Your Strength. Our Knowledge and Experience.

Dr. Mahmoudieh has been a vital member of El Portal Comprehensive Cancer Centers since 2008, bringing over a decade of dedicated experience to patient care. Before joining our team, he served as the Director of the Prostate Brachytherapy Program at Kaiser Permanente in Sacramento and Roseville, demonstrating his leadership in advanced cancer treatments.

He earned his medical degree from the Albert Szent-Györgyi School of Medicine in Szeged, Hungary, in 1996. With a strong interest in treating head, neck, and breast cancers, Dr. Mahmoudieh specializes in cutting-edge techniques such as Image-Guided Radiation Therapy (IGRT) and Intensity-Modulated Radiation Therapy (IMRT). His expertise extends to treating cancers of the head and neck, lung, gastrointestinal tract, and prostate.

A committed professional, Dr. Mahmoudieh is a member of the American Society for Therapeutic Radiology and Oncology (ASTRO), reflecting his engagement with ongoing developments in cancer treatment and research. His compassionate approach and advanced skill set ensure that each patient receives personalized, state-of-the-art care.

Outside of his professional life, Dr. Mahmoudieh enjoys traveling with his son and daughter, as well as reading and playing racquetball, embracing a balanced and active lifestyle. His dedication to both his patients and his personal passions makes him a trusted partner in your journey toward health.

Dr. Elhanafy is a highly respected Associate Professor of Medical Physics and serves as the Chief Medical Physicist at El Portal Comprehensive Cancer Centers since July 2013. He earned his Ph.D. in Medical Physics from the University of Wisconsin, Madison—where he began his foundational training and completed his thesis—in 2013, building on his initial joining of the university in 1999.

 With specialized training in advanced radiation oncology techniques—such as Intensity-Modulated Radiation Therapy (IMRT), High-Dose Rate Brachytherapy (HDR), Stereotactic Radiosurgery (SRS), Total Body Irradiation (TBI), Quality Assurance, and Radiobiology—Dr. Elhanafy brings a wealth of expertise to patient care. His dedication to the field is evident through numerous published research articles, as well as awards recognizing his leadership in organizing conferences, training sessions, lectures, and workshops.

Beyond his impressive credentials, Dr. Elhanafy is deeply committed to advancing medical physics and ensuring the best possible outcomes for his patients. His compassionate approach, combined with his extensive knowledge, makes him a trusted partner in your cancer care journey.

Outside of his professional pursuits, he values spending quality time with his family, reflecting his genuine care and balance in life.

Dr. Ahuja is a distinguished, board-certified Medical Oncologist with extensive training in medical hematology. He has refined his expertise at renowned institutions such as Tata Memorial Hospital, UCLA School of Medicine, and Roswell Park, under the mentorship of esteemed hematologists including Dr. S.H. Advani, Dr. Michael Caligiuri, and Dr. M.J. Cline.

With over 25 years of experience in both hematology and oncology, Dr. Ahuja offers a deep well of knowledge and a compassionate approach to patient care at El Portal Cancer Center. His dedication to advancing the field is reflected through active membership in prestigious professional organizations, including the American Society of Hematology, the American Society of Clinical Oncology, the European Society of Medical Oncology, and the Indian Society of Medical and Pediatric Oncology.

A passionate researcher, Dr. Ahuja has contributed significantly to ongoing scientific advancements—serving on the NRG Breast Committee and the Rare Subtype Committee, and acting as Principal Investigator for the “CROWN” NCORP study. His commitment to clinical excellence and groundbreaking research underscores his dedication to improving outcomes for his patients.

Outside of his professional pursuits, Dr. Ahuja values spending quality time with his family, and enjoys hiking and traveling, embracing life outside the clinic with the same dedication he brings to his medical practice. His compassionate nature and extensive experience make him a trusted partner in your cancer care journey.

Dr. Crain is a highly experienced and board-certified Medical Oncologist and Hematologist with over 45 years of dedicated service in the medical field. Throughout his distinguished career, he has established himself as a leading expert in the diagnosis, treatment, and prevention of various cancers and blood disorders.

He earned his medical degree from the University of Illinois College of Medicine in 1977 and is actively affiliated with esteemed institutions, including Adventist Health St. Helena. Dr. Crain’s extensive experience spans a broad range of conditions, including small intestine and colorectal cancers, breast cancer, prostate cancer, anemia, leukemia, and lymphoma.

Beyond his clinical expertise, Dr. Crain is deeply committed to advancing medical research and improving patient care. His approach to treatment is rooted in compassion and a thorough understanding of complex medical conditions, ensuring each patient receives personalized, comprehensive care.

