ONCOLOGY PROGRAMS

ONCOLOGY PROGRAMS

Cancer

Cancer is a group of more than 100 diseases whereby cell division and growth is abnormal and uncontrolled. In very simplified terms, normally cells divide, grow and die in a very regulated and controlled fashion and as needed by the body. Cancer develops when cells start to grow in an unconstrained and unsuppressed manner due to damage or alteration in the genetic makeup of the cell. That is, rather than dying and being replaced by new healthy cells, cancer cells continue to grow and multiply forming more and more abnormal cells that create lumps or masses of tissue called tumours.  Not only can tumours release hormones that have a negative effect on the body but they can also replace normal tissue and interfere with the digestive, nervous and circulatory system. Metastatic cancer is when cancer cells spread to other parts of the body and start to develop new tumours with cells from the primary tumour. Thus, if cancer originates in the breast and metastasizes to the lung, the cancer cells in the lungs are breast cancer cells.    However, not all tumours are considered harmful. Benign tumours are noncancerous and often not life-threatening though some might grow large enough to cause local pressure and may be uncomfortable. Also, some cancers, such as leukemia do not usually form tumours rather cancer does not allow normal blood forming and blood function.   

Treatment In Cuba

Cuba has long been recognized as a leader in the area of health care and has become world renown in medicine and medical training, with a large number of  scientists  who are well respected by foreign peers for the developments of such vaccines as meningitis B and hepatitis B. The Cuban government and Cuban researchers have in the last 30 years pushed biotechnology and immunotherapy (also known as biotherapy or biological therapy) to the forefront. According to the World Health Organization, Cuban researchers in biotechnology have made very important advancement in the development of new cancer prevention tools and treatments with emphasis on transferring cancer from a deadly disease to a chronic one. It is believed that cancer cells are naturally and frequently found in the body but are usually wiped out by the immune system and only become life threatening when the immune system cannot differentiate between healthy and unhealthy cells  Immunotherapy treatment for cancer stimulates the immune system to fight cancerous cells and to control cancer growth. It has a further benefit in that it aids chemotherapy and radiotherapy by making them more effective and less toxic hence increasing patient’s life expectancy and improving quality of life.

By 2013, Cuba biotechnology centers has 1200 international patents (including Nimotuzumab or CIMAher for head and neck cancer as well as the gastrointestinal (GI) tract cancer), CIMAVAX-EGF and Racotumomab or Vaxira (for non-small cell lung cancer). It also markets pharmaceutical products and vaccines in more than 50 countries and is currently testing 90 new products in more than 60 clinical trials.

  • Nimotuzumab (CIMAher)

For cancers that have an overexpression of EGFR (epidermal growth factor receptor) targeting therapy with anti-EGFR antibodies remain the only non-chemotherapy treatment against it. One such drug that has been gaining international recognition is Nimotuzumab developed by the Center of Molecular immunology in Cuba. Though it’s not the only one of it’s kind, it is safe to say that researchers at the center were globally the first to research and develop anti-EGFR antibodies.

Nimotuzumab is a humanized monoclonal antibody which is an antibody made by combining human antibody with a mouse or rat monoclonal (clone from a single cell) antibody. Unlike its competitors, Nimotuzumab has a greater number of human like epitopes (the part of the antigen -in this case, cancer cells- that the antibodies bind to) attached to the mouse or rat monoclonal antibody. It has specific ability to recognize, bind and disable the EGFR receptors. Since the overexpression of EGFR is confined for the most part to the tumour cells, and since Nimotuzumab is mainly active at the site of the tumour side effects are very minimal, so much so that it is the first cancer vaccine to be used on children.

Nimotuzumab is administered as monotherapy or in combination with radiotherapy and chemotherapy, increasing survival time and quality of life. It is a very well tolerated medication even with prolonged treatment and is approved for the treatment of patients with advanced cancer of head and neck as well as high-grade malignant glioma in adults and children and in advanced esophageal cancer.

  • CimaVax-EGF

CimaVax-EGF is the world’s first stage 3 and stage 4 non-small cell lung cancer (NSCLC) vaccine developed in Cuba by the Center for Molecular Immunology and the Center for Genetic Engineering and Biotechnology. It works by stimulating the immune system to produce antibodies that are specifically targeted for and bind to epidermal growth factor (EGF) a protein found naturally in the body and is responsible for signaling cells to divide and grow. In certain types of cancers the body produces too much EGF forcing the cells to grow and divide uncontrollably. CimaVax-EGF is not a preventive vaccine, rather it acts by restraining the growth and division of cancer cells slowing down its development converting a late stage lung cancer into a chronic disease.

CimaVax-EGF is given after chemotherapy and radiation have been administered. It is well tolerated and has few side effects

This vaccine is in the trial process in the Uk, Canada, China and Peru and is in the process of approval in Argentina, Brazil, Colombia and Paraguay. Furthermore, in the end of April, 2015 Roswell Park Cancer Institute, a US based cancer research center, has signed an agreement with the Molecular Immunology Center of Cuba to begin clinical trials for CimaVax-EGF.

  • Racotumomab

Racotumomab is the second non-small cell cancer (NSCLC) vaccine developed by the Center of Molecular Immunology in Cuba and has been used as the primary treatment for NSCLC in Cuba since January, 2013.

Racotumomab works by activating a cellular and humoral immune response against NeuGc GM3 ganglioside present in some tumors tissues by blocking the tumor growth and slowing down it’s development and hence increasing patient’s life expectancy and improving quality of life. Since NeuGc GM3 is not only found in lung cancer cells but also in breast cancer cells, in melanoma cells and neuroectodermal pediatric tumor cells it is hoped that this medication can be used as part of the treatment for such cancers. Racotumomab is presently being tested in a large multinational clinical trial.

Racotumomab is a well tolerated cancer treatment with the most common side effect is burning in the arm and slight pain in the injection area as well as a possibility of asthenia (physical weakness or lack of energy).

