General Surgery/ Oncology, University of Florida, Gainesville, FL

Breast Cancer	Back to Top
Once a woman learns she has breast cancer, we can offer her the best possible chance of saving her breast if this is an appropriate treatment for her. Breast conservation rates for patients with breast cancer are dependent on several factors including referral sources to an institution. Nevertheless, our breast conservation rates are excellent. Our doctors offer a conservative surgical procedure to many women who come to the UF-Shands Breast Center for breast cancer care -- one that is easier to tolerate, speeds their recovery, and enables them to return sooner to their normal day-to-day activities. Sentinel node biopsy is a current technique used by our surgical oncologists which spares many women from extensive surgery to remove a cluster of lymph nodes from under the arm to see if they contain cancer cells. With this procedure, surgeons need remove only one lymph node for examination -- the "sentinel" node, where cancer cells from a breast tumor would travel first. If this lymph node turns out to be free of cancer, the remaining nodes can be left intact, and the surgery to remove the tumor is completed. If it contains cancer cells, the remaining nodes are also removed and analyzed using standard axillary node dissection. This technique can save many women from the most troublesome side effect of more extensive surgery -- lymphedema, or swelling of the arm. For women who have had a mastectomy, our surgeons offer innovative reconstructive techniques. A major advance in breast reconstruction is called "skin-sparing mastectomy." The surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place; then the surgeon fills in the shell with tissue from the woman's abdomen and, later, reconstructs the nipple, resulting in a natural-looking breast. UF-Shands Breast Surgeons and Pathologists have an active program in intra-operative margin assessment for patients undergoing partial mastectomy for breast cancer. Physicians utilize special techniques to reduce the rates of margin positive excisions that mandate additional surgical procedures. UFSCC breast imaging specialists are now refining and demonstrating the benefits of stereotactic needle biopsy, a procedure for diagnosing a suspicious area that can be seen on a mammogram but is too small to be felt. The procedure uses computer-imaging techniques to guide a needle into the breast to collect abnormal cells from a suspicious area observed on an x-ray. For many women, stereotactic needle biopsy can spare them a more uncomfortable and expensive surgical biopsy. It can also allow them to start their treatment sooner. Advanced breast imaging is an important part of the care we provide. This includes digital mammography, MRI, and PET-CT Scan. We often utilize breast MRI in the pre-operative setting to optimize surgical and long-term oncologic outcomes. Women who need systemic medical therapy (such as chemotherapy) or radiation therapy benefit from UFSCC’s development of innovative systemic therapies, including new hormonal approaches and vaccines. Center physicians have pioneered sequential dose-density chemotherapy. Rather than giving several drugs simultaneously, they administer anticancer agents singly at optimal doses in a defined sequence over a certain period of time. This approach makes chemotherapy more tolerable and more effective for eradicating tumors. In addition, our oncologists offer partial breast irradiation as a type of radiation treatment which dramatically decreases the length of time for a course of radiation treatments for breast cancer. Our Surgical Oncologists, certified in Mammosite technology, work in conjunction with colleagues in radiation oncology. The surgical team has expertise in different types of partial breast irradiation (Mammosite, 3-D Conformal, and Interstitial). They are experts in tailoring a unique treatment plan to the needs of each individual patient in order to maximize results and minimize morbidity. The UF-Shands Breast Center is a major referral center for patients with breast cancer. Our experienced team works hard at providing individualized, quality service for our patients. Breast ultrasound, stereotactic breast biopsy, lymphatic mapping and sentinel lymph node biopsy are all examples of some of the most current techniques used to maximize treatment while minimizing invasive procedures. In addition, many of our surgical procedures for management of breast cancer are being performed on an outpatient basis. Enrollment and participation in ongoing national and regional clinical trials is also offered for patients with this type of malignancy.


