Radiosurgery is a type of radiation therapy used to treat tumors, usually brain tumors, which can not be surgically removed. For the first time in the region, using the most powerful and safest radiotherapy device TRILOGY, this type of radiation therapy is available at Acibadem Sistina.

Powerful and precise

In radiosurgery, tumor is treated with a single fraction of a high radiation dose, which is directly aimed at the target tumor without damaging the healthy tissue. This type of therapy destroys the tumor DNA so that tumor cells can no longer expand and develop. Radiosurgery is the only therapy for brain tumors localized in inaccessible places in the brain which not be removed with a surgery.

How is the treatment implemented?

In order for the treatment to be implemented, the patient's head is immobilized (fixed) thus providing a fixed position during treatment. CT simulation is performed at the same time in order to locate the tumor. During treatment the accelerator rotates around the patient, delivering high doses of radiation in the area previously and precisely marked by the team of specialists, including a radiologist, an oncologist and a neurosurgeon.

In which cases is radiosurgery used?

Radiosurgery is commonly used in the treatment of brain tumors that are located in inaccessible areas or that can not be surgically treated. Also,radiosurgery is used in the treatment of some benign changes in the brain such as arteriovenous malformations. The results obtained with this treatment are identical to the results of a neurosurgical treatment. The doctor determines which patient can undergo radiosurgery. The decision depends on the type, size and location of the tumor to be treated.

Which tumor types can be treated with TRILOGY radiosurgery?

Small tumors can be treated with this technology, using single high dose radiation. Healthy tissues are protected from the radiation side effects to the highest level. The patient comes to the hospital, recieve single therapy and can continue with the normal daily activities after the treatment. According to world statistics,radiosurgery with TRILOGY has a great success in treating patients who were treated with this method.

For many patients “cancer” is the scariest word in medicine. After the emotional shock from the diagnosis, patients need to learn how to live with cancer and fight against cancer. Dr. Deva Petrova, who is an oncologist, explains how to live with cancer.

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The laryngeal cancer accounts for 1-2% of all cancers, or in 2-10 cases of 100 000 inhabitants. Men are diagnosed with this type of cancer 4-10 times more often than women. According to Dr. Ljirim Demiri, an ENT physician, it usually occurs after the fiftieth year of life, and the biggest risk factor for its occurrence is smoking. The risk of this type of cancer is 5-25 times higher for smokers. Consuming alcohol, especially when combined with smoking , increases the risk of developing the disease by up to 40 times. Gastro reflux, irritation by chemicals, asbestos and so on, are also taken into account as risk factors.

First symptom, hoarseness

The tumor is usually located on the chords and the first sign is the change of the voice quality and hoarseness. If hoarseness lasts more than two weeks, you should consult an ear, nose and throat specialist. Other symptoms are ear or throat ache. In advanced cases difficulty breathing, pain when swallowing, as well as bloody sputum can also be noticed. If the cancer spreads to the lymph nodes, a swelling appears on the neck.

Diagnosis

The laryngeal cancer is diagnosed by an ENT specialist on the basis of several diagnostic procedures. First through a conversation with the patient about his/her symptoms and the period when they occurred, the physician receives important information about the patient's disease (history). The clinical examination implies a range of diagnostic procedures such as examination of the pharynx (oropharyngeal screening), examination of the larynx and vocal cords with rigid or flexible endoscope (laryngoscopy), palpation of the neck and radiological examinations of the neck (ultrasound, computed tomography and magnetic resonance imaging).  If an occurrence of laryngeal cancer is suspected, because of the  histopathological diagnosis of change, in short-term anesthesia and biopsy, a direct laryngoscopy with video laryngoscope or operating microscope is recommended. Depending on the results of the histological analysis, the patient is advised for further treatment.   

Surgery and radiotherapy

There are two treatment approaches for the laryngeal cancer: surgery and radiotherapy. Chemotherapy is often used as a complement to the surgery and the treatment with radiotherapy. The type and the scope of surgery depends on the position and the size of the cancer, as well as the progression of the disease. Depending on the size and location of the tumor, the surgery can be functional by removing only the tumor with part or all of the vocal cord (chordectomia). There are functional laryngectomies in which the tumor and a part of the larynx is removed (partial horizontal and vertical laryngectomy).

If the tumor is big and is detected too late, it will be necessary to remove the entire larynx (total laryngectomy). It is necessary to emphasize that, in order to provide breathing, in most surgical interventions it is necessary to create temporary or permanent tracheostomy, an aperture in the neck and trachea through which the patient can breathe postoperatively.