Recognized for his empathetic nature and unwavering dedication, Dr. Crain strives to achieve the best possible outcomes for his patients and foster a trusting, supportive environment. His lifelong commitment to the fields of oncology and hematology reflects his passion for making a meaningful difference in his patients’ lives.

Michael Kangas serves as the Director of Oncology and Diagnostic Imaging, where he spearheads initiatives that enhance revenue, profitability, productivity, and patient satisfaction within an underserved area. His leadership is instrumental in developing and guiding a highly skilled team of healthcare professionals across multiple clinics, providing comprehensive cancer care and diagnostic imaging services utilizing the most advanced technology. Michael’s commitment is rooted in delivering personalized, high-quality care to each patient, ensuring they receive the support they need throughout their journey.

With extensive expertise in Health Information Management, Electronic Medical Records (EMR), Radiation Therapy, Radiation Oncology, Clinical Operations, Healthcare Compliance, and Regulatory Standards, Michael ensures that all services meet the highest industry standards. He also focuses on monitoring performance, healthcare marketing, and supervisory skills to foster a collaborative, efficient, and patient-centered environment.

In addition to his clinical leadership, Michael actively volunteers with the Merced Cancer Society Foundation as its Executive Director. In this role, he oversees key operational and administrative functions to advance the foundation’s mission of positively impacting residents in the Central Valley. His efforts include community outreach, organizing fundraising events, and leading initiatives to expand the foundation’s support and resources for local cancer patients.

Michael’s dedication to improving healthcare and strengthening community ties highlights his unwavering commitment to healing, hope, and making a meaningful difference in the lives of those he serves.

El Portal Cancer Centers believe in a team solution customize for each patient with the primary ingredient being compassion.

Receiving a breast cancer diagnosis can feel overwhelming, filled with many appointments and decisions. It is important to remember that you are not alone. At El Portal Cancer Centers, we provide valuable resources and support to help you navigate this journey.

As you process this life-changing news, know that we stand by you, offering strength and encouragement as you navigate treatment and beyond. You can count on us to help you regain control and move forward with hope and resilience. Together, we are dedicated to supporting you through every phase of your cancer journey.

There are several methods for checking and detecting breast cancer. Here are some commonly recommended strategies:

1. Breast Self-Examination (BSE): Women can perform self-exams to familiarize themselves with the normal look and feel of their breasts. This involves checking for any unusual lumps, changes in shape, texture, or size, and reporting any concerns to a healthcare provider.

2. Clinical Breast Examination (CBE): A healthcare provider performs a physical examination of the breasts during a routine check-up. They look for any abnormalities, lumps, or changes and can provide guidance on what to watch for.

3. Mammography: This is an X-ray of the breast, and it is the most effective screening tool for early detection of breast cancer. The American Cancer Society recommends that women begin annual mammograms at age 40 or earlier, depending on individual risk factors.

4. Breast Ultrasound: This imaging test uses sound waves to create pictures of the breast tissue. It’s often used as a supplement to mammography, particularly for women with dense breast tissue or when there are abnormalities found.

5. Magnetic Resonance Imaging (MRI): Breast MRI may be used in certain high-risk individuals or to further investigate abnormalities detected during mammography or ultrasound.

6. Genetic Testing: For individuals with a strong family history of breast cancer, genetic tests (such as BRCA1 and BRCA2) can help determine susceptibility and the need for enhanced screening or preventive measures.

7. Biopsy: If a lump or abnormality is detected, a biopsy may be performed to remove a sample of breast tissue for laboratory analysis to confirm the presence of cancer cells.

Regular screening and monitoring are essential for early detection and improved treatment outcomes. Women should discuss their personal risk factors and screening plans with their healthcare providers to determine the best approach for their individual needs.

Side effects of hormone therapy can vary between men and women due to physiological differences. They may include:

• For Women (Breast Cancer Treatment): Hot flashes, vaginal dryness, mood swings, fatigue, and risk of osteoporosis.
• For Men (Prostate Cancer Treatment): Hot flashes, reduced libido, weight gain, fatigue, and risk of osteoporosis.

While hormone therapy can be a powerful tool against cancer, it’s important to understand potential risks:

• Bone Health:Long-term hormone therapy may affect bone density, leading to increased risk of fractures.
• Cardiovascular Health:Hormonal changes can impact heart health, especially in prolonged use.
• Mood and Cognitive Effects:Hormonal alterations may lead to mood swings or changes in cognitive function.
• Metabolic Changes:There may be a risk of weight gain or changes in metabolism, affecting energy levels.