*Please note that Cuba continues to follow the standard treatment for cancer by using surgery, radiation and chemotherapy in combination with immunotherapy. Treatment however is determined by the type, stage of cancer and patient’s overall health.

 

Head and Neck Cancer Programs

Head and Neck Cancers

About 90% of head and neck cancers are squamous cell carcinomas (squamous cell are found in the tissue that forms the thin layer of the skin as well as the lining of the digestive and respiratory tracts) that originate in mucosal lining (the layer of moist tissue). Head and neck cancers refer to different types of invasive cancer cells most common of which are:

Nasopharyngeal Cancer : Nasopharyngeal is the upper part of the throat behind the nose.
Nasal Cavity and Paranasal Sinus Cancer: The nasal cavity refers to the space behind the nose from which air passes to the throat. The paranasal sinuses refers to the groups of four paired air filled spaces surrounding the the nasal cavity.
Oral and Oropharyngeal Cancer: The oral cavity includes tongue, floor of mouth, hard palate, buccal mucosa, and alveolar ridges while the oropharynx refers to base of tongue, tonsils, and soft palate.
Laryngeal and Hypopharyngeal Cancer: The larynx, more commonly known as the voice box and the pharynx, more commonly known as the throat.
Salivary Gland Cancer: Salivary glands are responsible for the discharge of fluid secretion especially saliva.

Though head and neck cancers are aggressive and patients are at a high risk of developing other cancers they are highly curable if detected early.

There are a number of other cancers found in the same area as head and neck cancers, such as brain tumour and eye cancer, but are not classified to be part of the head and neck cancers.

Treatment

Cancer treatment in Cuba follows the standard treatment for cancer by using surgery, radiation and chemotherapy in combination with immunotherapy. Treatment program is dependent on the type of cancer, the stage it’s in and patient’s overall health.

The programs listed below include the following treatments:

Initial evaluation and preparation.
Pre-application medical checkup.
Cyclophosphamide 200mg
Nimotuzumab (CIMAher EGF) 24 pairs of vials for 6 weeks treatment.
The induction phase lasts six weeks corresponding to the application of 24 pairs of vials (4 vials x 6 vaccine applications), Cyclophosphamide and saline solutions.
The first dose will be given in Cuban health centers. Follow up doses can be continued the in Cuba or in home country.


Glossectomy medical program:

Glossectomy is a surgery of the tongue performed to remove all (total glossectomy), half (hemiglossectomy) or parts (partial glossectomy) of the tongue in order to treat malignant growth on the tongue.

Total glossectomy: removal of all of the tongue
Hemiglossectomy: removal of half of the tongue
Partial glossectomy: removal of parts of the tongue.
Transmaxillary Glossectomy with neck dissection : When cancer in the oral cavity spreads to the lymph nodes in the neck, removal of the nodes through surgery may become a necessary procedure in order to control the spread of cancerous tissue. Radical neck dissection, put in practice since 1906, is a major yet simple and well designed surgery and is usually performed at the same time as the surgery for the removal of the main tumour. Depending on the original cancer size and how much it has spread, neck dissection surgery can be one of the following:  

-Partial neck dissection: very few lymph nodes are removed .
-Modified neck dissection: more lymph nodes on the neck are removed
with the possibility of the removal of other structures such as some muscles, nerves and veins.
-Radical neck dissection: the most amount of lymph nodes and more muscles, nerves and veins are removed.
Larynx Medical Programs:

Laryngectomy is a surgery for the removal of the larynx (commonly known as the voice box) and possibly the detachment of the airway from the mouth, nose and esophagus in order to control the spread of tumours or cancerous tissue.

Depending on the original cancer size and how much it has spread, neck dissection surgery can be one of the following:

Partial Laryngectomy
Subtotal Laryngectomy Horizontal
Total Laryngectomy
Total laryngectomy with radical neck dissection
Total laryngectomy with selective neck emptying


Maxillary Medical Programs:

Maxillary cancer is very rare being most common in Asia and Africa, especially Japan and South Africa. The transmaxillary approach is usually the prefered method of treatment due to it being less intrusive, less destructive and more cosmetically appealing. This approach gives a better surgical exposure allowing for tumour resection with minimal blood loss. Vascularized flaps are put in place to provide and maintain blood supply in the area.

Transmaxillary approach offered in the maxillary program could be one of the following:

Transmaxillary resection with micro-vascularized flap
Transmaxillary resection with vascularized flap
Transmaxillary resection and reconstruction with vascularized flap
Miscellaneous Medical Programs for Head and Neck:

Exeresis of Neck Tumou r:

Removal of tumours in the neck is an inpatient operation. Administration of local or general anesthesia is subject to the age of the patient as well as the location of the neck mass.
Parotid medical programs:

Parotid glands are the largest and most important salivary glands located in front of each ear. A parotidectomy is the surgical procedure performed for the removal of the gland due to the development of tumours.  About 80% of tumours are benign.

The following parotidectomy are performed in Cuba. Please note that the specific surgery chosen is based on preservation of the facial nerve

-Subtotal parotidectomy:  less than a superficial lobectomy is performed and less than a full facial nerve is dissected.
-Total parotidectomy:  the deep portion of the gland is removed
Radical Neck Dissection Medical Programs:

-Radical Neck Dissection: is a major yet simple and straightforward surgery needed when cancer has spread to the lymph nodes in the neck. 
-Radical neck dissection and functional neck dissection: with functional neck dissection the spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle are preserved.
Craniofacial resections medical programs: 

Craniofacial resection refers to a group of operations involving the skull and the middle of the face and is the standard treatment for the removal of tumours affecting the anterior skull base.This is done through an incision along the side of the nose to the forehead or from one ear to the other over the head as well as through the skull giving better exposure to the tumours and a better chance of removing it with as little amount of damage to the brain, nerves and other major systems in and around the area.

