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Interventional Radiology

Welcome to the Department of Interventional Radiology website.

Interventional Radiology
As part of a multidisciplinary team approach in the treatment of cancer and cancer related disorders, interventional oncology is the fourth arm of cancer therapies, including medical oncology, surgical oncology and radiation oncology. Using image-guided, minimally-invasive surgery in combination with the most advanced diagnostic and molecular imaging techniques, interventional radiologists specialize in both minimal and non-invasive therapies, resulting in shorter recovery times and decreased post-procedural complications which, in turn, means shorter hospital stays and more outpatient procedures.
 
Specialty Treatment Programs
  • Deep vein thrombosis
  • Focal ablation therapy
  • Loco-regional therapy
  • Portal vein embolization
 
Our team and mission
City of Hope's interventional radiology team is comprised of a dedicated group of health-care professionals who are committed to providing exceptional patient care, clinical and translational research, and educational programs for our patients and the community abroad. Using the most advanced image-guided techniques, we provide a wide array of minimally-invasive procedures and surgeries to treat many types of benign and malignant conditions, including diseases of the blood vessels and many different types of cancers.
 
As part of a treatment team, we often work in collaboration with other clinical services and physicians, such as medical oncologists, surgical oncologists and radiation oncologists, to provide the most comprehensive care for each of our cancer patients. In a truly multidisciplinary team approach, our interventional radiologists, nurses and staff play pivotal roles in the overall care of each patient seen and treated here at City of Hope and are dedicated to helping our patients fight and overcome cancer.

If you would like to hear more, or would like to see one of our physicians in consultation, please contact us to schedule an appointment.
 
 

Deep Vein Thrombosis and Pulmonary Emboli

Certain cancer patients may develop blood clots in their arms or legs due to the biology of their tumors, or due to other risk factors. These blood clots are called "deep vein thrombus" or "DVTs" and sometimes can dislodge and travel into the venous circulation of the lungs, which can lead to a life-threatening condition called pulmonary embolus. Oftentimes these conditions can be treated with blood thinning medication alone. However, for some individuals, this may not be an option, or more aggressive treatment of their clots may be required.
 
Sometimes a simple procedure can be performed to place a filter device in one of the large veins that acts as a "net" to catch any large clots that may break off and migrate to the lungs.
 
Other times, more direct therapy, such as, "clot-busting" must be performed by the interventionalist.
 
Post-Thrombotic Syndrome
In addition to causing pulmonary emboli, deep venous thrombosis is a very serious condition that can cause permanent irreversible damage to veins of the leg and their valves, known as post-thrombotic syndrome. In the United States alone, approximately 600,000 new cases of acute DVTs are diagnosed each year, and 1 in every 100 people who develops a DVT may eventually succumb to this disorder or its complications. Post-thrombotic syndrome results in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers.
 
Risk Factors for DVTs
• Previous DVT or family history
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery
• Advanced age
• Hormone replacement therapy or oral contraceptives (OCP)
• Pregnancy or post-partum
• Cancer
• Coagulation abnormalities
• Obesity
 
Some Symptoms
• Discoloration of the legs
• Calf or leg pain or tenderness with leg swelling
• Prominent surface veins
• Leg fatigue
• Post thrombotic syndrome
• Life-threatening pulmonary emboli
 
Treatments
Catheter-directed thrombolysis is performed under direct imaging guidance by an interventional radiologist. This procedure, performed in a hospital’s interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserves valve function to minimize the risk of post-thrombotic syndrome or even pulmonary emboli. Treatment duration may range from one to a few days.
 
Enteric Access (Gastrostomy Tube)
Patients with Head and Neck cancer and certain individuals who are unable to tolerate oral intake of nutrition, may require additional direct enteric supplementation via a feeding tube. Doctors may sometimes recommend placement of a gastrostomy (G-tube) tube in the stomach if the patient is unable to take sufficient food by mouth. In this procedure, the feeding tube is inserted through a small nick in the skin and placed into the stomach under image-guidance.
 
More Information

Focal Tumor Interventions Non-surgical Resection

What is Focal Ablation Therapy?
Focal ablation therapy is a minimally invasive treatment for cancer or other symptomatic soft tissue or bone lesions. It is an image-guided technique that utilizes small, percutaneously placed electrodes (needles) or probes to destroy cancer cells using chemical (ethanol), thermal-based (radiofrequency ablation, cryosurgery), or non-thermal (irreversible electroporation) techniques.
 
