The Wellington Blood & Cancer Centre
The Wellington Blood & Cancer Centre at Capital and Coast District Health Board (C&CDHB) encompasses secondary and tertiary Medical Oncology, Radiation Oncology, Haematology, Anticoagulation and Palliative Care Services.
The Wellington Blood & Cancer Centre (WBCC) incorporates the three specialties of Medical Oncology, Radiation Oncology and Clinical Haematology into an integrated regional and supra-regional inpatient and outpatient cancer service. There are strong links with the Paediatric Oncology service and Palliative Care services within C&CDHB.
Wellington Blood & Cancer Centre outreach consultation services are provided at Masterton and Wairau Hospitals. Clinics are also held at Kenepuru Hospital, Hutt Hospital and occasionally Nelson.
The following services are provided at the Wellington Blood & Cancer Centre:
- Medical Oncology
- Radiation Oncology
- Haematology, including Clinical Haematology and Anticoagulation Service
- Palliative Care.
What is Cancer?
Everyone’s body is made up of millions of cells, which normally grow, divide and are renewed in a balanced or programmed way. Sometimes this process is disrupted and the cells grow in an uncontrolled way – a solid group of these cells is called a tumour. Another word commonly used for tumour is growth and it can mean the same thing.
A tumour/growth can be benign (grows but will not spread into different parts of the body) or malignant (spreads into different parts of the body as well as grows locally). Tumours spread by cells travelling through the lymphatic system (the body’s cleaning system) to lymph nodes (often known as glands) or through blood to other organs in the body. These cells can then multiply. If this happens the cancer is called metastatic.
Cancer isn't contagious, so you can go on being close to family and friends.
What is Oncology?
Oncology is the area of medicine involving cancer. An oncologist is a doctor specialising in the treatment of cancer either with chemotherapy (medical oncologist) or radiation (radiation oncologist). Other doctors are involved in the treatment of cancer such as surgeons, palliative care specialists (doctors who specialise in the treatment of symptoms from cancer that cannot be cured) and general physicians (who often are involved in the diagnosis of cancer). If you have cancer you are likely to be referred to some of these doctors depending on the type of treatment that is advised. The Oncology Service also consists of specialised nurses, therapists and social workers as the diagnosis of cancer can affect people and their families in many ways. The Oncology Department also works alongside hospices and the Cancer Society who provide support to patients with the diagnosis of cancer.
What is Haematology?
Haematology is the branch of medicine concerned with the diagnosis and treatment of disorders of the blood and blood-forming organs. Such disorders may involve the:
- components of blood (cells and plasma)
- coagulation (blood clotting) process
- blood cell formation
- haemoglobin (oxygen-carrying protein on red blood cells) synthesis.
To help in the diagnosis of blood disorders, you will probably have to have blood samples taken for analysis in the laboratory. These may include:
- FBC (Full Blood Count): gives information on the number of cells (red blood cells, white blood cells, platelets) in your blood.
- ESR (Erythrocyte Sedimentation Rate): a screening test that may give an indication of inflammatory disease or abnormal protein levels.
- INR (International Normalised Ratio): monitors your clotting function when on warfarin (anticoagulant/anticlotting) therapy.
- Coagulation/Clotting Screen: a group of tests to check coagulation or clotting function.
Doctors who specialise in haematology are called haematologists.
Making the Diagnosis
Cancer is diagnosed with a number of tests but usually a biopsy is needed. This is where a sample of the lesion, growth or tumour is sent to the laboratory to be examined under the microscope. This can tell the doctors exactly what type of cancer is present and guides them to what sort of treatment might be best.
Samples can be obtained with different techniques:
- Fine needle aspirate (FNA): a small needle is inserted into a lump and some cells are sucked out and sent to the laboratory. If the lump is on the surface of your body the doctor will do this in the consultation room with some local anaesthetic injected into the skin so the procedure won’t hurt. If the tumour is inside your body an FNA can still be done but it is done with guidance from a CT scanner or ultrasound so the doctor can see where the needle needs to go. This is done by a specialist radiologist (a doctor trained in the specialty of x-rays).
- Biopsy: a small piece of a lesion is cut out and sent to the laboratory. If it is on the outside of your body this procedure is done with local anaesthetic (makes the area numb so it doesn’t hurt). Sometimes it can be done by putting tiny telescopes into areas they can’t reach to take the biopsy. Sometimes an operation is required to be sure about the diagnosis.
- Endoscopy: a flexible tube with a viewing lens and a fibre optic light on the end is passed through natural body orifices (openings) to view the colon (colonoscopy), stomach (gastroscopy) or lungs (bronchoscopy).
- Laparoscopy: similar to endoscopy, but requires a small cut (incision) to be made in the body such as the abdominal (tummy) wall. The laparoscope is then pushed through the incision to look for possible areas of cancer, which can then be biopsied. When this type of procedure is done in the chest it is called a thoracoscopy or mediastinoscopy.
Other tests are often needed to establish the diagnosis and extent of a cancer. These include blood and urine tests, CT or MRI scans, ultrasounds, nuclear medicine scans.
Once the diagnosis is established you will meet with various specialists to talk about what treatment options are available and the benefits and risks of those treatments as well as what the diagnosis means. It is a good idea to have a support person with you for these consultations as a lot of information is often given and it can be hard to take it all in. It is a good idea to write down a list of questions you might want to ask.