The following options are offered in Cuba:

-Middle fossa dissection
-Middle fossa dissection and reconstruction with vascularized flap  
-Anterior fossa dissection  
-Anterior fossa dissection and microvascular flap reconstruction
Thyroid Medical Programs:

The thyroid, a small gland made up of two connected lobes, is found in the front of the neck below the larynx and is responsible for controlling body functions such as body temperature, metabolism, heart rate and blood pressure. Thyroid cancer develops when some cells change and become cancerous.  In general, thyroid cancer is slow in developing, least deadliest of the head and neck cancers and the most curable of all cancers.

The following procedures are offered in Cuba:

-Hemithyroidectomy: standard surgical procedure for the removal of one of the thyroid lobes. The procedure is very safe with little risk of damage.
-Thyroidectomy with radical dissection : a common surgical procedure for the removal of part or all the gland. Radical dissection is performed if there are lymph node metastases.

Sarcomas Medical Program

Sarcomas

Sarcomas are a rare group of cancers that affect any age group and can develops in the connective tissue in any part of the body such as nerves, fat, muscles, blood vessels, fibrous tissue, bones, tendons, deep skin tissues and cartilage. Though there are different types of sarcomas they usually can be divided into two parts: soft tissue sarcomas and bone sarcomas (commonly known as bone cancer).

Surgical Treatment for Sarcomas

Surgical removal of the tumor and neighbouring healthy tissue remains one of the most effective treatments for soft tissue sarcomas. At times however, the only possible treatment is the removal of all or part of a limb where the sarcomas is developing in.

Soft Tissue Cancer Medical Programs

  • Malignant Soft Tissue requiring extended Surgery with locoregional emptying
  • Malignant Soft Tissue requiring Shoulder dislocation
  • Malignant Soft Tissue requiring Arm Amputation
  • Malignant Soft Tissue requiring Femur Amputation
  • Malignant Soft Tissue requiring Surgery Reconstruction
  • Malignant Soft Tissue requiring hip disarticulation
  • Malignant Soft Tissue requiring knee disarticulation

Bone Tumors Medical Programs

  • Malignant Bone tumours requiring Arm Amputation
  • Malignant Bone tumours requiring Femur Amputation
  • Malignant Bone tumours requiring hip disarticulation
  • Malignant Bone tumours requiring shoulder disarticulation
  • Malignant Bone tumours requiring knee disarticulation

Lung Cancer Medical Program

Lung Cancer

Lung cancer is one of the deadliest cancers worldwide mainly due to the fact that in most cases the cancer has already metastasized (spread) and is at an advanced state before it is detected. Lung cancer is the abnormal and uncontrolled cell growth in one or both lungs. It is usually divided into two main groups: non-small cell lung cancer (85% - 90% of all cases) and small cell lung cancer (10% - 15% of all cases) the main difference being is in the size of the cancer cells and the speed of spreading consequently different treatment is prescribed to each lung cancer group.  Due to the aggressive nature of small cell lung cancer surgery is often not a recommended procedure.  Nevertheless, it is considered as an option if the cancer is a single lung tumour and has not spread to the lymph nodes and/or other organs. 

As with all cancers, treatment of lung cancer depends on the size of the cancer, how far it has spread and on the overall health of the patient. 

The following are treatment programs offered: 

Resection Program:

Pneumonectomy: A major surgical procedure for the removal of a lung in its entirety to extract tumorous lung tissue. This is usually performed if the tumour is too close to the center of the chest or if smaller portions of the cancer cannot be removed. A pneumonectomy is an open chest technique. Lobectomy: The surgical removal of one lobe (section) of the lung that has cancerous cells in non-small cell lung cancer. It is the most common and most effective surgery for this type of lung cancer.Pancoast Tumour Resection: The removal of cancer tumour found on the top of the lung. 95% of pancoast tumours are part of the non-small cell lung cancer. 

Thorax medical programs:

The thorax is the chest area between the neck and the diaphragm and contains all major respiratory and circulatory organs. 

The following programs are offered: 

  • Diagnostic Thoracoscopy: the insertion of a tube (an endoscope) with a small camera attached through a small cut in the chest wall to diagnose and examine the thorax area.

  • Thoracoscopy for Lung metastasectomy: a thoracoscopic surgery for the removal of secondary cancers that had spread to the lung(s) from another part of the body.

  • Thoracoscopy for resection of Lung Bullae (Bullectomy): a thoracoscopic surgery for the removal of air pocket(s) in the lung as a result of lung cancer or other lung diseases. 

Mediastinum medical programs:

The mediastinum is the partition separating the two lungs. The heart and its vessels,thymus gland, the esophagus, the lymph nodes of the central chest, cardiac nerves and the tracheae are included in the mediastinum. The lungs are not included in the mediastinum. 

Mediastinal Tumour Resection: the surgical removal of tumours in the mediastinum in order to stop the cancer from spreading and to stop tumours from compressing organs in the area such as the heart or lungs. 

CimaVax Vaccine for Non-Small Cell Lung Cancer:

Initial evaluation / Medical History Issuance of Medical Certificates Diagnostic tests CBC, ESR, full coagulogram Alkaline Phosphatase Blood (Serum) Glutamic-Oxaloacetic Transaminase (SGOT) Test, Blood (Serum) Glutamate Pyruvate Transaminase (SGPT) Test Urea, creatinine, uric acid The induction phase lasts for 2 months, corresponding to the application of 16 pairs of vials (4 vials x 4 vaccine applications), Cyclophosphamide and saline solutions. The first dose will be given in our health centers and you can continue the treatment in Cuba or in your country of your own choosing.