Radiofrequency Ablation and Cryoablative Surgery
In both radiofrequency ablation (heat) and cryosurgery (cold), imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide needle-like electrodes into a cancerous tumor or symptomatic lesion. Precisely localized heat or cold is then applied at the desired location and margins, which destroys the abnormal cells, all without the need for invasive surgery. Advantages of this form of therapy include decreased pain, less complications, faster recovery times and may potentially be done on a same-day outpatient basis.
 
What are some common areas of treatment?
Focal ablation is used to treat many different cancers, including:
• Liver - primary liver tumors, colon or other cancers that spread to the liver (ie. breast, pancreas, neuroendocrine, melanoma)
• Lung - primary and metastatic lesions
• Kidney - primary tumors
• Bone - cancers for pain palliation, osteoid osteomas
 
How Do I Prepare for the Procedure?
You should report to your doctor all medications that you are taking and if you have any allergies, especially to certain medications or intravenous contrast dye (x-ray dye).
You may be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or any blood thinners you may be on for a specified period of time before your procedure.
Prior to your procedure, you may require a blood test to determine how well your liver and kidneys are functioning and whether your blood clots normally. An EKG may also be ordered.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
You may be instructed not to eat or drink anything after midnight before your procedure.
Your doctor will tell you which medications you may take in the morning.
You should plan to have a relative or friend drive you home after your procedure.
 
Where will the procedure be performed?
In most cases, procedures will performed in a CT procedural suite by a professionally trained minimally-invasive specialist. Most procedures will be performed under general anesthesia. However, some patients may qualify for deep sedation only.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol. Stringent follow-up is vital as residual or recurrent tumors may be detected when they are small and may be treated early with repeat focal ablation.

Bone Tumor Ablation and Cementoplasty
Certain individuals with bone tumors/metastases outside of the spine may also benefit from combination tumor ablation and cementoplasty in order to debulk the bone-eroding and painful tumor, while stabilizing the adjacent bone with cement injection. This process is performed in a similar fashion as with Vertebroplasty and Kyphoplasty and may offer palliative relief to qualified individuals.

More Information
Interventional Radiology Treatments for Liver Cancer
Chemoembolization
 

Intra-arterial Tumor Treatment - Locoregional Therapy

What is "locoregional" therapy?
Minimally-invasive, intravascular, catheter-based therapies at targeting the individual blood vessels that directly supply tumor, using localized high-dose chemotherapy, blood-supply constricting embolic particles, and/or radioactive particles. There are many forms of locoregional, transcatheter-based therapies, with newer, increasingly effective treatment devices and regimens being developed. These therapies are considered “bridging therapy”, but are also at times employed as definitive treatment in certain situations.

Chemoembolization (TACE, Precision-TACE)
Chemoembolization is a form of locoregional therapy that specifically targets tumors by simultaneously delivering high dose local cancer killing agents, while also, blocking the blood vessels that supply the tumor (embolization). The end effect is higher local doses of the tumoricidal agent, without the typical side-effects of traditional systemic chemotherapy. Additionally, by closing the blood vessels that supply the tumor, cancer cells that may survive the chemotherapy starve resulting in eventually tumor regression.
 
Radiotherapy (Y-90)
Internal radiation therapy is another form of locoregional therapy that utilizes targeted delivery of small, radioactive particles into certain liver tumors, resulting in death of the rapidly dividing tumor cells, while preserving the relatively sturdy normal liver cells.
 
What are some common areas of treatment?
Currently, locoregional therapy is primarily being used in the setting of liver cancers, both primary and metastatic tumors.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol.
 

Interventional Radiology Team

Pain Palliation

Many patients with cancer often experience chronic, debilitating pain, whether due to the main tumor itself, or from a painful metastasis involving other soft tissue organs or bone. Pain can manifest as focal bone and back pain, soft tissue pain, or as diffuse "belly" pain in patients with spread of their tumors within the abdomen. Due to the excruciating nature of their pain, many patients often require large amounts of pain medication just to remain functional. However, these medications, especially narcotics, may lead to many other problems, such as constipation, nausea, and in some situations, addiction. Certain patients may, however, qualify for specific pain reduction procedures provided by a minimally-invasive specialist.
Below are some of the procedures that we offer, both for cancer related, and other benign, sources of acute and chronic pain.
• Celiac Neurolytic Blockade (for intractable belly pain)
• Bone Pain Palliation (for bone metastases and other lesions)
• Spinal Nerve Block
 
For more information, please contact us.