Colorectal Cancer	Back to Top
This year, about 148,000 people in the United States will be diagnosed with colorectal cancer. Although many people think of colorectal cancer as a disease that primarily affects men, it is slightly more common in women. Today, the average person has about a 1 in 20 chance of developing colorectal cancer during his or her life. Colorectal cancer is cancer that occurs in the large intestine and rectum. The colon is a muscular tube that is about five feet long. It absorbs water and nutrients from food. The rectum, the lower six inches of the digestive tract, serves as a holding place for stool, which then passes out of the body through the anus. The colon is divided into four sections: the ascending colon, transverse colon, descending colon, and sigmoid colon. Most colorectal cancers arise in the sigmoid colon -- the portion just above the rectum. They usually start in the innermost layer and can grow through some or all of the several tissue layers that make up the colon and rectum. The extent to which a cancer penetrates the various tissue layers determines the stage of the disease. Most colorectal cancers grow slowly over a period of several years, often beginning as small benign growths called polyps. Removing these polyps early, before they become malignant, is an effective means of preventing colorectal cancer. Innovative approaches to the management of colorectal cancers are being employed at the UFSCC. This includes the use of sentinel lymph node biopsy and laparoscopic resections. Multimodality treatment for rectal cancer leading to tumor down staging and sphincter preserving tumor resections are being employed with excellent success. This includes the use of colo-anal reconstruction for patients with rectal tumors and for patients with familial adenomatous polyposis. In addition, we offer transanal endoscopic microsurgery (TEM) for selected patients to increase the chance of sphincter preservation as well as decrease the invasiveness of the procedure. Phase 2 clinical trials which aim to enhance sphincter preservation rates are offered to selected patients.


Esophageal Cancer	Back to Top
The esophagus is the organ that lies mostly behind the chest bones and serves to bring food and water from the mouth to the stomach. While the treatment of esophageal cancer can seem complex, it is best done at specialized centers. At our center, patients are staged with endoscopy and endoscopic ultrasound, PET and CT scans and laparoscopy. Frequently, we prefer treatment with chemotherapy and radiation therapy prior to surgical resection. Surgical removal is offered via different approaches (transthoracic, transhiatal) depending on the tumor location and other factors. Esophageal replacement with the stomach or colon is available. Our mortality rate following surgical resection is among the lowest in the Southeastern United States. At our center, clinical trials are studying new agents to achieve maximal shrinkage of the tumor prior to surgery, in order to improve patient survival. In addition, new molecular targeted therapies are being evaluated. Minimally invasive surgical approaches for esophageal cancer are available. Finally, photodynamic therapy is available for premalignant tumors.


Gastric Cancer	Back to Top
The survival for patients with gastric cancer is dependent in part on the quality of surgical treatment. Unfortunately, there are few effective therapies besides surgical resection. Gastric cancer can spread early to lymph nodes. At our center, world experts perform surgical resection with extensive removal of lymph nodes. We feel that this improves patient survival. Following surgery, treatment with chemotherapy and radiation are offered to appropriate patients. For early stage tumors, minimally invasive or laparoscopic resection is performed with sentinel lymph node biopsy techniques. In addition, resections through the endoscope (scarless) are possible in selected patients.


GI Oncology Center	Back to Top
At our GI Oncology Center, malignancies of the rectum, esophagus, stomach, liver and pancreas are diagnosed, staged and treated by world experts utilizing state of the art strategies. In fact, we treat more than 500 patients a year with complicated gastrointestinal malignancies. Work up and treatment methods include the use of endoscopic ultrasound (EUS), triple phase contrast CT, MRI with MRCP, laparoscopy with ultrasound and sentinel lymph node procedures. All patient diagnoses and treatment are discussed at multidisciplinary tumors conferences. This allows for multiple specialists to provide input on the care of each individual patient. Novel multi-disciplinary treatment strategies are being employed in both routine clinical practice and as part of ongoing phase II clinical trials in these tumors. Currently, minimally invasive resections for lesions throughout the entire gastrointestinal tract are an option and are available to appropriate candidates.