Digestive Tract Cancers Medical Program

Digestive (Gastrointestinal) Tract Cancers

The digestive tract, also known as the gastrointestinal tract or GI, is a tubular passage extending from the mouth to the anus. It’s main function is to consume and digest food, extract nutrition and energy from it and then eliminate waste. The tract includes the esophagus, stomach, the intestines, pancreas, gallbladder and the liver. Cancer in the gastrointestinal tract, which is the most common type of cancer, refers to the development of cancerous tumours in any organ in the digestive tract.  

Treatment:

Cancer treatment in Cuba follows the traditional treatment for cancer by using surgery, radiation and chemotherapy in combination with immunotherapy. Treatments are dependent on the type and stage of cancer as well as patient’s overall health.

The standard procedure is as follows:

  • Initial evaluation and preparation.

  • Pre-application medical checkup.

  • Cyclophosphamide 200 mg

  • Nimotuzumab (CIMAher EGF) 24 pairs of vials for 6 weeks treatment.

  • The induction phase lasts six weeks corresponding to the application of 24 pairs of vials (4 vials x 6 vaccine applications), Cyclophosphamide and saline solutions.

  • The first dose will be given in Cuban health centers. Follow up doses can be continued the in Cuba or in home country.

Colon Medical Programs:

The colon is the largest part of the large intestine (large bowel) and together with the rectum as well as the anal canal make up the last part of the digestive system. It’s main responsibility is to reabsorb fluids and other nutrients and send it back into the body while sending the remainder of undigested food with bacteria and juices from the digestive system to be stored in the rectum which are later sent to the anal canal and released out of the body.

Colorectal cancers is a term often used for cancers that begins in the colon or the rectum due to the fact that they have much in common.

The following is a list of programs offered:

  • Combined laparoscopic abdominoperineal resection for low rectal tumors of the anal canal and anal sphincter preservation: abdominoperineal resection involves the removal of the anus, rectum and sigmoid colon in order to treat cancer low in the rectum or in the anus close to the sphincter muscle (the muscle surrounding the anus that controls bowel movement). A colostomy is then performed whereby a section of the colon is connected to the surface of the abdomen through an opening called the stoma so that waste and gas can pass out of the body. A laparoscopy, a surgical procedure in which a small incision is made in the abdomen to allow a laparoscope (an optic instrument) to be inserted, is performed in order to giving the surgeon better exposure.

  • Abdominoperineal resections in lower rectal tumors and anal channel with anal sphincter preservation:  this procedure is similar to the one described above with the difference of the preservation of the sphincter muscle in order to avoid a colostomy. Cancer free end of sigmoid colon is attached to the anal sphincter for the continuation of normal bowel function. This procedure is dependent on the size of the tumour, its location, how far away it is from the annus and how well the sphincter is functioning.

  • Abdominoperineal resection in low rectal tumors and anal channel: the standard operation for the removal of the anus, rectum and sigmoid colon in order to treat cancer low in the rectum or in the anus close to the sphincter muscle. It is done by making an incision in both the abdomen and the perineal area (the area between the anus and vulva in women and the between the anus and scrotum in men). A permanent colostomy is then performed in order for waste and gas to be released out of the body.

  • Partial colectomy: is the surgical removal of the cancerous part of the colon or rectum as well as a small parts of nearby healthy tissue.  The remaining healthy parts of the colon and rectum are joined together.

  • Anterior Proctosigmoidectomy: this is usually performed due to rectal cancer and involves the removal of a part or all of the rectum with part of the sigmoid colon. The anus is not affected and hence waste and gas movement remain unimpaired.

  • Conservative Resection of middle and lower rectal cancer: This is the least aggressive surgery for rectal cancer and the most tissue conserving.

Gastrectomies (Stomach) Medical Programs:

Gastric cancer, commonly known as stomach cancer, begins in the inner lining of the stomach as cancer cells form and grow into tumors. The stomach, located in the left side of the upper part of the abdomen, is part of the digestive system and is responsible for the breakdown of food. About 95% of stomach cancer begin the glandular tissue that line the stomach (glandular tissue is responsible for the production of digestive juices such as acid and enzymes). Cancer may spread across the stomach wall or may expand to the bloodstream or lymphatic system spreading to other organs in the body.  Stomach cancer usually affects the elderly and is more common in men.

The following is a list of treatment programs offered:

  • Partial gastrectomy:  the removal of only a part of the stomach and if necessary parts of the esophagus or part of the small intestine. Most often but not alway the lower part of the stomach is removed.

  • Partial Gastrectomy with lymphadenectomy: In addition to the removal of a part of the stomach nearby lymph nodes containing cancer cells from the original tumour are also removed in order to reduce the risk of the cancer recurring.

  • Total Gastrectomy with lymphadenectomy: this procedure is usually put in practice if the cancer is in the upper or middle parts of the stomach or has spread throughout the stomach. It involves the removal of the whole stomach as well as nearby lymph nodes and depending how far the cancer has spread, the removal of parts of the esophagus, intestines and other nearby organs. The esophagus is then attached directly to the small intestines.

Hepatectomy (Liver) Medical Programs:

The liver, located under the diaphragm in the right side of the abdomen, is the largest gland and second largest organ in the body after skin. It is responsible for over 300 different functions vital to life some of which include the production of many essential proteins, regulation of a number of hormones, regulation of cholesterol, conversion of fat to energy, production of bile, helping blood clot and the breakdown of harmful substance.  It is the only organ in the body that can regenerate even if 75% of it is diseased or removed.

Liver cancer is the sixth most common kind of cancer globally being most prominent within Africa and East Asia. Primary cancer of the liver develop in the tissues of the cells, blood vessels, connective tissue and bile ducts. Most cancer of the liver is not primary but is metastasized cancer usually spreading from the colon, stomach, pancreas, rectum, kidney, lungs and breasts. It is very crucial to determine the origins of the primary cancer since cancer cells are treated in accordance to the original cancer cells. Cancer of the liver that originated in the breast for example must follow the treatment given for breast cancer.