Pediatric Interventions

As with adults with cancer, children may also require similar interventions as the ones described in the other sections. Often these must be performed under general anesthesia due to the young age of the patients; however, similar minimally invasive procedures are available by the interventional oncologist.
 
 

Portal Vein Embolization

In certain patients with primary or metastatic liver cancer, liver transplantation may not be an option, and surgical resection and/or tumor ablation may be the only solutions. However, removing too much liver tissue may result in life-threatening liver failure. Therefore, a procedure can be performed prior to liver resection or ablation in order to promote liver regeneration and growth in non-diseased liver segments. This is accomplished by "starving" and shrinking the diseased segment of liver, while sparing viable liver and improving the success of surgery and patient recovery. This can be performed both as inpatient and outpatient procedures by the interventional oncologist.

Tumor Biopsy

Once a mass has been discovered, it will often require a tissue sample/biopsy in order for the pathologist to determine the diagnosis. This can be a challenging time for patients as undergoing biopsies can be difficult to bear for patients and loved ones.

Therefore, the City of Hope interventional oncology team offers minimally invasive, percutaneous or transvenous biopsies that can be conducted as outpatient procedures in the evaluation of liver, kidney, thyroid, bone, lung, and other soft tissue masses.

Depending on the type and location of the mass being tested, the doctor will either perform Fine Needle Aspiration (FNA) or a Core Needle Biopsy (CNB), which will immediately be sent to the cytopathologist or surgical pathologist for special staining and results.

Tumor Fiducials

Some patients may qualify for external beam irradiation of their tumors. However, in order to accurately target the lesion, pre-procedural "marking' of the tumor margins is necessary for the radiation oncologist to adequately plan the treatment. This pre-procedural marking is done by placement of targetable clips or coils within the tumor using imaging guidance by the interventional radiologist.

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Philanthropy Department at 800-667-5310 or philanthropy@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 

Interventional Radiology

Interventional Radiology

Welcome to the Department of Interventional Radiology website.

Interventional Radiology
As part of a multidisciplinary team approach in the treatment of cancer and cancer related disorders, interventional oncology is the fourth arm of cancer therapies, including medical oncology, surgical oncology and radiation oncology. Using image-guided, minimally-invasive surgery in combination with the most advanced diagnostic and molecular imaging techniques, interventional radiologists specialize in both minimal and non-invasive therapies, resulting in shorter recovery times and decreased post-procedural complications which, in turn, means shorter hospital stays and more outpatient procedures.
 
Specialty Treatment Programs
  • Deep vein thrombosis
  • Focal ablation therapy
  • Loco-regional therapy
  • Portal vein embolization
 
Our team and mission
City of Hope's interventional radiology team is comprised of a dedicated group of health-care professionals who are committed to providing exceptional patient care, clinical and translational research, and educational programs for our patients and the community abroad. Using the most advanced image-guided techniques, we provide a wide array of minimally-invasive procedures and surgeries to treat many types of benign and malignant conditions, including diseases of the blood vessels and many different types of cancers.
 
As part of a treatment team, we often work in collaboration with other clinical services and physicians, such as medical oncologists, surgical oncologists and radiation oncologists, to provide the most comprehensive care for each of our cancer patients. In a truly multidisciplinary team approach, our interventional radiologists, nurses and staff play pivotal roles in the overall care of each patient seen and treated here at City of Hope and are dedicated to helping our patients fight and overcome cancer.

If you would like to hear more, or would like to see one of our physicians in consultation, please contact us to schedule an appointment.
 
 

Deep Vein Thrombosis and Pulmonary Emboli

Deep Vein Thrombosis and Pulmonary Emboli

Certain cancer patients may develop blood clots in their arms or legs due to the biology of their tumors, or due to other risk factors. These blood clots are called "deep vein thrombus" or "DVTs" and sometimes can dislodge and travel into the venous circulation of the lungs, which can lead to a life-threatening condition called pulmonary embolus. Oftentimes these conditions can be treated with blood thinning medication alone. However, for some individuals, this may not be an option, or more aggressive treatment of their clots may be required.
 
Sometimes a simple procedure can be performed to place a filter device in one of the large veins that acts as a "net" to catch any large clots that may break off and migrate to the lungs.
 
