Cancerology

Ccancerology is the branch of medicine concerned with the study, diagnosis and treatment of cancerous diseases.

It aims to identify the mechanisms of tumour formation (carcinoma, sarcoma, lymphoma, myeloma, leukaemia, mesothelioma, melanoma, glioma, metastasis, etc.) in order to establish the best possible therapy for each specific case.

Multidisciplinary cancer treatment

Surgical oncology
Medical oncology
Psychoncology
Radio-oncology
Medical imaging
Haematology
Nuclear medicine

Cancer in Switzerland

Every year, cancer affects over 44,000 people in Switzerland (approx. 20,000 women and 24,000 men). Due to demographic reasons (an ageing population), the number of new diagnoses is still on the rise, but thanks to various screening programmes and ongoing advances in diagnosis and therapy, chances of survival continue to increase.

Cancer centres

For over a decade, Swiss Oncology Network has set its sights on one overriding goal: to offer everyone living with cancer privileged access to treatments and the best and safest treatment strategies for their specific illness.

Our cancer centres

Types of tumours

Cancer cells

Cancer cells are so-called ‘immortal’ cells because they multiply without dying, accumulating to form a tumour. As they do not function like a normal cell, they divert ‘local resources’ to feed on them (neoangiogenesis), blocking and attacking the body’s immune defences.

Benign tumour

A localised mass consisting of cells that retain their function; this mass does not alter the surrounding tissues (e.g. wart, mole), but if it presses on an organ, it must be removed.

Malignant tumour (cancer)

A mass of cancerous cells that can invade and destroy healthy neighbouring tissues and migrate to other parts of the body to form metastasis. A distinction is made between solid tumours and cancers of blood cells (haematologic malignancies)

Carcinoma/adenocarcinoma

Tumours are formed on tissues that cover an external (skin, mucous membranes) or internal (digestive tract, glands) surface of the body (breast cancer, prostate cancer, skin cancer, bowel cancer, lung cancer)

Sarcomas

A distinction is made between soft tissue sarcoma and bone sarcoma (osteosarcoma): Soft tissue sarcoma develops in the connective or supporting tissues (adipose, fibrous, blood and synovial tissues; muscles, lymph vessels and peripheral nerves) and is relatively rare in adults. Osteosarcoma, or bone sarcoma, is mainly formed on long bones (femur, tibia) or flat bones (ribs, sternum).

Lymphoma

A malignant tumour that develops in the lymph nodes and vessels (the body’s immune system); a distinction is made between Hodgkin lymphoma (a rare disease that affects certain types of lymphocytes) and non-Hodgkin lymphoma.

Myeloma

Cancer of plasma cells (white blood cells in the bone marrow), which can affect the bones, immune system, kidneys and red blood cells in the blood.

Leukaemia

Blood and bone marrow cancer affects the production of blood cells (white blood cells).

Mesothelioma

Tumour of the tissue surrounding the lungs (pleura), the abdominal cavity (peritoneum) or the heart (pericardium).

Melanoma – skin cancer

Tumour that develops from skin cells, melanocytes.

Glioma

Brain tumour which can develop in the brain and other parts of the nervous system (brain stem, spine).

Metastasis

Tumours formed by cancer cells that have broken away from the ‘primary tumour’ (first tumour) and which – via the lymph or blood vessels – have migrated to another part of the body (lung, bone, brain, liver).

Risk factors

It is now known that many cancers are caused by a genetic component. But there are also many external risk factors, resulting from environmental factors or individual lifestyles. These include:

  • Ageing
  • Unbalanced diet
  • Being overweight
  • Smoking
  • Excessive alcohol consumption
  • Sedentary lifestyle
  • Lack of physical activity
  • Pollutants and other harmful substances
  • UV rays
  • Hereditary or genetic factors
     

Radiology

Radiology works at different stages of cancer:

  • Initial diagnosis (screening programmes, biopsy guidance)
  • Staging assessment (metastasis screening)
  • Treatment follow-up
  • Monitoring

Radiology is based on several techniques which can be combined with one another. A distinction is made between diagnostic and functional imaging.

Standard radiology (radiography)

Standard radiology or radiography is the study of joints at bone level. As a first-line examination, radiography makes it possible to visualise specific parts of the human body (bones and certain organs) and detects fractures and osteoarthritis. It uses X-rays (high-frequency waves), which – when passing through the body – are absorbed by different structures (e.g. bones, soft tissues). On X-rays, bones will appear white, while soft tissue will appear grey.

