Oncology Services



Specializing Institutions

Oncology is a branch of medicine that deals with tumors (cancer), from screening, diagnosis, therapy and surgery. The most important diagnostic tools in oncology are biopsies, endoscopies, X-rays, MRI scanning and blood tests. Interventions depend on the nature of the tumor. Often, surgery is attempted to remove a tumor entirely. Chemotherapy and radiation therapy are used as first-line radical treatments. Since cancer can occur in so many of the body’s systems, many doctors choose to specialize in a particular branch of oncology, such as bone cancer or blood diseases. Oncology also involves the research into cancer, its causes and possible cures. Lung cancer is by far the most fatal cancer in men, followed by prostate and colon. In women, lung and breast cancer are the leading sites of cancer death.

The South Texas Medical Center is home to the only academic treatment and research center in the South Texas Region. Patients can benefit by gaining access to new drugs that are unavailable in other cancer centers. We are also home to an internationally recognized Phase I clinical drug program.

Oncology services at the South Texas Medical Center extend the sophistication of radiation therapy. Our oncologists and researchers practice and pioneer innovative techniques to treat patients using advanced radiation systems such as the TomoTherapy® Hi Art® unit. The unit, one of only three available in Texas, integrates optimized planning, image guidance, and continuous 360° delivery for precise radiation therapy from all angles around the patient. Other cancer therapies and services that patients can find at the South Texas Medical Center include Intensity Modulated Radiation Therapy (IMRT), High Dose Rate (HDR) brachytherapy and Novalis Tx Radiosurgery.

Patients and their families can receive non-medical oncology services at the South Texas Medical Center. These services include lectures, support groups, nutrition advice, psychological and emotional assistance, social services and more.

The National Cancer Institute has recognized one of our institutions for its excellence in cancer treatment and patient service, making the South Texas Medical Center a source of hope for many and a hub of oncology research and innovation.

Pediatric Oncology Services

Pediatric Oncology is a branch of medicine concerned with the diagnoses and treatment of cancer in children. It is considered one of the most challenging specialties because of its high mortality rate. Pediatric Oncologists take a slightly different course in their education compared to regular oncologists. Some of them, for instance, become pediatricians after completing medical school and later specialize further in oncology. Cancer affects about 14 of every 100,000 children in the United States each year. The most common cancers in children are leukemia, lymphoma and brain cancer. Typically, factors that trigger cancer in kids differ from those that cause cancer in adults, such as smoking or exposure to environmental toxins. Rarely, there may be an increased risk of cancer in kids who have a genetic condition, such as Down syndrome. Childhood cancers can occur suddenly, without early symptoms.

The South Texas Medical Center features one of the most specialized children’s cancer research centers in the nation. The research center is organized around our major programs and is comprised of an interdisciplinary group of faculty and field experts. The center’s mission is to advance scientific knowledge relevant to childhood cancer and to accelerate the translation of knowledge into novel therapies.

Oncology Articles

  • Costly eye drug and far cheaper alternative have similar side effects -study

    By Ben Hirschler

    LONDON (Reuters) - Injecting Roche's cancer drug Avastin as a cheap eye treatment does not appear to increase deaths or serious side effects, according to an independent study that is likely to fuel a row over the medicine's unapproved use.

    An analysis of nine clinical trials - including three unpublished ones - concluded that health policies favoring the much more expensive eye drug Lucentis over Avastin were not supported by current evidence.

    The study was published on Monday in The Cochrane Library journal, which is produced by the Cochrane Collaboration, a non-profit group that reviews trial data to assess the value of drugs.

    There has been a fierce debate for many years over whether Avastin should be used as a cut-price alternative in patients with wet age-related macular degeneration (wAMD), a leading cause of blindness in the elderly.

    Avastin is not licensed for wAMD but it works in a similar way to authorized treatments for the condition - Lucentis, which is marketed by Novartis and Roche, and Eylea, from Bayer and Regeneron Pharmaceuticals.