Your Treatment & Care
The consultant is a specialist doctor responsible for your care. This doctor will discuss with you possible treatment options and direct your medical management.
The registrar is a doctor who is specialising in medical or radiation oncology or haematology. Registrars are responsible for the day to day management of your care and all decisions made regarding your care are made in consultation with the consultant.
The house surgeon is a doctor who is yet to choose a specialty and who is primarily responsible for the day to day management of patients in 5 North Ward.
You will encounter oncology nurses in many settings from the inpatient ward to the community. The nurses can help you access other health professionals and they also provide education and support throughout your treatment. The outpatient oncology nurses work in the outpatient clinics and the day ward and should be contacted for any enquiries regarding your treatment or if you are not well enough to keep your appointment.
The community oncology nurse will contact you at home after your visit to the doctor and will provide information, education and support to you and your family. The nurses form the link between you and the Wellington Blood & Cancer Centre and will provide you with their contact details when you meet. You can request this service either through your GP or through the Wellington Blood & Cancer Centre.
Forms of Cancer Treatment
Surgery is the oldest form of treatment for cancer. Surgery offers the greatest chance for cure for many types of cancer, especially those cancers that have not yet spread to other parts of the body. People often see just a surgeon for the surgical treatment of cancer and are then referred to an oncologist if other treatments are thought to add benefit.
Preparing for Surgery
Both you and your doctor need to prepare before surgery to make sure you have the best chance for a good outcome. For your part, this involves knowing what to expect (as much as possible) and being comfortable that the decision you’ve made is the best one for you. Knowing as much as you can about your care plan can help reduce your level of stress.
Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you give your written permission for your doctor to perform surgery, after you have been informed of all aspects of the treatment.
Chemotherapy - Medical Oncology
Chemotherapy is the use of medicines to kill or reduce the spread of cancer cells. Chemotherapy is given as cycles and may be given once a day, once a week or even once a month. This depends on the type of cancer and the best regimen (course) as determined by research. Chemotherapy, unlike radiation (which treats only the part of the body exposed to the radiation), treats the entire body. As a result, any cells that may have escaped from where the cancer originated are treated. A doctor who administers chemotherapy is known as a medical oncologist.
Depending on what type of cancer you have and whether it has spread, your doctor may use chemotherapy to:
- Eliminate all cancer cells in your body, even when cancer is widespread
- Prolong your life by controlling cancer growth and spread or
- Relieve symptoms and improve your quality of life.
Most chemotherapy drugs are given in one of the following ways:
- You might take a tablet or medicine orally (swallow)
- It may be given intravenously as an injection over a short period of time or as an infusion over a longer period of time. For these treatments you come into the Department usually for part of the day.
Some people have no side effects at all from chemotherapy. Sometimes, however, chemotherapy will make you feel sick. As each type of chemotherapy has different side effects they will be discussed with you prior to starting any treatment so you know what to expect. Chemotherapy targets cells that are quickly dividing, whether it's a cancer cell or not. Therefore, some non-cancer cells that divide quickly are also damaged. The following is a list of some normal cells that divide quickly in the body and may be susceptible to the effects of chemotherapy:
- Cells in your hair (can cause hair loss)
- Cells of the skin and mouth (can cause sores in your mouth and dry skin)
- Cells in your stomach and intestines (can cause you to feel sick, vomit or have diarrhoea)
- Cells in your bone marrow. This is where your red and white blood cells are made. White blood cells fight infections, so temporarily you are very prone to these and they can become serious. Loss of red blood cells can make you anaemic and tired.
There are many medicines you can take to reduce or lessen these unwanted effects of chemotherapy.
In some cases, chemotherapy may be the only treatment you need. More often, it's used in conjunction with other treatments, such as surgery or radiation, to improve results. For example, you may receive:
- Neoadjuvant chemotherapy. The goal of neoadjuvant therapy is to reduce the size of a tumour with chemotherapy before surgery or radiation therapy.
- Adjuvant chemotherapy. Given after surgery or radiation, the goal of adjuvant chemotherapy is to eliminate any cancer cells that might linger in your body following earlier treatments.
Radiation Therapy - Radiation Oncology
Radiation therapy (or Radiotherapy) uses special equipment to deliver high doses of radiation (beam of x-rays) to cancerous tumours, to kill or damage them so they cannot grow or spread. Normal cells may be affected by radiation, but most appear to recover fully from the effects of the treatment. Radiation therapy affects only the tumour and the surrounding area. Some cancers are very sensitive to radiation but not all.
Radiation therapy is usually given in small doses over a period of time; this is known as a course. A doctor who manages your radiation therapy is called a radiation oncologist.
Some common side effects of radiation therapy treatment include:
- Fatigue or tiredness
- During the first 2 weeks of treatment, a faint and short lasting redness may occur on your skin. Dryness and peeling of the skin may occur in 3 to 4 weeks. The skin over the treatment area may become darker.
- Mucositis (inflammation of the lining of the mouth) is a temporary side effect that may happen when radiation is given to the head and neck area.
- Radiation to the head and neck area can increase your chances of getting cavities. Before starting radiation therapy, notify your dentist and plan for a complete check-up.
- When radiation treatments include the chest area, the lungs can be affected and you may experience shortness of breath or a cough.
- Radiation to the abdomen may result in swelling and inflammation to the oesophagus (tube from throat to stomach) or intestines, causing nausea, vomiting, or diarrhoea.