The following treatment is offered:

  • Hepatectomy: The removal of tumours from the liver. This is done by the removal of only the part in which the tumour is in, a larger portion of the liver or an entire lobe leaving behind an enough portion of liver tissue in order for the liver to continue in its functions and so that it regenerates. This surgery is dependent on whether the cancer has spread to nearby lymph nodes and whether the liver is in good working order as well as on the size, number and location of the cancer.

Pancreatic Cancer:

The pancreas is located deep in the abdomen and is part bothe the digestive system and the endocrine system. 90% of the pancreas is  responsible for the production of enzymes that aid in digesting fat, cholesterol and proteins the remaining 10% is responsible for the production of hormones, such as insulin and glucagon, that regulate glucose metabolism. Pancreatic cancer is often hard to detect due to its deep location within the body and because it gives off little symptoms until the cancer is well developed.  There are two types of pancreatic cancers the first and most common is cancer of the exocrine pancreas (the part of the pancreas that makes the enzymes); the second is cancer of the endocrine pancreas (the part of the pancreas that makes the hormones).

The following treatment programs are offered:

  • Pancreatoduodenectomy: also known as the Whipple procedure and is the most commonly performed surgery for pancreatic cancer. This procedure is the removal of tumours found in the head of the pancreas (the widest part and where most tumours are found). Due to the fact that the pancreas is intermingled with other organs,the duodenum (the first part of the small intestine), bile duct and at times part of the stomach are also removed and then are reconnected to the digestive and biliary system.  

  • Distal pancreatoduodenectomy: the body and tail of the pancreas (the narrowest part) are surgically removed when tumours are located in one of these two areas. This procedure also includes the removal of the spleen.

  • Total pancreatoduodenectomy: performed if the cancer is in advanced stage and has spread to many parts or the whole of the pancreas. It entails the removal of the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. Please note that this procedure is inoperable with obstructive jaundice (a blockage of  of the flow of bile from the liver to the duodenum also known as mechanical jaundice).

Breast Cancer and Gynecologic Cancers Medical Programs

Breast Cancer 

Breast cancer refers to cancer that has its origin in breast cells. It is a cancer that affects mostly women but has been known to affect men as well, though to a much lesser degree. 

Primary tumour first develops in the breast and can become invasive and metastasize to other parts of the body usually through the lymph nodes and/or blood vessels. Most common sites to be involved include the lungs, skin, liver and soft tissue. The number of lymph nodes with cancerous cells continue to be the best indicator of how widespread the cancer is. 

Most common types of breast cancer include: 

  • Ductal carcinoma in situ: most common non-invasive breast cancer which develops in the milk ducts.
  • Invasive ductal carcinoma: most common invasive breast cancer which develops in the milk ducts. It is the breast cancer that men usually develop.
  • Invasive lobular carcinoma: develops in the milk producing gland.
  • M edullary carcinoma: a slow growing and a rare subtype of invasive ductal carcinoma.
  • Paget disease of the nipple: a rare type of breast cancer that affects the skin of the nipple. People with this type of cancer usually have one or more tumours inside the breast. 

Mastectomy: 

The surgical removal of all or part of  breast(s) for the treatment of breast cancer. The following are mastectomy programs offered: 

  • Quadrantectomy or Partial Mastectomy : the surgical removal of cancerous parts of the breast as well as some tissue in the surrounding area.
  • Quadrantectomy with axillary dissection: the surgical removal of the axilla (lymph nodes under the arm) while performing a partial mastectomy.
  • Simple or Total Mastectomy: the surgical removal of all of the breast. Muscle beneath the breast and lymph nodes under the arm are left intact with the exception of lymph nodes located within the breast.
  • Modified Radical Mastectomy: the surgical removal of all of the breast as well as some of the lymph nodes under the arm. Chest muscle are left intact.
  • Radical or Halsted mastectomy: the surgical removal of all of the breast, lymph nodes, chest muscle as well as surrounding tissue.  
  • Surgery for local, regional and soft tissue recurrence of breast cancer: the surgical removal of affected area is generally the prefered treatment for recurrent breast cancer restricted to the breast or to the surrounding area. 

In addition, the following implant procedure is offered: 

  • Silicone Implant Placement: a surgical breast implant after a mastectomy. It is simple and safe and causes little scarring. 

Gynecologic Cancers 

These are cancers that develop in the different organs of the female reproductive system within the pelvis (between the hip bone below the stomach) including the cervix, the uterus, the vegina, the overies, the vulua and the fallopian tubes. Most common among gynecologic cancers are endometrial cancer (uterine cancer), cervical cancer and ovarian cancer, with ovarian cancer being most dangerous due to the fact that, unlike cervical and endometrial cancers, it is often not detected before it has spread to other organs. Other less common gynecologic cancers include fallopian tube cancer, vulvar cancer, vaginal cancer and placenta cancer (molar pregnancy in which tissue rather than developing into a fetus become abnormal growth). 

The following treatment programs for the different types of gynecologic cancers are offered: 

Pelvic Exenteration: 

Pelvic exenteration is the the surgical removal of all or some of the inner organs in the pelvic and, in some cases, the rectum and anus for the treatment of recurrent gynecologic cancers. 

The following pelvic exenteration operations are offered: 

  • Anterior exenteration : the removal of organs found in the front of the pelvic cavity including the urethra, lower part of the ureters, uterus, cervix, vagina, and bladder while sparing the rectum. In order for the urine to exit the body a cavity is created from the lower part of the ileum (the third portion of the small intestine) which is then connected to the abdominal wall. Vaginal reconstruction may be performed during the exenteration or later.
  • Posterior exenteration: the removal of organs in the back of the pelvic cavity including the vagina, uterus, adnexa, rectum, anus, and adjacent lymph nodes while sparing the bladder and urethra. This procedure requires a colostomy (the connection of the colon to the abdominal wall) a stoma is attached in order for feces to pass out of a body and is collected in a small bag.
  • Total exenteration: the removal of  the bladder, rectum, uterus, fallopian tubes, ovaries, vagina, urethra, and a parts of the levator muscles. A urinary stoma and a colostomy stoma are required in order to collect waste. 