    A number of doctors in the United States and Europe already use Avastin in wAMD on an unapproved basis and some pharmacies provide a service of splitting the cancer medicine into smaller doses for eye injections.

    The issue is particularly hot in Europe after French lawmakers voted in July to allow Avastin's use, while Roche and Novartis have faced recent regulatory scrutiny in France and Italy on suspicion of anti-competitive practices. The companies have denied any wrongdoing.

    COST DIFFERENCE

    In France, Avastin costs about 30 euros ($38.84) per dose, against the 900 euros charged for an injection of Lucentis.

    Novartis and Roche have always discouraged the substitution of Avastin for Lucentis, saying that the two drugs were developed for different therapeutic purposes.

    A closely watched U.S. government-sponsored study in 2011 concluded that Avastin worked as well as Lucentis in treating vision loss from wAMD but had more adverse side effects.

    However, the Cochrane paper found that the safety of Avastin when used in wAMD appeared to be comparable with that of Lucentis, except for a higher rate of gastrointestinal disorders.

    David Tovey, editor in chief of the Cochrane Library, said the review addressed a question of "immense importance to health systems in many countries".

    The Cochrane researchers noted, however, that their findings were not definitive and that they now plan to conduct a larger review to assess additional sources of evidence.

    Novartis said in a statement that Lucentis had a well-known safety profile with more than 2.8 million patient-treatment years of use globally. Avastin's use in the eye, by contrast, has not been systematically reviewed by health authorities.

    Roche said it believed that Lucentis is the most appropriate medicine for wAMD, adding that the Cochrane review appears to be based on studies that were not designed to detect differences related to safety aspects.

    Lucentis is marketed by Novartis outside the United States and is the company's third-biggest seller, with $2.4 billion in sales last year. Sales of Lucentis for Roche, which markets the treatment in the United States, were $1.9 billion.

  • Toronto Mayor Rob Ford has tumor, election campaign up in air

    By Andrea Hopkins

    TORONTO (Reuters) - Speculation swept Canada's biggest city on Thursday after Toronto Mayor Rob Ford, who made global headlines last year for admitting he had smoked crack cocaine, was hospitalized with an abdominal tumor just six weeks before the mayoral election.

    With biopsy results expected by the end of the week, Ford's illness raised the possibility that he might have to pull out of the Oct. 27 election after having clung to power through a string of scandals, including his appearance in expletive-ridden videos and accusations that he ordered a jailhouse beating.

    Ford's brother and campaign manager, Doug Ford, was expected to update the city on the mayor's health and political future on Thursday, but pundits were already mulling the mayor's options in a close-run election race in which Ford is one of three frontrunners.

    "To some extent or another, the future of the city rests in the status of a tumor in the mayor's belly," columnist Edward Keenan wrote in the Toronto Star, the city's biggest daily newspaper and the one most critical of Ford.

    "Whether he can carry on and fight, and what that will mean for his support, whether he needs to withdraw and turn a campaign that has been largely about his governance on its head, whether his brother might run in his place. The decisions need to be made soon," Keenan wrote.

    Friday is the deadline for candidates to remove their names to the ballot and for new ones to be added. Rob Ford's brother Doug is also a city councillor.

    News of the tumor broke in the early evening on Wednesday after the mayor went to hospital complaining of unbearable abdominal pains. "It's not a small tumor," the hospital's president said, noting that Ford had been suffering from pain for more than three months.

    Rob Ford's father, Doug Ford Sr., a politician and businessman, died of colon cancer less than three months after being diagnosed in 2006.

    In 2009, doctors removed a tumor from Rob Ford's appendix but the then-city councillor returned to work in good health.

    The mayor spent two months in rehab for drug and alcohol abuse in May and June, emerging noticeably thinner though still obese. He said he regretted not getting treatment "years ago" to treat his alcohol addiction.