Interventional radiology

Interventional radiology combines both radiology (using X-rays) and disciplines such as surgery, medical oncology and urology. The advantage of this new technique is to carry out minimally invasive, imaging-guided procedures to:

a) Stop bleeding (by plugging the bleeding vessel from the inside)

b) Destroy tumours

Interventional radiology uses percutaneous techniques that, using different types of probes and medical imaging (scanners, MRI, ultrasound), locate and reach the tumour. Then, depending on the chosen technique and probe, the tumour will either be burned from the inside (heat emitted by radiofrequencies or microwaves) or frozen to -80 °C (cryotherapy: the liquid injected by the probe will freeze the cancer cells, which will eventually burst)

Even some previously incurable tumours can now be treated with a new technique called radioembolisation, where radioactive particles are injected into the tumour and irradiated from the inside until it is destroyed.

c) Another very promising technique is to inject modified viruses into the tumour, which will then only attack the cancer cells. Naturally, the virus is modified in such a way that it cannot develop into healthy cells.

CT scan

The CT scanneris a device that rotates around the patient using an X-ray tube. Sensors scan all or part of the human body and provide data to reconstruct the image digitally. CT scans can also be used for biopsies, drainage and radiofrequency cancer treatments (interventional radiology: destruction of the tumour using heating or cooling).

For irradiation, only low doses are used and every precaution is taken to limit the exposure to X-rays in the area under examination to an absolute minimum. For example, a single image corresponds to the average natural (cosmic) exposure during a four-hour flight. However, for pregnant women, special precautions must be taken on a routine basis. This is why it is important to notify the medical team about any potential pregnancy.

Mammogram

Mammograms, recommended for all women between the ages of 50 and 75 years, are designed to detect abnormalities in breast tissue as early as possible, before they even cause clinical symptoms. This allows breast cancer to be detected, ruled out or diagnosed before it becomes palpable. This radiological examination has evolved considerably in recent years, therefore the doses given during the examination are extremely low. Mammograms are equipped with tomosynthesis, a technique allowing for sectional imaging, which improves the resolution of the image produced and facilitates the detection of any abnormality.

During the mammogram, which only lasts a few minutes, the patient will be accompanied by an experienced radiologist who will explain the procedure in detail and answer any questions she may have. For a so-called diagnostic examination, it is likely that the patient will undergo an ultrasound scan in addition to the mammogram.

The patient will receive the results of the mammogram by post within eight working days. The results will also be sent to the GP whose name was given on the health questionnaire. This is sufficient time for two experienced radiologists to analyse and interpret the mammogram in detail, so that no abnormalities are missed.

Most of the Swiss Medical Network’s radiology centres actively support and collaborate in breast cancer screening. These examinations are coordinated by screening centres or cantonal bodies (Swiss Cancer Screening).

Densitometry

Bone densitometry (or osteodensitometry or mineralometry) is a radiological technique that measures bone mineral density to determine bone strength. It thus makes it possible to:

  • measure the amount of minerals in the bones (calcium)
  • detect bone calcium deficiencies, such as osteopenia (early stage) or osteoporosis (advanced stage)
  • assess the fracture risk
  • check for bone loss

Sites measured are typically the lumbar spine, proximal femurs (hips and femoral necks) and sometimes forearms (radius). In rare cases, a full body measurement may also be taken. During the examination, using the same apparatus, lateral spine imaging (vertebral morphometry) is usually carried out in order to look for any spinal defects or compression fractures. Furthermore, it is important to be able to assess not just the amount of calcium in the bones (quantitative) but also its distribution (qualitative) by analysing vertebral microarchitecture.

This is done using a software programme that allows for a vertebral trabecular bone score to be calculated. Based on all these parameters and a targeted medical questionnaire, the 10-year fracture risk may be determined for all major osteoporotic fractures or hip fractures. These are essential factors in establishing when and which treatment should be put in place.     

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a technique that does not use X-rays. The device consists of a magnet characterised by its power (1, 1.5 or 3 Tesla) and an examination bed which glides down its centre. The examination creates images of the human body thanks to the hydrogen atoms it contains. In a strong magnetic field, all hydrogen atoms move towards this field. They are then excited by radiofrequency waves for a very short period of time. When the wave emission stops, the atoms return to the equilibrium state and the accumulated energy produces a signal that is recorded and processed as an image. Specific antennas according to the area studied are connected and used to collect the emitted signal. These signals are mathematically analysed to produce images.

According to the technique or sequences, MRI enables the morphology of the organs studied to be brought to light in a detailed way. It demonstrates an increased sensitivity in detecting different pathologies of the soft tissues, making vessels, cartilage and nerve pathways stand out. The acquisition of three-dimensional images allows for their reconstruction on all planes.