If there are metastases in the lymph nodes in the neck, it is necessary to make selective or radical neck dissection and to remove the lymph nodes of one or both sides of the neck. The surgery is followed by oncology examinations and assessment for further treatment (radiotherapy, chemotherapy). Sometimes the tumor may be so big that it does not allow a surgical treatment and in those cases the only way of treatment is radiotherapy and chemotherapy.

Most often this emotion occurs because people at this point feel that they must stop with their usual way of living and get used to the new situation.

Anger and rage are common feelings people feel when they are diagnosed with cancer. Although rage is the first emotional reaction, anger can develop during treatment. Most often this emotion occurs because people at this point feel that they must stop with their usual way of living and get used to the new situation. Others feel angry because they are concerned how their family members will react to the diagnosis. Many people wonder, "Why me?".  Sometimes the side effects of radiation therapy and chemotherapy, such as sleep problems, fatigue, pain, nausea, hair loss, can make the patients who are optimists become nervous, disappointed or irritated. Dr. Vladimir Ortakov, a neuropsychiatrist, explains that many people living with cancer feel guilty and angry and do not know what to do in order to express their feelings. As a result, people can fall into depression and try to neutralize their anger with alcohol or drugs.

Dealing with rage

The best way to deal with rage is to identifyit and find a healthy way to express it. Dr. Ortakov gives advices how to cope with your overwhelming feelings of anger:

Admit your anger - Accept that you are angry and enraged about the condition and try to change yourself. Hope and positive energy are the ones that will help you to go through the process of healing. Showing your emotions is simpler than hiding them.

Do not overthrow your anger on to your close ones - Patients with cancer often focus too much on their illness and do not notice the support of their close relatives, which is  something you need the most in these moments

Do not wear a mask - sometimes it is much easier to share your anger and rage with your close ones instead of putting a mask and acting. Talk to your dear ones, they are here for you,  you can drop a tear in front of them and express your deepest fears. Explain to them that they are loved even when you are angry and furious.

If you properly refine anger, it can happen to be a source of positive energy that will induce you to fight the disease and to change things for the better. Anger about cancer can provide you strength to overcome challenges during the treatment.

• Talk about the reasons for anger and rage

• Do a physical activity at full intensity while you are angry

• Do particular sport in order to waste negative energy

• Go to the nearest forest and shout loudly, or go to a sports game

• Visit a psychiatrist and talk with him about your anger

• Do yoga, listen to music or do art and get rid of your feelings

• Join a support group for cancer patients and share your experience with them

The kidneys are susceptible to malignant diseases like all organs in the body. Studies show that the number of patients who are diagnosed with kidney cancer is growing. According to the statistics it occurs in 3 to 5 patients per 100,000. In Macedonia 80 to 100 new cases are revealed each year. This type of cancer usually occurs in older persons and is more common in men. There are two types of kidney cancers - one attacks the renal cortex and the other attacks the core of the kidney, drainage ducts, renal pelvis and urethras. Prof. Dr. Ljupco Lekovski, who is a specialist in Urology at Acibadem Sistina Hospital, answers all your questions about how the diagnosis is set and how the treatment is like.

Which are the symptoms?

Symptoms are usually quiet and unnoticeable. It is therefore very important that people over 50 make a visit to the urologist once a year. One of the symptoms that can occur is blood in the urine, which is a signal that something is wrong with your kidneys. Dull and indefinite pain may occur after the blood in urine. Diagnosis of kidney cancer can be set after a CT is done. If you have any of these symptoms immediately contact a urologist and based the findings he will determine whether he will be able to do a surgical intervention, which technique of intervention will be done and how it will affect the general health of the patient.

How can I detect kidney cancer on time?

Ultrasonography examination is a very effective and available examination for early detection of kidney tumors. Many doctors advice that you do preventive examination of the kidneys in good health because the earlier you detect this type of cancer the earlier it’s treated. If diagnosed in more advanced stages, then the treatment process must include a team of oncologists plus the urologist. Despite the ultrasound, it is necessary that laboratory examinations of blood and urine, CT and MRI are done.

Treatment

You can decide on the best treatment option together with your doctor, which depends on many factors such as general health, type, stage and progression of the disease. Surgical intervention is the initial treatment that is applied, but a combination of radiotherapy, chemotherapy and immunotherapy can be also done. Since the kidneys are paired organs, if the other kidney is fine it can be completely removed without compromising the overall health. The multidisciplinary approach is used in many cases of patient treatment. After the kidney cancer treatment finishes, the patient must do regular follow ups.

Prevention

Quit smoking, maintain a normal weight, be physically active, regularly control your blood pressure and annually visit an urologist.

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