Hysterectomy 

Hysterectomy is the surgical removal of cervix, ovaries, uterus and/or fallopian tube in order to stop cancer from spreading to other organs. 

The following hysterectomy programs are offered: 

  • Total Hysterectomy: the removal of the uterus and the cervix. This is the most performed hysterectomy for gynecologic cancers.
  • Video-assisted Laparoscopic Pelvic lymphadenectomy with Vaginal Radical Hysterectomy: Vaginal hysterectomy is a surgery for the removal of the uterus through the vagina if the uterus has not greatly enlarged. The ovaries and the fallopian tubes may also be removed. Using a laparoscope (a thin lighted tube) lymph nodes in the pelvis are also removed and examined to determine they contain cancer.  This may be used in early stage cancers of the cervix and uterus
  • Videolaparoscopy with hysterectomy : a minimally invasive surgery for the removal of the uterus. The procedure is done by a small incision in the abdominal (in the belly button) and a tiny camera is inserted so that the surgeon can see the image on aTV screen and performs the operative procedure.
  • Wertheim Meigs: is the most extensive hysterectomy used mainly for the treatment of invasive cervix cancer; it may also be performed for the staging and treatment of endometrial cancer, upper vaginal carcinomas (cancer on the lining) and/or other cancerous tumours found in the cervix area.   

Oophorectomy: 

Also known as ovariectomy or ovarian ablation (detachment) is the surgical removal of one or both ovaries for the treatment of ovarian cancer or for the prevention of other diseases, such as breast cancer. Usually the surgery is performed by making an incision in the abdomen so as to be able to separate the ovary(ies)  from the blood supply and surrounding tissue. Oophorectomy can be done with or without a hysterectomy. 

The following oophorectomy are offered: 

  • Videolaparoscopy with oophorectomy: the surgical removal of one or both ovaries by making few small incision in the abdomen. A tiny camera is then inserted in one of them while surgical tools in the others. The images from the camera will be displayed on a monitor so as to guide the surgeon during the operation.
  • Unilateral oophorectomy : is minimal invasive surgery for the removal of one ovary. This procedure allows for the continuation of menstruation and the ability to have children.
  • Bilateral oophorectomy: the removal of both ovaries. 

Vulvectomy: 

A vulvectomy is the surgical removal of all or parts of the vulva. 

The following vulvectomy procedures are offered: 

  • Partial Vulvectomy: least severe and most common vulvectomy and involves the removal of only affected portion of the vulva and some of the surrounding tissue.
  • Radical vulvectomy: least common vulvectomy and involves the removal of all of the vulva, the clitoris, the lymph nodes and nearby tissue. The uterus, vegina and overies stay intact.
  • Ultra-radical vulvectomy with lymphadenectomy: a radical vulvectomy with posterior exenteration (the removal of organs in the back of the pelvic cavity including the rectum but not the bladder) or total pelvic exenteration (the removal of both the bladder and the rectum). This procedure also includes the surgical removal of the lymph nodes.

Skin Cancer Medical Program

Skin Cancer

The skin is the biggest organ in the body and protects against infections, injuries, heat and sunlight. It also helps to control body temperature and stores water, fat and vitamin D.  Skin cancer develops in the epidermis (the upper or outer layer of the skin)  and is defined by the type of cells it grows in. There are two types of skin cancer nonmelanoma skin cancer and melanoma skin cancer. 

Nonmelanoma skin cancer medical programs:

The most common cancer worldwide is nonmelanoma skin cancer which is highly treatable and has low mortality rate. Though there are many types of nonmelanoma skin cancer, it is usually divided into two main types: 

  • Basal Cell Carcinoma (BCC) : basal cells are cells in the deepest layer of the epidermis. It accounts for about 8 out of 10 skin cancers and is usually slow in development and seldom spreads to other parts of the body.
  • Squamous Cell Carcinoma (SCC):   squamous cells are cells in the upper layer of the epidermis. it accounts for 2 out of 10 skin cancers. In very small number of cases squamous cell carcinoma can spread to the deeper epidermis layer and to other parts of the body. 

Most basal cell carcinoma and squamous cell carcinoma can be quickly and easily surgically destroyed or removed along with surrounding cancer free tissue. 

Nonmelanoma skin cancer medical programs include the following treatments: 

  • Nonmelanoma skin cancer that requires surgery without reconstruction
  • Nonmelanoma skin cancer that requires extended surgery with reconstruction 

Treatment for this type of cancer is dependent on the size and location of the growth as well as the age and overall health of the patient. 

Melanoma Medical Programs:

Melanoma is the rarest but most serious of skin cancers. It develops in the melanocytes, pigment producing cells which give skin its color. Melanoma is considered to be a dangerous cancer because it spreads very easily and sends roots down into fat and other tissue. It can also travel through the bloodstream and the lymph nodes system to other parts of the body. 

Treatment for melanoma is based on the size, location and stage of of the cancer as well as the overall health of the patient and will include chemotherapy, radiation, targeted therapy, immunotherapy and/or surgery. In very rare cases and when melanoma is confined to a limb amputation may be needed when all other options have failed. Disarticulation, the separation of two bones at the joint during amputation, may also be performed. 

Melanoma skin cancer amputation program include the following: 

  • Melanoma skin cancer requiring arm amputation
  • Melanoma skin cancer requiring femur amputation
  • Melanoma skin cancer requiring hip disarticulation
  • Melanoma skin cancer requiring shoulder disarticulation
  • Melanoma skin cancer requiring knee disarticulation
  • Melanoma skin cancer requiring extended surgery without reconstruction
  • Melanoma skin cancer requiring extended surgery with reconstruction

Urological Cancer Medical Program

Urological cancers:

Urological cancers are a group of cancers that develop in the urinary tract and the male reproductive system They include kidney cancer, bladder cancer, testicular cancer, prostate cancer, penile cancer, adrenal cancer and cancers of of the ureter.