Ultrasound

This painless and non-radiation imaging technique allows a diagnosis to be made or a rapid intervention to be carried out alongside the patient. It can be repeated as often as necessary without any health risks. It is very useful in many fields of radiology (ENT, breasts, musculoskeletal system, blood vessels, liver, gall bladder, pancreas, kidneys, bladder and pelvis).

Technically, it is a beam of ultrasound whose frequency is adapted to the organ to be examined. This beam is reflected more or less depending on the anatomical structures it encounters. In turn, this allows for an image of the organ in question to be reconstructed. It is shown directly on the screen of the apparatus for an immediate and dynamic interpretation.

PET/CT examination (positron emission tomography)

A PET/CT scan is used for oncological, cardiological and neurological examinations and to investigate sources of infection. In oncology, this technique can be used to confirm the presence of a cancer. As the patient’s whole body is examined, it can also detect tumour cells present in other organs (metastasis). With the PET/CT scan, quantitative values can be obtained and used to track tumour cells in order to determine if a treatment is working and evaluate if the cancer is improving.

From a therapeutic point of view, nuclear medicine uses radioactive pharmaceuticals to destroy diseased cells. A pre-treatment scintigraphy or PET/CT scan ensures the radiation correctly targets the diseased cells. Afterwards, the patient is administered radioactive pharmaceuticals that are specific to the cells that need to be destroyed.

Scintigraphy

The device records the gamma rays emitted by the patient to create functional images. Activity curves can be generated, for example to map kidney function or compare the activity of a body part on the left with a body part on the right. This is often used to examine stress fractures or bone disorders.

Two radioactive tracers are usedto examine the lungs; one is inhaled and the other injected. This technique is used to explore lung function before an operation, in cooperation with a pulmonologist, and to detect pulmonary embolisms.

To confirm a diagnosis of Parkinson’s disease, a cerebral scintigraphy scan (Datscan) may be carried out on the request of a neurologist.

In endocrinology, a scintigraphy can be carried out on the thyroid or parathyroid glands. This is the preferred examination for hormonal issues, or to investigate thyroid or parathyroid nodules.

In the case of symptoms that can suggest coronary artery disease (feelings of suffocation, chest pain, shortness of breath), a cardiac scintigraphy is indicated. For this examination, a cardiac stress test is carried out with a cardiologist once the radiotracer is administered. The result shows the activity of the cardiac muscle and allows doctors to diagnose an ischaemia or infarct.

Surgical oncology

Surgical oncology involves examining, removing or repairing cancerous tissue, and oncological surgery can be carried out at various points along the patient treatment pathway.

Prevention

In preventive or prophylactic care, surgery is carried out before the cancer develops.  In this particular case, the oncology surgeon will remove the tissue. Although the tissue is not yet cancerous, genetic screening will have revealed an abnormality in a gene, which may in turn cause cancer (in some cases of genetic mutation, prophylactic mastectomy and/or bilateral ovariectomy may be considered)

Diagnostics

Surgery can also be used to diagnose cancer, determine its stage and check the extent to which it has spread in the body. This usually involves a biopsy, i.e. a tissue sample, which is then analysed under a microscope by a pathologist.

Tumour ablation

The main aim of oncological surgery is tumour ablation, i.e. to remove the tumour or cancerous tissue. The earlier the tumour is removed and the more localised it is (located in one place (primary tumour) without spreading to other parts of the body (metastasis)), the more effective the surgery will be. In this type of procedure, the surgeon will also remove a small piece of normal tissue around the tumour – known as the ‘surgical margin’ – to ensure that no cancer cells remain.

To minimise damage to healthy tissue while ensuring that all cancer cells are removed, the surgeon may perform a biopsy to find the sentinel ganglion (the first lymph node to which the cancer is likely to spread from its original location). If there are no cancer cells in the sentinel ganglion, there will be no need for lymph node dissection.

Lymph node dissection

For some types of cancer, it may be necessary to remove the lymph nodes located near the tumour, which is referred to as lymph node dissection. These removed lymph nodes are then analysed to determine if they contain cancer cells, which could form new tumours or spread to other parts of the body.

Tumour reduction

In some cases, it is not possible to remove the entire tumour and so tumour reduction is performed (‘cytoreductive surgery’), which may increase the effectiveness of systemic therapy or adjuvant radiotherapy.

Relieving the symptoms

Palliative surgery or septic surgery can relieve symptoms and thus improve the patient’s quality of life (e.g. relieve pain, bypass a blocked organ, etc.). The main objective of this type of surgery is often to control symptoms (and thus improve quality of life) rather than to treat the disease.