    Ford, who came to power in 2010 pledging to cut waste at city hall and keep a lid on taxes, has a core base of suburban support, but he has come under fire for use of crack cocaine and for several videos showing him drunk, spewing racial slurs, and threatening violence.

    His two main opponents in election wished the mayor well as they went ahead with a two-hour breakfast debate on Thursday that Ford had been scheduled to attend.

    A poll released on Wednesday showed Ford running in second place with 28 percent of the vote, behind conservative frontrunner John Tory, who had 40 percent of voter support. Left-leaning candidate Olivia Chow was in third place with 21 percent of the vote.

  • REFILE-Cancer-zapping proton therapy only suitable for rare patients

    (Corrects byline, no change to article text)

    By Kate Kelland

    LONDON (Reuters) - A new cancer-zapping therapy for which a British couple took their child to the Czech Republic amid an international police hunt and media storm can be highly effective, experts say, but is only suitable for rare tumors.

    The parents of British five-year-old Ashya King, who has a brain tumor, ignored medical advice, removed him from hospital and left the country at the end of August, saying they wanted to take him to a private clinic in Prague for proton beam therapy - a type of radiotherapy not currently available in Britain.

    The couple were detained in Spain after an international manhunt that drew condemnation in British media, separated from their sick son and then released days later by a Spanish judge.

    They arrived with Ashya in Prague on Monday and visited the clinic to begin discussing a treatment plan.

    Experts caution, however, that the treatment - a more targeted way of destroying cancerous cells than conventional radiation using photon beams - only offers extra benefits in a small minority of cancer cases.

    They declined to comment directly on Ashya King's case but said the type of brain cancer he has - medulloblastoma - is not usually suited to proton beam treatment.

    "Dose for dose, proton beam therapy is actually no more effective on the cancer cells than conventional radiotherapy - so it isn't a magic bullet in that sense," said Adrian Crellin, a consultant clinical oncologist and the government's national clinical lead in proton beam therapy.

    "What it does do, however, is allow us to take advantage of a different set of properties of the proton, and that - particularly for something like some children's cancers - gives the opportunity to reduce some of the later side effects."

    The treatment uses beams of protons rather than X-rays or photons and targets them at the cancerous cells to kill them.

    The protons are directed at a tumor more precisely than X-rays and unlike in conventional radiotherapy, the proton beams stop once they hit the target rather than continuing through the body - making them less likely to harm healthy tissue.

    Simon Jolly, a lecturer in accelerator physics at University College London (UCL), said these key features of the proton beam make it highly suited to some hard-to-reach tumors, or tumors growing very close to other key organs that could be badly affected by radiation, such as the brain stem or spinal cord.

    "What you're trying to do is deliver dose to the cells that you want to kill... and do it in a targeted way," Jolly told reporters at a briefing for reporters given by experts on proton therapy.

    "The key advantage with the proton is that it goes in and then stops. And it dumps must of its energy, doing most of its damage, at the end of its path. So not only are you doing less damage on the way in, but it also means that if there are sensitive areas on the far side of the tumor, you will not damage them."

    But proton beam therapy is not recommended for medulloblastoma because the treatment should not be targeted to the tumor only.

    "There are some tumors that require radiotherapy to the whole brain and whole spinal cord," said Yen-Ching Chang, a specialist in pediatric radiotherapy at UCL.

    In cases of medulloblastoma, she added, "we're unable to spare any part of the brain (from radiation)...so the reduction of long-term side-effects is less."

    The government's department of health says that from April 2018, proton beam therapy will be offered to up to 1,500 cancer patients at two major hospitals - UCL in London and the Christie cancer hospital in the northern hub city of Manchester.

    Until then, British cancer patients who doctors believe would benefit from the specialist treatment will continue to be sent overseas - either to the United States or Switzerland - for treatment paid for by the taxpayer-funded National Health Service (NHS), the experts said.

    Crellin said that in 2013, almost 100 children and 24 adults in Britain were approved for NHS funding to have proton beam treatment abroad.