Treatment of each urological cancer differs and is dependent on the size of the cancer, how far it has spread and on the overall health of the patient.

Bladder Cancer:

The bladder, an expandable muscular sac, is the body’s urine storage before it is released out the body. Bladder cancer is a common type of cancer that, as with other cancers, develops when cells begin to divide and grow uncontrollably. There are three main types of bladder cancer most common of which is transitional cells carcinoma (develops in the cells that line the inside of the bladder), squamous cell carcinoma (usually develops after an infection and irritation) and adenocarcinoma (begins in the mucus secreting glands). Most types of bladder cancers are highly treatable (50%) when diagnosed at an early stage.

Surgical operation, alone or combined with other treatment, are usually performed in the treatment of bladder cancer.  The following is a list of surgical treatments offered:

  • Transurethral resection of bladder lesions (TURB): the initial treatment for beginning stages of bladder cancer.  A cystoscope (a viewing instrument for examining the bladder) is inserted in the urethra in order to remove tumours and to examine bladder tissue.
  • Cystectomy : the surgical removal of all or part of the bladder for the treatment of bladder cancer or the treatment of a recurred bladder cancer after initial treatment.
  • Partial cystectomy : the surgical removal of parts of the bladder where the tumour has developed as well surrounding bladder wall. This is only performed if the cancer is not at the opening of the bladder (where the urine enters and exists).
  • Partial cystectomy with ureteral re-implantation: the surgical removal of parts of the bladder in which cancer has developed with the re-routing of the ureter to another part of the urinary bladder.
  • Cystectomy with sigmoid or ileal bypass: the surgical removal of all of the bladder. An ileal bypass or conduit (urostomy) is created to allow urine to flow out of the body through a stoma ( a small surgically made opening in the abdomen to allow the passage of urine). A sigmoid bypass (also known as Mainz II pouch) is created from a segment of the rectum and sigmoid colon and is used to allow urine to flow out of the body with the stool out of the rectum.
  • Cystectomy with Reservoir Development and emptying: the surgical removal of the bladder with a reservoir (Indiana pouch) to store and eliminate urine. This is done by surgically creating a pouch by sewing together the ileum and parts of the large colon. Though the pouch functions as a bladder it cannot empty on demand and the patient needs to catheterize to drain the urine.

Kidney (Renal) Cancer

Kidney cancer develops when cells in the one or both kidneys grow uncontrollably and form tumours. Found on both sides of the backbone just below the rib cage, the kidneys filter water and waste material from the blood creating urine. Kidneys also regulate electrolyte balance (salts and minerals such as sodium, potassium, chloride, calcium and phosphate, that conduct electrical impulses in the body) and produce hormones and enzymes (such as erythropoietin and renin) that regulate blood pressure and the production of red blood cells.

Nephrectomy is the most common type of treatment practiced for kidney cancer if the cancer has not spread to other body parts. It involves the surgical removal of the cancerous tissues in order eliminate the cancer and to stop it from developing further.

The following are surgical treatment offered:

  • Partial Nephrectomy: the surgical removal of part of the kidney.
  • Simple Nephrectomy: the surgical removal of all of one kidney.
  • Radical Nephrectomy: the surgical removal of all of one kidney, the surrounding lymph nodes as well as the adrenal gland.

Penile Cancer

A rare type of cancer that can develop anywhere on the penis, but is most often found on the foreskin. It is slow to spread and can be cured when diagnosed early.  If left untreated however,it can spread to the lymph nodes and other other body parts. Surgery remains one of the most common type of treatment for penile cancer. Not all growth on the penis are cancerous though they can look and act as such. Non cancerous (benign) abnormal growth sometimes can develop on the penis. Most affect the foreskin or the glans.

Treatment for penile cancer is dependent on stage and location of the cancer. The following are surgical treatments offered:

  • Exeresis of large lesions of the penis: the surgical removal of the tumour as well as surrounding non cancerous skin. If the area removed is small the remaining skin is stitched back together.  
  • Exeresis of deep lesions of the peins (penectomy): the surgical removal of all or part of the penis in order to ensure the removal of all of the cancer.
  • Exeresis of small superficial lesions of the penis: the surgical removal of tumours that have not developed beyond their site of origins and have not invaded other parts of the body (in situ).

Prostate Cancer:

The prostate is a walnut shaped gland located under the bladder and in front of the rectum and is responsible for the production of seminal fluids. Prostate cancer is one of the most common cancer in men and is due to cancerous cells developing in the prostate gland.  For the most part prostate cancer is slow in developing and slow in spreading to other organs. However as tumours begin to develop cells break away and may reach the lymph nodes,  seminal vesicles, bones around the hip and pelvis area and/or the lungs. Depending of the stage of the most common treatment for prostate cancer is surgery.

  • Radical Prostatectomy:  The surgical removal of all of the prostate gland and neighbouring tissue.
  • Transurethral prostatic resection: a minimally invasive surgery for the removal of parts of the prostate gland through the penis in order to treat benign swelling of the prostate or if the the cancer puts pressure on the urethra.

Endocrine Cancer Medical Program

The endocrine glands are responsible for the carefully balanced production of  hormones which act to chemically control various body functions such as reproduction, metabolism and growth.  They include the pituitary gland, the thyroid gland, parathyroid gland, the pancreas, the adrenal glands, the ovaries and the testis. All hormones are directly released into the bloodstream reaching targeted cells or organs. Tumours can develop in any of the endocrine glands and may cause disruption in the normal hormone production by either causing hormonal deficiency or overproduction both of which can cause serious illness.  

Endocrine cancer is very rare with ovarian cancer and thyroid cancer most common. Most endocrine are benign (non cancerous) can easily be treated with ovarian cancer and pancreatic cancer being the exception.