Other times, more direct therapy, such as, "clot-busting" must be performed by the interventionalist.
 
Post-Thrombotic Syndrome
In addition to causing pulmonary emboli, deep venous thrombosis is a very serious condition that can cause permanent irreversible damage to veins of the leg and their valves, known as post-thrombotic syndrome. In the United States alone, approximately 600,000 new cases of acute DVTs are diagnosed each year, and 1 in every 100 people who develops a DVT may eventually succumb to this disorder or its complications. Post-thrombotic syndrome results in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers.
 
Risk Factors for DVTs
• Previous DVT or family history
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery
• Advanced age
• Hormone replacement therapy or oral contraceptives (OCP)
• Pregnancy or post-partum
• Cancer
• Coagulation abnormalities
• Obesity
 
Some Symptoms
• Discoloration of the legs
• Calf or leg pain or tenderness with leg swelling
• Prominent surface veins
• Leg fatigue
• Post thrombotic syndrome
• Life-threatening pulmonary emboli
 
Treatments
Catheter-directed thrombolysis is performed under direct imaging guidance by an interventional radiologist. This procedure, performed in a hospital’s interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserves valve function to minimize the risk of post-thrombotic syndrome or even pulmonary emboli. Treatment duration may range from one to a few days.
 
Enteric Access (Gastrostomy Tube)
Patients with Head and Neck cancer and certain individuals who are unable to tolerate oral intake of nutrition, may require additional direct enteric supplementation via a feeding tube. Doctors may sometimes recommend placement of a gastrostomy (G-tube) tube in the stomach if the patient is unable to take sufficient food by mouth. In this procedure, the feeding tube is inserted through a small nick in the skin and placed into the stomach under image-guidance.
 
More Information

Focal Tumor Interventions Non-surgical Resection

Focal Tumor Interventions Non-surgical Resection

What is Focal Ablation Therapy?
Focal ablation therapy is a minimally invasive treatment for cancer or other symptomatic soft tissue or bone lesions. It is an image-guided technique that utilizes small, percutaneously placed electrodes (needles) or probes to destroy cancer cells using chemical (ethanol), thermal-based (radiofrequency ablation, cryosurgery), or non-thermal (irreversible electroporation) techniques.
 
Radiofrequency Ablation and Cryoablative Surgery
In both radiofrequency ablation (heat) and cryosurgery (cold), imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide needle-like electrodes into a cancerous tumor or symptomatic lesion. Precisely localized heat or cold is then applied at the desired location and margins, which destroys the abnormal cells, all without the need for invasive surgery. Advantages of this form of therapy include decreased pain, less complications, faster recovery times and may potentially be done on a same-day outpatient basis.
 
What are some common areas of treatment?
Focal ablation is used to treat many different cancers, including:
• Liver - primary liver tumors, colon or other cancers that spread to the liver (ie. breast, pancreas, neuroendocrine, melanoma)
• Lung - primary and metastatic lesions
• Kidney - primary tumors
• Bone - cancers for pain palliation, osteoid osteomas
 
How Do I Prepare for the Procedure?
You should report to your doctor all medications that you are taking and if you have any allergies, especially to certain medications or intravenous contrast dye (x-ray dye).
You may be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or any blood thinners you may be on for a specified period of time before your procedure.
Prior to your procedure, you may require a blood test to determine how well your liver and kidneys are functioning and whether your blood clots normally. An EKG may also be ordered.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
You may be instructed not to eat or drink anything after midnight before your procedure.
Your doctor will tell you which medications you may take in the morning.
You should plan to have a relative or friend drive you home after your procedure.
 
Where will the procedure be performed?
In most cases, procedures will performed in a CT procedural suite by a professionally trained minimally-invasive specialist. Most procedures will be performed under general anesthesia. However, some patients may qualify for deep sedation only.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol. Stringent follow-up is vital as residual or recurrent tumors may be detected when they are small and may be treated early with repeat focal ablation.

Bone Tumor Ablation and Cementoplasty
Certain individuals with bone tumors/metastases outside of the spine may also benefit from combination tumor ablation and cementoplasty in order to debulk the bone-eroding and painful tumor, while stabilizing the adjacent bone with cement injection. This process is performed in a similar fashion as with Vertebroplasty and Kyphoplasty and may offer palliative relief to qualified individuals.