Reduced risk of recurrence

In some cases, in addition to removing the tumour with a healthy tissue margin, the surgeon may also remove other structures (e.g. muscles, nerves, normal lymph nodes) in the vicinity of the tumour. This procedure (radical surgery), as demonstrated by various studies and research findings, reduces the risk of reappearance or recurrence (e.g. radical mastectomy: breast removal (whole), pectoral muscles and underarm lymph nodes).

Medical oncology (systemic treatments)

Medical oncology, also known as systemic treatment (or general treatment because it predominantly affects the whole body and not a specific organ), is used to treat cancer with drugs (systemic treatments). These treatments can be administered as neoadjuvant (before surgery), adjuvant (after surgery) or palliative (for relief care) therapy and are combined with oncological surgery or radiotherapy, depending on the type of cancer. There are various types of treatment:

Chemotherapy

The drugs (cytostatic/cytotoxic) which are administered to the patient (oral or IV injection) block the growth of cells and destroy them

Hormone therapy

is a type of cancer treatment that slows or stops the activity/production of hormones that stimulate the growth of cancer (only used to treat ‘hormone-dependent’ or ‘hormone-sensitive’ tumours)

Immunotherapy

does not specifically target the tumour, but is a type of cancer treatment that uses drugs to boost or activate the body’s own natural defences to fight cancer (immune response)

Targeted therapies

are a group of drugs that selectively intervene in certain tumour cellular processes to block tumour growth or slow its metabolism

Through regular monitoring, medical oncologists will not only check that the treatment is progressing smoothly, but will also be able to manage any side effects that the patient may experience, both during and after treatment.

Psycho-oncology

A cancer diagnosis changes not only the life of the person concerned, but also the lives of the people around them. It often has a bearing on physical, psychological, professional, social and family life, thus making people re-examine their entire existence.

In close collaboration with doctors and paramedics, psycho-oncology focuses on the relationship between the disease and its impact on everyday life, offering patients and their loved ones targeted support and listening in order to help them better manage this new life situation.

Radio-oncology

Radio-oncology, also known as Radiotherapy, uses radiation (high-energy X-rays or other radioactive sources) to destroy a tumour. These rays, administered in an ultra-precise and targeted manner to spare healthy tissue as much as possible, repeatedly damage the DNA of cancer cells (which make up this tumour mass), preventing them from dividing and therefore stopping or slowing the growth of the tumour. Because they don’t have time to regenerate between radiotherapy sessions, they end up dying.

Often in combination with oncological surgery or systemic treatment (medical oncology), radiotherapy is indicated for localised cancers (e.g. breast, prostate, lung, uterus, lymph nodes, bone, skin, brain, etc.). It may be used as a first step in treatment (e.g. before surgery) to reduce the size of the tumour, thus reducing the surgical impact, or as a second step, to destroy the remaining cancer cells and thus prevent local recurrence.

Depending on the type and location of the cancer, radiotherapy may be carried out in a single session (e.g. IORT) or in daily sessions for several weeks.

Techniques used:

  • External radiotherapy
  • Intensity modulated radiotherapy (IMRT)
  • Hypofractionated radiotherapy
  • Stereotactic body radiotherapy (SBRT)
  • Radiosurgery
  • Superficial radiotherapy
  • Intraoperative radiotherapy (IORT)
  • Contact radiotherapy (PAPILLON)

Technical facilities

  • Varian Clinac® linear particle accelerator
  • IORT® intraoperative accelerator
  • Radixact® tomotherapy with Synchrony® artificial intelligence respiratory tracking system, high-quality on-board imaging using ClearRT™ kVCT, high-speed binary collimator
  • Cyberknife® S7™ Radiosurgery Robot with InCise™ high precision multileaf collimator, real time submillimetre tracking with motion compensation, non-coplanar beam technique
  • PAPILLON® contact accelerator
  • RayStation® unified planning system with auto-segmentation and AI-assisted planning, advanced adaptive radiotherapy technology, bio- and multi-criteria optimisation, calculation on GPU
  • Da Vinci® Robot (robotic surgery, improves vision (3D) and surgical precision (no tremor or restricted motion)

Nuclear medicine

Nuclear medicine uses radioactive substances for diagnostic and therapeutic purposes.

For diagnosis, a ‘radiotracer’ – a radioactive isotope linked to a physiological substance – will be administered to the patient (most often intravenously). The radioactive element will be carried by the physiological substance to the organ that needs to be examined. Depending on its metabolism, more or less radiation will be detected in the organ (any potential illness will alter this radiation level). After a waiting period (which varies from immediately to up to several hours after the injection), images will be taken using a gamma camera (scintigraphy, SPECT/CT) or PET/CT (positron-emission tomography linked to a scanner).

