and any metastatic cancer outside the nodes (M0-1).

Additional pathologic studies performed in our lab may include immunohistochemical staining of the cancer using antibodies to certain substances found on tumor cells. This is to clarify exact tumor type in tumors that appear unusual microscopically. Genetic testing is sometimes performed on tumors to look for mutations that suggest genetic susceptibility to cancer; these are typically performed at reference pathology laboratories on paraffin blocks from our hospital.

At St. Anthony’s Medical Center, all 6 board certified pathologists, with a combined 100+ years of practice experience, are trained to diagnose colorectal specimens. We receive about 20 colorectal specimens a day, including about 120 colorectal cancer surgical resections each year. We communicate with our clinical colleagues who treat these patients via pathology reports, telephone calls, and Tumor Conferences, where a multidisciplinary team including surgeons, medical and radiation oncologists, radiologists and pathologists discuss cancer cases and develop individualized treatment plans. This ensures we serve our mission, to provide the best care for every patient, every day.

Dr. Lodato

Radiation therapy and rectal cancerRadiation therapy has been used in rectal cancer for some time due

to the problem of local recurrences in the operative bed after surgery. The rationale is based on the anatomical considerations of where the rectum lies. As opposed to the colon, which is largely intraperitoneal free floating in the abdomen, the rectum represents the transition of the intestinal tract out of the abdomen and to the skin surface at the anus. As such, the large colon transitions from a free floating structure to one that passes outside of the lining of the abdomen into an area that would be considered retroperitoneal surrounded by fat in the presacral space. The clinical implication is that cancers that invade into the muscular wall of the rectum can extend into the perirectal fat and into the lymph nodes nearby, making the risk for local recurrence quite a bit higher than you would see in colon cancer. This being the case, radiation therapy can help sterilize any microscopic disease remaining after surgery to help maintain control of the disease. Radiation therapy is also commonly given before surgery to decrease local recurrences.

Early studies in the use of radiation therapy in the postoperative setting showed an improvement in local control, but not in survival.

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Radiologic imaging in colorectal cancerRadiologic imaging has an impact in colorectal cancer in several

ways. Radiology used to play a larger role in the initial diagnosis of colon cancer with the barium. Over time, colonoscopy has nearly replaced the barium enema since it is very accurate and polyps can biopsied or removed in the same procedure. Keep in mind that routine screening colonoscopy can reduce your chance of dying from colon cancer by 90 percent. A few centers are beginning to perform CT colonoscopy, which uses a specialized CT protocol and reconstructions to see the colon. It has positive and negative features, but is not use widely at this time.

Radiology plays a much larger role in the staging of colon cancer. Once the diagnosis of colon cancer has been made, CT and PET scanning are used to evaluate the extent of the disease. CT scanning can often show if the cancer has extended through the wall of the colon to invade adjacent organs or tissues in the abdomen or pelvis. It is also used to evaluate the liver, which is often an early organ to

Eric J. Sutphen, M.D.

It wasn’t until the advent of concurrent chemotherapy along with radiation therapy that survival benefits were seen. These studies showed a 20-30 percent improvement in all indices of local control, disease free survival, and overall survival in the late 1980s. This ushered in the current state of the art for rectal cancer, including all three modalities of surgery, radiation therapy and chemotherapy as the standard for rectal cancer that is intermediate to advanced in stage.

The next issue that was addressed was that of doing preoperative radiation therapy and chemotherapy versus postoperative treatment. There are benefits and down sides to both forms of treatment, but there is some evidence in the literature showing a survival advantage to preoperative treatment. One down side of postoperative treatment is that the area of connection between the bowel and the anorectal region is in the area of radiation treatment, thus putting it at risk for leaks or strictures. Preoperative treatment on the other hand allows you to take an un-irradiated segment of bowel to connect to the anorectal region after radiation therapy thus increasing the chances of a competent connection and lessening the chances of stricture.

Advances in the technology of radiation therapy have also been beneficial in rectal cancer, including IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy) and RapidArc Treatment delivery, all of which are available here at St. Anthony’s Medical Center. These technologies increase the efficiency and accuracy of patient treatment, lessening time on the table and improving overall results and lessening complications.

Eric J. Sutphen, M.D.Medical Director Radiation Oncology

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Paul Oberle, M.D.

find metastatic lesions. If suspicious areas are identified, CT and US may be used to as an imaging guide to perform a needle biopsy. MRI is playing a larger role, particularly in the initial staging of rectal cancer. High resolution images of the MRI are used to determine if the cancer has invaded through the wall of the rectum into the adjacent perirectal fat and lymph nodes. This information is very important for the cancer team, who will then decide if chemotherapy or radiation therapy is needed prior to any surgical procedure. All of the preoperative imaging and testing is to assure that the patient has the best odds of beating the cancer.