Pituitary Adenoma:

The pituitary gland is located at the base (but not part) of the brain and is often referred to as the "master gland" due to it’s great influence on body organs and in regulating hormones responsible for the overall well being of individuals. Although tumors in the pituitary gland are usually benign (adenoma -  the name given to non cancerous tumour in glandular system) and rarely spread to other parts of the body they can grow in size and may cause visual impairment, headaches, reduction of sex hormones, infertility, headaches and irritability. 

The following treatment is offered:

  • Neurosurgery: surgery for the removal of the tumour and surrounding tissue remains one of the most common method of treatment depending on the size of the tumour, its location and whether it is creating other health issues such as visual impairment.

Thyroid Cancer:

The thyroid, a small gland made up of two connected lobes, is found in the front of the neck below the larynx and is responsible for controlling body functions such as body temperature, metabolism, heart rate and blood pressure. Thyroid cancer develops when some cells change and become cancerous.  In general, thyroid cancer is slow in developing, least deadliest of the head and neck cancers and the most curable of all cancers.

The following procedures are offered in Cuba:

  • Hemithyroidectomy: standard surgical procedure for the removal of one of the thyroid lobes. The procedure is very safe with little risk of damage.
  • Thyroidectomy with radical dissection : a common surgical procedure for the removal of part or all the gland. Radical dissection is performed if there are lymph node metastases.

Pancreatic Cancer:

The pancreas is located deep in the abdomen and is part bothe the digestive system and the endocrine system. 90% of the pancreas is  responsible for the production of enzymes that aid in digesting fat, cholesterol and proteins the remaining 10% is responsible for the production of hormones, such as insulin and glucagon, that regulate glucose metabolism. Pancreatic cancer is often hard to detect due to its deep location within the body and because it gives off little symptoms until the cancer is well developed.  There are two types of pancreatic cancers the first and most common is cancer of the exocrine pancreas (the part of the pancreas that makes the enzymes); the second is cancer of the endocrine pancreas (the part of the pancreas that makes the hormones).

The following treatment programs are offered:

  • Pancreatoduodenectomy: also known as the Whipple procedure and is the most commonly performed surgery for pancreatic cancer. This procedure is the removal of tumours found in the head of the pancreas (the widest part and where most tumours are found). Due to the fact that the pancreas is intermingled with other organs,the duodenum (the first part of the small intestine), bile duct and at times part of the stomach are also removed and then are reconnected to the digestive and biliary system.  
  • Distal pancreatoduodenectomy: the body and tail of the pancreas (the narrowest part) are surgically removed when tumours are located in one of these two areas. This procedure also includes the removal of the spleen.
  • Total pancreatoduodenectomy: performed if the cancer is in advanced stage and has spread to many parts or the whole of the pancreas. It entails the removal of the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. Please note that this procedure is inoperable with obstructive jaundice (a blockage of  of the flow of bile from the liver to the duodenum also known as mechanical jaundice).  

Adrenal Cancer

The adrenals are two glands each of which is located on top of a kidney. There are two parts to the adrenal glands.  The outer part called the adrenal cortex and is responsible for the production of the hormones cortisol, aldosterone, and dehydroepiandrosterone which controls metabolism and body characteristics. The inner part is called adrenal medulla and is responsible for the production of hormones that control the body’s responses to stress. 

There are two types of adrenal cancer, functioning tumour (tumour that causes the overproduction of hormones) and non-functioning tumours (tumour that does not produce hormones). However most cancers found in the adrenal glands have their origins in other parts of the body such as the lungs or breast. 

  • Adrenalectomy: the most common treatment for adrenal cancer and is the surgical removal of the one or both adrenal glands in both benign or cancerous tumours.  Adrenalectomy may also be performed if cancer has metastasized (spread) from another area. If only one adrenal gland is removed then the remaining one takes over without the need for medication.

Neurological Cancer Medical Program

Together the brain and the spinal column make the central nervous system (CNS) whereby the brain acts as the control center of the body while the nerves in the spinal cord act as a messenger between the brain and body. Both the brain and the spinal cord are enclosed in a protective bony structure (the skull and the spinal column). There are a number of different types of CNS tumours which may be cancerous (malignant) or noncancerous (benign) both of which can put enough pressure as to cause severe to life threatening symptoms and can have serious effects on normal functions such as thought and movement. 

Primary brain tumours are those that have their origins in the brain cells and though they often do not spread outside of the CNS they can spread rapidly throughout the brain tissue and spinal cord. There are two grades to primary tumours the first is low grade tumour which is usually a slow growing and don’t usually spread to neighbouring tissue; the second is high grade tumour which grows at a faster rate and can spread to neighbouring tissue and to other parts of the CNS. Low grade tumours can sometimes develop into high grade ones. 

Secondary brain tumours is when cancer has originated from another part of the body, such as the lungs, breasts, colon and has metastasized (spread) to the CNS. Secondary cancers are more common than primary ones. 

Treatment for CNS tumours is dependent on the type, size and grade of tumour, location of tumour, age and overall health of the person. Neurosurgery for the removal of the tumour and possibly neighbouring tissue remains as the main treatment for CNS tumours. 

The following neurosurgeries for the treatment of CNS are offered: 

  • Pituitary Adenoma
  • Anaphasic gliomas of cerebral hemispheres
  • Low grade malignant gliomas of cerebral hemispheres
  • Craniocerebral metastatic tumors
  • Spinal cord metastatic tumor
  • Intramedullary Vascular Lesions
  • Supratentorial Meningioma
  • Acoustic Neuroma
  • Optic pathway tumors
  • Tumors of fourth ventricle and cerebellar hemispheres
  • Tumors of the cerebral ventricles
  • Pineal Region Tumors
  • Brainstem Tumors
  • Intramedullary tumors
  • Tumors of the Skull Base