More Information
Interventional Radiology Treatments for Liver Cancer
Chemoembolization
 

Intra-arterial Tumor Treatment - Locoregional Therapy

Intra-arterial Tumor Treatment - Locoregional Therapy

What is "locoregional" therapy?
Minimally-invasive, intravascular, catheter-based therapies at targeting the individual blood vessels that directly supply tumor, using localized high-dose chemotherapy, blood-supply constricting embolic particles, and/or radioactive particles. There are many forms of locoregional, transcatheter-based therapies, with newer, increasingly effective treatment devices and regimens being developed. These therapies are considered “bridging therapy”, but are also at times employed as definitive treatment in certain situations.

Chemoembolization (TACE, Precision-TACE)
Chemoembolization is a form of locoregional therapy that specifically targets tumors by simultaneously delivering high dose local cancer killing agents, while also, blocking the blood vessels that supply the tumor (embolization). The end effect is higher local doses of the tumoricidal agent, without the typical side-effects of traditional systemic chemotherapy. Additionally, by closing the blood vessels that supply the tumor, cancer cells that may survive the chemotherapy starve resulting in eventually tumor regression.
 
Radiotherapy (Y-90)
Internal radiation therapy is another form of locoregional therapy that utilizes targeted delivery of small, radioactive particles into certain liver tumors, resulting in death of the rapidly dividing tumor cells, while preserving the relatively sturdy normal liver cells.
 
What are some common areas of treatment?
Currently, locoregional therapy is primarily being used in the setting of liver cancers, both primary and metastatic tumors.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol.
 

Interventional Radiology Team

Interventional Radiology Team

Pain Palliation

Pain Palliation

Many patients with cancer often experience chronic, debilitating pain, whether due to the main tumor itself, or from a painful metastasis involving other soft tissue organs or bone. Pain can manifest as focal bone and back pain, soft tissue pain, or as diffuse "belly" pain in patients with spread of their tumors within the abdomen. Due to the excruciating nature of their pain, many patients often require large amounts of pain medication just to remain functional. However, these medications, especially narcotics, may lead to many other problems, such as constipation, nausea, and in some situations, addiction. Certain patients may, however, qualify for specific pain reduction procedures provided by a minimally-invasive specialist.
Below are some of the procedures that we offer, both for cancer related, and other benign, sources of acute and chronic pain.
• Celiac Neurolytic Blockade (for intractable belly pain)
• Bone Pain Palliation (for bone metastases and other lesions)
• Spinal Nerve Block
 
For more information, please contact us.

Pediatric Interventions

Pediatric Interventions

As with adults with cancer, children may also require similar interventions as the ones described in the other sections. Often these must be performed under general anesthesia due to the young age of the patients; however, similar minimally invasive procedures are available by the interventional oncologist.
 
 

Portal Vein Embolization

Portal Vein Embolization

In certain patients with primary or metastatic liver cancer, liver transplantation may not be an option, and surgical resection and/or tumor ablation may be the only solutions. However, removing too much liver tissue may result in life-threatening liver failure. Therefore, a procedure can be performed prior to liver resection or ablation in order to promote liver regeneration and growth in non-diseased liver segments. This is accomplished by "starving" and shrinking the diseased segment of liver, while sparing viable liver and improving the success of surgery and patient recovery. This can be performed both as inpatient and outpatient procedures by the interventional oncologist.

Tumor Biopsy

Tumor Biopsy

Once a mass has been discovered, it will often require a tissue sample/biopsy in order for the pathologist to determine the diagnosis. This can be a challenging time for patients as undergoing biopsies can be difficult to bear for patients and loved ones.

Therefore, the City of Hope interventional oncology team offers minimally invasive, percutaneous or transvenous biopsies that can be conducted as outpatient procedures in the evaluation of liver, kidney, thyroid, bone, lung, and other soft tissue masses.

Depending on the type and location of the mass being tested, the doctor will either perform Fine Needle Aspiration (FNA) or a Core Needle Biopsy (CNB), which will immediately be sent to the cytopathologist or surgical pathologist for special staining and results.

Tumor Fiducials

Tumor Fiducials

Some patients may qualify for external beam irradiation of their tumors. However, in order to accurately target the lesion, pre-procedural "marking' of the tumor margins is necessary for the radiation oncologist to adequately plan the treatment. This pre-procedural marking is done by placement of targetable clips or coils within the tumor using imaging guidance by the interventional radiologist.

Support This Program

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Philanthropy Department at 800-667-5310 or philanthropy@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 
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