Liver and Bile Duct Cancer	Back to Top
The majority of malignant tumors in the liver are metastatic from another organ. Colon cancer can spread to the liver; however, the Surgical Oncologists in our division are experts at taking care of this type of problem. Treatment approaches available include chemotherapy (to shrink tumors to smaller sizes) followed by surgical resection. Radiofrequency ablation is available to burn small tumors. Localized radiation therapy to the liver is also available as is radioactive bead treatment of colorectal metastases in the liver. Laparoscopic resections of metastatic tumors to the liver are available for these lesions that are situated in the proper location. Primary liver cancer, or hepatocellular carcinoma, is the most common type of cancer originating in the liver itself. (Most tumors in the liver do not originate there; they start elsewhere in the body and spread, or metastasize, to the liver.) In the United States, primary liver cancer is relatively rare -- it accounts for less than one percent of all cancers. But worldwide, hepatocellular carcinoma is the most common solid organ tumor. This is believed to be due to widespread viral hepatitis infection, a known risk factor for primary liver cancer. Hepatocellular carcinoma most commonly occurs in people whose livers have been damaged. This damage may be caused by alcohol abuse, by chronic infection with the hepatitis B or hepatitis C virus, from food contaminants called aflatoxins (though this is rare in the United States), or from metabolic diseases. Cancer can spread from the liver to other areas in the body through the blood or the lymph system, most often to the lungs, bones, and abdomen. Diagnosis of primary liver cancer is generally made using blood tests, diagnostic imaging, surgical biopsy or laparoscopy, or a combination. The alpha-fetoprotein blood test and ultrasound imaging of the liver are also used to screen high-risk populations (including those with hepatitis B and hepatitis C infections) for the disease. Since the risk of liver cancer is relatively low for healthy individuals, these tests are not used to screen the general population. The alpha-fetoprotein (AFP) blood test measures the level in the blood of a certain protein produced by the liver. Elevated levels of AFP can be an indication of hepatocellular carcinoma, the most common type of primary liver cancer. If liver cancer is suspected, other blood tests are done to measure liver function. These tests can help doctors determine the condition of the liver. Since successful treatment for liver cancer involves removing a substantial part of the normal liver tissue in addition to the cancer, other treatments might be used in people with blood tests that indicate a high degree of liver disease. As non-invasive diagnostic imaging techniques have become more sophisticated, they can be used to gather important information about a newly diagnosed tumor -- including its exact size, and density. These techniques can also be used to gauge how well a tumor will respond to treatment. In some cases, diagnosis is performed invasively, by removing a small amount of tissue for a biopsy, or by laparoscopy (insertion of a small tube with an attached camera into the abdomen to survey the cancer site). Laparoscopy can also be used to remove a sample of tissue for biopsy. Bile duct cancer can occur in the ducts within the liver (intrahepatic cholangiocarcinoma) or outside the liver (extrahepatic cholangiocarcinoma). Cancers of the bile duct are uncommon -- about one to two cases for every 100,000 people are diagnosed in the United States each year. Clinicians at the UFSCC are experts in the diagnosis and treatment of this cancer, and perform a variety of different surgical procedures for these types of tumors. Our Surgical Oncologists care for patients with a variety of liver tumors and perform many liver resections each year for primary liver lesions as well as metastatic disease. Patients are reviewed by all disciplines including Surgical and Medical Oncologists, radiologists, and radiation oncologists to obtain the most effective treatment for their malignancy, including resection, local ablation techniques or chemo radiotherapy. Referrals for liver transplant are also available. Researchers are conducting clinical trials involving colon cancer and offer state of the art treatment approaches. These aggressive treatment strategies are available for the treatment of colorectal cancer metastases to the liver. Those include surgical resection and/or tumor ablation with regional chemotherapy to the liver combined with systemic chemotherapy. Our physicians are now treating patients who have inoperable liver cancer with a state-of-the-art internal radiation therapy that uses millions of microscopic radioactive beads to help destroy tumors from the inside out. Selective Internal Radiation Therapy, or SIRT, uses millions of microscopic radioactive spheres called SIR-spheres. Our physicians inject them directly into the liver tumor through one of three arteries. The spheres then lodge in the tumor, where the radiation helps stunt cancer cell growth for up to 11 days. This treatment is designed for patients with advanced colorectal cancer that has spread to the liver. The addition of SIR-spheres, along with chemotherapy, acts to slow down the progress of the disease and offers the patient a better quality of life and increased life expectancy.


