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The Thoracic Oncology and Esophageal Disease Center Programs at the St. Joseph's Center for Thoracic Disease provide patient-centered care through a multidisciplinary team approach. The Thoracic Oncology and Esophageal Disease Programs represent the largest and most advanced programs of their kind in the Southwest. Specifically the programs available are:
Multidisciplinary Thoracic Oncology Program
The Thoracic Oncology Program at St. Joseph's specializes in a multidisciplinary approach to evaluating, diagnosing and treating individuals with known or suspected cancers of the lung, chest or esophagus. The program’s structure provides access to resources in a single visit, at a single location. The American College of Surgeons' Commission on Cancer supports multidisciplinary care as a best practice model. Services include state-of-the-art diagnostic technology, treatments, a second-opinion service and supportive care.
Special Aspects of the Program:
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A team approach to care with an experienced group of specialists who are nationally recognized leaders in the treatment of lung and esophageal cancers as well as metastatic disease to the chest.
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A multidisciplinary clinic with medical/surgical consultations and supportive-care consultations.
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Multidisciplinary case conferences to plan and coordinate care
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Collaboration with Barrow Neurological Institute® for neurological metastatic disease
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Second-opinion pathology reviews.
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Cancer nurse coordinators
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Access to a wide variety of standard and clinical research trial chemotherapeutic protocols. Participation in national, regional and cooperative group trials
Thoracic Oncology Clinic
New patients are seen in the Thoracic Oncology Clinic. A team of physicians from select specialties evaluates the patients. A thoracic oncology conference is held immediately after the clinic and is attended by additional faculty, fellows, residents, clinical and research nurses, and other support staff. Each patient's case is presented, and each sub-specialty group gives input on that particular patient’s management. A personalized treatment plan is discussed. Tests and procedures are scheduled in a coordinated, rapid manner, and follow-up plans are established. Referring physicians are notified of management decisions and recommendations, usually within 24 hours of the patient’s visit to the clinic.
State-of-the-Art Radiation Therapy
Our Thoracic Oncology Program has a team of experts in radiation oncology who utilize the latest technology to provide patients with the best possible treatment outcomes.
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External beam, 3-D conformal radiotherapy, stereotactic radiotherapy (brachytherapy, Gamma Knife, thermal ablation)
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Participation in RTOG protocols
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Radiosurgery
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CyberKnife, the latest in radiosurgical treatments, has been used to successfully treat more than 6,000 patients worldwide with lesions located in such areas as the brain, spine, lung and pancreas. This advanced technology uses image-guided robotics to deliver surgically precise radiation to destroy intracranial and extracranial lesions such as spinal and soft tissue tumors without the need for open surgery.
Tumor Ablation
For those who are not surgical candidates, radiofrequency ablation is often a viable alternative. Results of radiofrequency ablation in terms of global and disease-free survival currently approach those reported for surgical resection.
Ablation techniques include:
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Chemoembolization
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Cryoablation
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High-intensity focused ultrasound
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Laser ablation
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Microwave ablation
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Percutaneous ethanol instillation (PEI)
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Radiofrequency ablation (RFA)
Benefits
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Feasibility of treatment in previously resected patients and non-surgical candidates due to extent of metastatic involvement, age and co-morbidities.
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Repeatability of treatment when incomplete and when local recurrence or development of metachronous lesions occur.
The Esophageal Disease Center
The Esophageal Disease Center within the HLI Center for Thoracic Disease is the only dedicated center in Arizona offering comprehensive multidisciplinary evaluation for esophageal disease in adults and children. Our team comprises specialists in thoracic surgery, radiology, gastroenterology, surgery, pulmonology, rehabilitation, speech pathology, otolaryngology and pathology.
The team evaluates all esophageal disorders including:
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Diverticulae
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Esophageal and gastric cancer
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Gastroesophageal reflux disease, including Barrett's
esophagus
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Hiatal hernia
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Swallowing disorders, including achalasia and diffuse esophageal spasm
The Center works closely with the patient's physician to monitor and offer ongoing treatment recommendations.
Advanced Evaluation Techniques
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Esophageal pH monitoring using either catheter probes or the Bravo probe (remote radiotelemetry device)
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Manometry using ManoScan (high-resolution esophageal manometry). With solid-state micro transducer technology, assessment of the entire esophagus including the cricopharyngeus is performed. Reports are generated within 72 hours and returned to the referring physician.
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Endoscopy
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Esophageal ultrasound
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Digital video-esophagram to evaluate real-time swallowing and bolus transport
Expertise in Treatment
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Barrett's Ablation (Bârrx). A new technique using radio-frequency ablation to circumferentially remove the Barrett's lining in an outpatient setting. Patients have the opportunity of participating in a Barrett's registry to follow the progression of their disease.
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Surgical therapy for GERD including minimally-invasive approaches (lap Nissen) and revision surgery after failure of previous procedures
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Resection of diverticulae, cricopharyngeal myotomy and Heller myotomy
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Resection of esophageal and gastric cancer, in the context of multidisciplinary decision-making regarding the benefits of neo- and adjuvant chemo-radiation
- Laser therapy, Argon beam coagulation, stenting, and brachytherapy are available to treat esophageal and gastric cancers in the palliative setting
To view a brief webcast of a recent lecture on this topic click here
Faculty Physicians
Ross Bremner, MD, PhD, Director, Center for Thoracic Disease
Referrals and Consultations to the Center for Thoracic Disease
For more information about our physicians and services, or to refer a patient, please contact us at 1-877-602-4111 or e-mail us at lungcancer@chw.edu. For more information or referrals to the Esophageal Disease Center, please call 602-406-6770.
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