After the initial staging and treatment, CT, PET, and ultrasound are used to monitor the cancer. CT and PET can be used to see how well the cancer is responding to chemotherapy and radiation therapy if metastatic lesions are present. They can also be used to periodically examine the chest, abdomen and pelvis where most of the metastatic or recurrent lesions will be found if they develop. Ultrasound is used primarily to evaluate or follow masses in the liver. The surveillance of the patient allows the cancer team to diagnose and treat any problems that may arise.

Paul Oberle, M.D.Diagnostic Radiology

314-525-1145

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Cancer Treatment & ServicesThe Cancer Care Center at St. Anthony’s Medical Center provides patients with comprehensive cancer care, utilizing state-of-the-art technology, patient-friendly treatment areas and a full scope of services, including:

• Breast Center St. Anthony’s Breast Center is located in the Medical Plaza building adjacent to the main hospital campus.

• Inpatient Oncology

• Outpatient Infusion

• Radiation Oncology

• Patient Resource Center

• Oncology Data Services

• Pathology

• Diagnositc Radiology

• Cancer Research: At St. Anthony’s Cancer Care Center, our patients have the opportunity to be considered for cutting-edge clinical research studies offered conveniently close to home. The National Cancer Institute (NCI) funds many clinical research studies around the nation. We participate in studies with many NCI sponsored research groups. All research studies are reviewed by St. Anthony’s Medical Center’s Institutional Review Board (IRB) which has been granted the endorsement of the Federal Office for Human Research Protections (OHRP), a division of the Department of Health and Human Services.

Support ServicesAs a full service medical center, St. Anthony’s provides a full and comprehensive scope of health care services to make the cancer journey easier for patients and their families, including:

• Palliative care

• Pastoral care services

• Social workers to assist families with finances, counseling, transportation, home care, emotional support and more

• Educational classes and support groups for patients and families

• Nutritional counseling

• Lymphedema program

• Hospice, in-home and on-campus hospice house

• St. Anthony’s Senior Services

• St. Anthony’s Wound Treatment Center.

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• Holistic therapies and complementary medicine, such as guided imagery, massage and meditation

• On-site amenities, including chapel, beautiful grounds with outdoor seating and multiple dining options

• Special programs focused on the cancer patient, including

professional makeup and hair-styling sessions, wigs and hats, and certificates for dinner and ice cream treats

• Access to literature that addresses all aspects of life during cancer treatment

• Senior Service Home Transportation for convenient and economical transportation for senior citizens and people with disabilities.

Reaching Out to the CommunityAs the leading health care provider in South St. Louis County and Jefferson County, as well as St. Clair and Monroe Counties in Illinois, St. Anthony’s Medical Center provides a wide spectrum of services to help improve the overall health of our served communities, including screenings, support groups and awareness campaigns.

Screenings: St. Anthony’s Medical Center provides screenings for skin cancer, prostate cancer, and head and neck cancer, as well as other health tests and screenings at specially designated events throughout the year.

Building awareness: St. Anthony’s also participates in a number of national cancer awareness events each year, including: Colorectal Cancer Awareness Day, the Great American Smoke-Out, Breast Cancer Awareness Month, and Cancer Survivors Day.

Support Groups: The Cancer Care Center provides support groups, co-sponsored by the American Cancer Society, including:

Man to Man Prostate Cancer Support Group Look Good…Feel Better, a free program that teaches beauty

techniques to women cancer patients in active treatmentThe Breast Cancer Support Group, a survivorship program for

patients.

St. Anthony’s Medical Center employee breast cancer survivors in front of the Cancer Care Center (October, 2012).

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Cancer data

Treatment Type # of PatientsNo Treatment 5Surgery Only 67XRT Only 0Chemo Only 4Combo TX 35Total 111

Cancer Site # of PatientsLung 241Breast 218Colorectal 159Prostate 149Melanoma 83Total 850

Stage # of Patients

Stage 0 (in situ) 2Stage 1 23Stage 2 32Stage 3 38Stage 4 14Unkown 2Total 111

RectalTreatment Type # of PatientsNo Treatment 1Surgery Only 20XRT Only 0Chemo Only 1Combo TX 26Total 48

Rectal Stage # of PatientsStage 1 19Stage 2 9Stage 3 10Stage 4 8Unknown 2Total 48

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C C C10010 Kennerly RoadSt. Louis, MO 63128

314-525-1355 • 314-525-1688www.stlouiscancer.org

Contact usSt. Anthony’s Medical Center314-525-1000

Radiation Oncology314-525-1688

Outpatient Infusion314-525-1625

Research, Clinical Trials314.525.4928

Oncology Data Services314-525-1240

Pathology314-525-4928

Diagnostic Radiology314-525-1145