Melanoma	Back to Top
The University of Florida Shands Cancer Center is a major referral center for patients with skin cancers and melanoma. We routinely perform sentinel lymph node biopsy techniques for appropriate Squamous cell cancers and melanomas. All patients are discussed at multidisciplinary management conferences. Adjuvant therapy (i.e. interferon treatment) is offered to selected melanoma patients following surgery. We have an intense follow up program which is coordinated with our skin specialists (Dermatologists). Clinical trials which investigate novel therapies in melanoma are available at our cancer center. Surgeons at UF-Shands cancer center have an active program in isolated limb infusion for patients with locally recurrent, in transit, or advanced melanoma of the extremity. This minimally invasive technique has limited side effects and is associated high rates of disease control. This technique is only offered in a few centers in the Southeastern United States, and we are proud to be in this select few.


Melanoma & Soft Tissue Sarcoma Center	Back to Top
Care of the patient with melanoma or soft tissue sarcoma remains a therapeutic challenge as treatment paradigms rapidly evolve. A multidisciplinary approach to these tumors with input from many cancer specialists (surgical oncology, pathology, radiology, plastic surgery, nuclear medicine, radiation oncology, medical oncology, rehabilitation) are important to insure patients the best chance for long-term care and function. The physicians involved in the care of patients with melanoma and sarcoma at The University of Florida-Shands Hospital have special training in melanoma and sarcoma management and are focused on the care of patients. They are involved in the ongoing education, training, and research that enables them to provide their patients with a state-of-the-art approach to these tumors. Melanoma and Soft Tissue Sarcoma Center physicians are widely considered regional and national experts in the areas of melanoma and soft tissue sarcoma and serve as a referral source for patients across the Southeastern United States. Surgical resection is the mainstay of treatment for patients with malignant melanoma. The Center provides state of the art surgical care (surgical oncology as well as plastic and reconstructive surgery when needed). Our surgeons are experts in the application of minimally invasive sentinel node biopsy for patients with melanoma. We are currently establishing a program in regional infusional therapy for in-transit disease. Surgical resection for metastatic melanoma may also be useful in some appropriately selected cases. Our surgeons are experts on the role of surgery for metastatic melanoma. Surgical resection is the mainstay of treatment for patients with soft tissue sarcoma of the extremity and retroperitoneum. The surgeons in the Center are strong advocates of combined modality therapy for soft tissue sarcoma. They believe that the addition of radiation therapy and chemotherapy in selected patients provides the best opportunity for long term outcome and lessens the chance of recurrence. Surgery for recurrent and metastatic soft tissue sarcoma is offered for cure or palliation in many cases. Our surgeons are experts on the role of surgery and other types of therapy for metastatic sarcoma. The goal of the Center is to provide coordinated individualized care to patients with melanoma and soft tissue sarcoma. Coleen Booker, RN, or Kim Vaughn, ARNP can be contacted directly for referrals of new patients or patients seeking a second opinion: 352-265-0990, or 352-265-0664.


Pancreatic Cancer	Back to Top
At our Gastrointestinal Oncology Center, we have adopted a team approach to optimize results for patients with pancreatic cancer. This involves a select team of radiologists, pathologists, gastroenterologists, surgical, medical and radiation oncologists. Patients are staged with high quality imaging that rivals any other institution in the South. Patients are offered surgical removal of their tumor and postoperative treatment or, in select cases, chemotherapy and radiation treatment prior to surgery. In both situations, clinical trials are available for the enrollment of patients. We have significant experience with aggressive surgical approaches which include major vascular resection and reconstruction. In selected patients, minimally invasive (laparoscopic) resections are offered. In these patients who are not surgery candidates, or have spread of their tumor, a variety of clinical trials are offered that attempt to improve outcome in this disease. Surgeons at UF-Shands perform approximately 100 pancreatic resections for cancer each year. Perioperative mortality rates for patients undergoing these operations at UF-Shands are ~3%. Average hospital stay at UF-Shands following major pancreatic resection is 9 days. These results rival other major high volume centers in the United States and around the entire world. Currently, clinical trials which evaluate the use of proton therapy in the treatment of pancreatic cancer are in development.