In its therapeutic point of view, nuclear medicine will use radioactive pharmaceuticals to destroy diseased cells. A pre-treatment scintigraphy or PET/CT scan will ensure that the radiation from the radiotracer correctly targets the diseased cells. Afterwards, the patient will be administered radioactive pharmaceuticals that are specific to the cells that need to be destroyed. Some therapies can be carried out as outpatient procedures and the patient can leave the nuclear medicine centre shortly after the injection.

Pathology

Pathology is the study of diseases, their causes, their evolution and their effects on the body (symptoms, processes, manifestations of a disease) in order to determine a diagnosis, prognosis and treatment to consider.

To do this, the pathologist will use a microscope to analyse previously collected cells and tissues (e.g. urine, blood, skin, lymph node, bone marrow, organ (breast, prostate, lungs)) to:

  • determine the cell types present in the sample
  • establish their degree of abnormality (size, shape)
  • identify the status of hormone receptors in cells (e.g. oestrogen and progesterone receptors in breast tissue);
  • find tumour marker proteins

The molecular genetics study will look for abnormalities in the chromosomes (part of the cell containing genetic information) or in the DNA of cells to:

  • diagnose certain cancers (e.g. lymphoma, leukaemia, soft tissue sarcoma)
  • assess a patient’s prognosis
  • anticipate the aggressiveness of cancer/the likelihood of treatment efficacy
  • find out if the cancer has gone away

Haematology

Haematology specialises in the diagnosis and treatment of diseases affecting the blood, bone marrow and lymph nodes:

  • Anaemia: lack of red blood cells (paleness, fatigue, problems with concentration and performance, fragility of hair and nails)
  • Haemophilia: coagulation problem (injury won’t stop bleeding)
  • Thrombosis: overactive coagulation (formation of blood clots)
  • Leukaemia: cancer of the blood (paleness, fatigue, lack of energy, bleeding of the gums, bruising of the skin)
  • Lymphoma: cancer of the lymphatic organs

Diagnosis of a haematological disease is based on physical tests (size of lymph nodes, spleen, liver; check for rashes or bruises on the skin) and a blood test. Depending on the initial results, additional tests may be required (sample of bone marrow cells/lymph nodes). 

Plastic and reconstructive surgery

The aim of plastic and reconstructive surgery is to correct abnormalities and mutilations of certain parts of the body (e.g. following oncological surgery such as lumpectomy or mastectomy).

The most common procedures include surgery carried out to treat conditions linked to ageing, reconstruction after removing a tumour (e.g. breast cancer), scar removal and correction of defects. These reconstructions can be carried out using tissue from the patient’s body (autologous tissue) or by working with implants. The most commonly used techniques:

Grafts

Portions of tissue (autologous) are taken from a certain part of the patient’s body (‘donor area’ (e.g. abdomen)) and then implanted into another part of the body (‘recipient area’ (e.g. thigh))

Flaps

Portions of tissue (autologous) that are connected to the donor area are transferred to the adjacent recipient area (e.g. DIEP, TRAM)

Implants

They are generally used to complete or correct birth or acquired defects (accident, trauma, illness, severe burns, surgical procedures). Breast implants are undoubtedly the most well-known implants; however, there are prostheses with similar materials to reconstruct or reshape calves, buttocks and also cheekbones. External prostheses should be used for nose or ear abnormalities.

Breast reconstruction

In recent years, breast reconstruction has become an integral part of breast cancer treatment. Even in the case of a lumpectomy or radical mastectomy, it is now possible to reconstruct the size and shape of the breast, allowing every woman affected by the disease to rediscover her femininity.

Research and Studies – Science & Innovation Swiss Medical Network

The doctors of Swiss Cancer Care and Swiss Medical Network are actively involved in research – the following studies are currently being conducted in oncology:

PREVENT
SAKK 96-12 (REDUCE)
SAKK 23-16 (TAXIS)
SAKK 23-18 (VISION I)
RIBELLE
MyRisk
HEDGE

Would you like to learn more about the research work at Swiss Cancer Care and Swiss Medical Network? Click here Annual Report Science & Innovation SMN.

Genolier Foundation

A financing fund for medical research and training 

In order to provide optimum care and state-of-the-art therapies, the Genolier Foundation sponsors clinical research projects and training in areas such as high-end biotechnology in collaboration with internationally renowned institutions such as the Ecole Polytechnique Fédérale de Lausanne (EPFL), the New York-Presbyterian Hospital and AGORA (CHUV).

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