  • REFILE-What cancer patients want and what Medicare covers may differ

    (Adds new paragraph 19 to clarify that Medicare has a limited pilot program offering some services not usually covered for cancer patients)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - When asked what Medicare should cover for cancer patients in their last months of life, many patients and their caregivers choose benefits the federal insurance does not offer, like home-based long term care and concurrent palliative care, according to a new study based on interviews.

    Given an array of options, a limited budget and a chance to discuss the choices, patients and caregivers were not very likely to devote all coverage to curative cancer treatment, said lead author Donald H. Taylor Jr, of the Sanford School of Public Policy at Duke University in Durham, North Carolina.

    "It is important to not over-interpret our results, because they were obtained in a hypothetical context, meaning the choices stated did not impact the actual care they received," Taylor told Reuters Health by email.

    Medicare covers what it defines as "reasonable and necessary care" and its standards have come to guide what private insurers are willing to pay for as well, Taylor and his colleagues write in the Journal of Clinical Oncology. As Medicare spending is targeted by federal cost cutting, the risk that patient choices will be narrowed increases, they write.

    To gauge what cancer patients most want from Medicare coverage, the researchers gathered more than 400 participants who were either Medicare beneficiaries over age 65 undergoing treatment for cancer, had recently been treated for cancer or were helping to care for a cancer patient on Medicare.

    Of the 194 caregivers, most were spouses of cancer patients. Half of the patients reported spending more than $2,000 out of pocket on medical care over the previous year.

    The participants met in small groups for a 2.5 hour session that included going over educational materials about Medicare benefit categories, individually choosing benefit categories and discussing as a group what benefits should be covered.

    Each person was given a circular game board and 50 stickers to allocate between 15 benefit categories, some of which are not covered by Medicare. The number of stickers given to each benefit category indicated the level of care the patient or caregiver wanted for that benefit.

    Some of the covered benefit categories were cancer therapy and primary care, while cash payments, home-based long term care and "concurrent" palliative care that's integrated into cancer treatment were options that are not covered by Medicare.

    The researchers estimated that Medicare pays out about $35,000 for a cancer patient over the last six months of life. Divided into 50 units, that meant that one sticker on the board represented $700 of coverage.

    Almost everyone allocated coverage to cancer care itself, usually an intermediate or high level of care, and most also chose primary care and prescription drug coverage, which are covered by Medicare.

    More than 80 percent of participants also chose palliative care, home care and nursing home care. Only 12 percent chose the maximum amount of cancer care.

    Around half of the group also chose some level of unrestricted cash, home-based long term care services or concurrent palliative care, which is beyond the current hospice benefits covered by Medicare. People who chose these categories allocated up to 30 percent of their hypothetical budget to them, the researchers note.

    "We placed participants under a serious resource constraint," Taylor said. "So, when around half of participants choose some level of unrestricted cash, they are not simply saying 'I would like some money.' Instead, they are saying 'I will take less health care in order to get unrestricted cash."

    Currently, Medicare covers curative cancer treatment and hospice care, but not at the same time. Many participants in this study would choose concurrent palliative care which may indicate that system should change, he said.

    "The existing bright line 'curative v. hospice' choice that currently exists in Medicare I think does need to be changed toward a concurrent palliative care model," he said.

    Other options, like cash benefits, were more outlandish and speculative, Taylor said.

    "Unrestricted cash seems very unlikely, while concurrent palliative care seems quite likely to be covered within the next few years," he said.

    Indeed, Taylor said, Duke's hospice is among several centers that will be participating in a three-year Medicare Care Choices pilot program offering concurrent palliative care and other services to patients still receiving cancer treatment. (See Reuters article of May 14, 2014, here: http://bit.ly/1lEogpl).

    It makes sense that people would want palliative and long term care, said Peter Neumann, professor of medicine at the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston. Neumann was not part of the new study.

    "It's a very interesting exercise to ask people the kinds of benefits they want and compare it to what exists," Neumann told Reuters Health.