Parathyroid Disease	Back to Top
Hyperparathyroidism is a common disorder involving tissues of the parathyroid gland located at the base of the neck, near the thyroid gland. The parathyroid gland makes a hormone which helps the body store and use calcium. When this hormone is produced in excess, hyperparathyroidism develops. In patients with hyperparathyroidism, one of the four parathyroid glands behaves inappropriately by making excess parathyroid hormone regardless of the level of calcium . In other words, one of the parathyroid glands continues to make large amounts of parathyroid hormone even when the calcium level is not high and at a time when the parathyroid glands should not be making any hormone at all. The most common cause of excess hormone production (hyperparathyroidism) is the development of a benign tumor in one of the parathyroid glands. This enlargement of one of the parathyroid glands is called a parathyroid adenoma which accounts for 95% of all patients. This parathyroid tumor is typically only 1/2 inch in diameter. Several years ago, standard parathyroid surgery involved making a big incision to identify this small parathyroid tumor. Now utilizing state of the art technology, Surgical Oncologists at UF can remove this tumor in over 90% of patients with minimally invasive surgery. This involves making a small incision (typically about 1 inch) to take out the one bad parathyroid gland. The other three normal parathyroid glands are left alone. Most operations can be done in the outpatient setting with patients going home the same day as the surgery. All surgeries are done using a special monitoring device which ensures the safety of the nerves that supply the vocal cord and larynx.

Soft Tissue Sarcomas	Back to Top
Soft-tissue sarcomas arise in tissues such as fat, muscles, nerves, tendons, and blood and lymph vessels. These are essentially the soft tissues that connect, support and surround other parts of the body. While these sarcomas are rare, according to the American Cancer Society, approximately 9,400 new soft tissue sarcomas will be diagnosed in the US in 2007. Some sarcomas are minor, non-threatening tumors that can be cured with simple surgery. Others may require more aggressive treatment involving chemotherapy, radiation therapy, as well as surgery. Sarcomas can occur at many sites in the body. They are most common in the extremities. Diagnostic procedures can involve ultrasonography (ultra-sound), computed tomography (CT), magnetic resonance imaging (MRI), as well as biopsy techniques (fine needle aspiration, incisional biopsy and core needle biopsy) which are less invasive and less painful and give quicker results than previous procedures. Surgery remains the primary treatment for soft-tissue sarcoma. Most procedures involve removing the tumor and at least 2-3 centimeters of the surrounding tissue. Certain abdominal tumors can be excised using laparoscopic techniques which involve making several very small incisions in order to insert a camera as an aid to see inside the body while performing the surgery. This technique speeds recovery times and hospital stays. The UFSCC treats soft-tissue sarcomas using a multimodality approach of chemotherapy, radiation treatment including IMRT, Brachytherapy and proton therapy) and surgery. Clinical trials are investigating whether radiation treatment prior to surgery improves outcomes compared to surgery treatment alone. Surgical Oncologists at UF-Shands have specialty training in management of these rare tumors at all sites in the body (extremity, retroperitoneal, trunk, intra-abdominal, head, and neck). Surgeons work closely with a team of others who have specialty training in soft tissue sarcoma (pathologists, radiologists, radiation oncologists, and medical oncologists.) UF surgical oncologists offer isolated limb infusion for locally advanced or recurrent extremity soft tissue sarcoma. UF Surgeons have and continue to publish important papers in the area of soft tissue sarcoma. These surgeons are considered nationally as experts in the management of these rare tumors. Patients and referring physicians should contact Kim Vaughn, ARNP for patient referrals or second opinion at 352-265-0604.


Thyroid Cancer	Back to Top
Because the thyroid gland is close to the skin, tumors often appear as bumps in the neck. They are called thyroid nodules. Thyroid nodules can develop at any age, but they are most common in adults, occurring in one third of all people. Often people find these bumps themselves by seeing or feeling them. Other times they are never noticed and never cause a problem. Only 5% to10% of thyroid nodules are cancerous. Diagnosis may be assisted by a thyroid scan, ultrasound, computed tomography (CT scan), magnetic resonance imaging (MRI), or an octreotide scan. Methods for thyroid cancer treatment include surgery, radioactive iodine treatment, thyroid hormone treatment, external beam radiation therapy and chemotherapy. The UFSCC uses a multimodality approach which involves endocrinologists, thyroid surgeons, radiologists and pathologists. All surgeries are performed utilizing a special monitoring device to ensure the safety of the nerves that supply the vocal cord and larynx.

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