    "Medicare can't cover everything," he said. "To change the law to cover more long term care, for example, would be a big change."

    Traditionally, Medicare has covered non-experimental medical care, but custodial services and long-term care have not been covered because they are not "medical care," Taylor said.

    "If we moved toward focusing on quality of life improvements, then long term care would likely rise as well, certainly as compared to many health care options for which the evidence of benefit is quite low, while the cost is quite high," Taylor said.

    SOURCE: http://bit.ly/1uiW2lw Journal of Clinical Oncology, online August 25, 2014.

  • REFILE-Cancer-zapping proton therapy only suitable for rare patients

    (Corrects byline, no change to article text)

    By Kate Kelland

    LONDON (Reuters) - A new cancer-zapping therapy for which a British couple took their child to the Czech Republic amid an international police hunt and media storm can be highly effective, experts say, but is only suitable for rare tumors.

    The parents of British five-year-old Ashya King, who has a brain tumor, ignored medical advice, removed him from hospital and left the country at the end of August, saying they wanted to take him to a private clinic in Prague for proton beam therapy - a type of radiotherapy not currently available in Britain.

    The couple were detained in Spain after an international manhunt that drew condemnation in British media, separated from their sick son and then released days later by a Spanish judge.

    They arrived with Ashya in Prague on Monday and visited the clinic to begin discussing a treatment plan.

    Experts caution, however, that the treatment - a more targeted way of destroying cancerous cells than conventional radiation using photon beams - only offers extra benefits in a small minority of cancer cases.

    They declined to comment directly on Ashya King's case but said the type of brain cancer he has - medulloblastoma - is not usually suited to proton beam treatment.

    "Dose for dose, proton beam therapy is actually no more effective on the cancer cells than conventional radiotherapy - so it isn't a magic bullet in that sense," said Adrian Crellin, a consultant clinical oncologist and the government's national clinical lead in proton beam therapy.

    "What it does do, however, is allow us to take advantage of a different set of properties of the proton, and that - particularly for something like some children's cancers - gives the opportunity to reduce some of the later side effects."

    The treatment uses beams of protons rather than X-rays or photons and targets them at the cancerous cells to kill them.

    The protons are directed at a tumor more precisely than X-rays and unlike in conventional radiotherapy, the proton beams stop once they hit the target rather than continuing through the body - making them less likely to harm healthy tissue.

    Simon Jolly, a lecturer in accelerator physics at University College London (UCL), said these key features of the proton beam make it highly suited to some hard-to-reach tumors, or tumors growing very close to other key organs that could be badly affected by radiation, such as the brain stem or spinal cord.

    "What you're trying to do is deliver dose to the cells that you want to kill... and do it in a targeted way," Jolly told reporters at a briefing for reporters given by experts on proton therapy.

    "The key advantage with the proton is that it goes in and then stops. And it dumps must of its energy, doing most of its damage, at the end of its path. So not only are you doing less damage on the way in, but it also means that if there are sensitive areas on the far side of the tumor, you will not damage them."

    But proton beam therapy is not recommended for medulloblastoma because the treatment should not be targeted to the tumor only.

    "There are some tumors that require radiotherapy to the whole brain and whole spinal cord," said Yen-Ching Chang, a specialist in pediatric radiotherapy at UCL.

    In cases of medulloblastoma, she added, "we're unable to spare any part of the brain (from radiation)...so the reduction of long-term side-effects is less."

    The government's department of health says that from April 2018, proton beam therapy will be offered to up to 1,500 cancer patients at two major hospitals - UCL in London and the Christie cancer hospital in the northern hub city of Manchester.

    Until then, British cancer patients who doctors believe would benefit from the specialist treatment will continue to be sent overseas - either to the United States or Switzerland - for treatment paid for by the taxpayer-funded National Health Service (NHS), the experts said.

    Crellin said that in 2013, almost 100 children and 24 adults in Britain were approved for NHS funding to have proton beam treatment abroad.