Hormone therapy offers a vital route to managing and treating certain cancers, personalized to each patient’s needs and circumstances. Patients are encouraged to maintain open communication with their healthcare providers, ensuring that they fully understand the benefits and possible impacts of treatment. With comprehensive care and support, hormone therapy can contribute positively to a patient’s cancer journey.

The most critical warning sign of skin cancer is the appearance of a new spot on the skin or changes in an existing spot that seem abnormal. Following the A B C D E guidelines can help you identify the common signs of skin cancer:

• Asymmetry:One half of a mole (or birthmark) does not match the other half.
• Border:Edges are irregular, ragged, notched, or blurred.
• Color:The color is uneven, often featuring different shades of brown or black, along with patches of pink, red, white, or blue.
• Diameter:The spot is larger than 6 millimeters across (about the size of a pencil eraser).
• Evolving:The mole is changing in size, shape, color, or elevation. 

Skin cancer is typically identified first by a healthcare professional during an examination of an unusual area on the skin. However, determining whether it is cancerous requires removal and subsequent testing, known as a biopsy. This is the only reliable method to confirm a skin cancer diagnosis.

You may have your biopsy performed in a dermatologist’s office or as an outpatient procedure in a hospital or clinic, depending on the size and location of the abnormal area. Local anesthesia is usually administered to ensure your comfort.

There are four common types of skin biopsies:

• Punch Biopsy:A sharp, hollow tool is used to remove a circle of tissue from the abnormal area.
• Incisional Biopsy:A scalpel is employed to remove a portion of the growth.
• Excisional Biopsy:The entire growth and some surrounding tissue are removed with a scalpel.
• Shave Biopsy:A thin, sharp blade is used to shave off the abnormal growth.

If there is a possibility of melanoma, dermatologists will generally avoid simply shaving or cauterizing the growth. Instead, an excisional biopsy will be performed, or if the growth is too large, a tissue sample will be collected.

Upon receiving a biopsy confirmation of skin cancer, you will be referred to a specialized oncologist for further evaluation and care. Understanding the extent, or stage, of your cancer is crucial, whether you have melanoma or nonmelanoma skin cancer. Staging involves a meticulous assessment to determine how thick the tumor is and whether it has metastasized to other parts of the body. If the tumor is particularly thick, your doctor may recommend chest x-rays, blood tests, and imaging scans of the liver, bones, and brain.

Knowing the stage of your cancer enables your oncologist to:

• Assess the seriousness of your cancer and your chances for survival
• Formulate the most effective treatment plan for your unique situation
• Identify clinical trials that may present additional treatment options

In some cases, your oncologist may need to examine your lymph nodes to accurately stage the cancer. Surgical procedures may be part of the treatment plan to remove cancerous lymph nodes, which can aid in managing the disease.

Staging Criteria
Staging is based on several key factors:

• The size of the tumor
• How deeply it has penetrated below the surface of the skin
• Whether it has spread to nearby lymph nodes or other organs

Oncologists utilize Roman numerals I through IV to designate the cancer stage. Stage I indicates small tumors that are confined to their original site, while Stage IV signifies advanced cancer that has spread to distant sites in the body.

Nonmelanoma Skin Cancer Staging
The stages of nonmelanoma skin cancer are as follows:

• Stage 0: The cancer is localized to the top layer of skin, classified as carcinoma in situ.
• Stage I: The tumor measures 2 centimeters (approximately three-quarters of an inch) or smaller.
• Stage II: The tumor exceeds 2 centimeters in diameter.
• Stage III: The cancer has spread beyond the skin to underlying tissues such as cartilage, muscle, or bone, or to nearby lymph nodes, but not to distant locations.
• Stage IV: The cancer has metastasized to other areas in the body.

Melanoma Staging
The staging for melanoma specifically is defined as follows:

• Stage 0: Melanoma cells are confined to the outer layer of skin (epidermis) and have not invaded deeper tissues.
• Stage I: In Stage I, the melanoma is considered thin:
  • The tumor is no thicker than 1 millimeter (1/25 inch) and may show signs of ulceration (a scraped appearance).
  • Alternatively, the tumor measures between 1 and 2 millimeters thick without ulceration, and melanoma cells have not spread to nearby lymph nodes.
• Stage II: At this stage, the tumor is at least 1 millimeter thick:
  • It may be between 1 and 2 millimeters thick and present with ulceration.
  • Alternatively, the tumor may be greater than 2 millimeters thick, potentially with ulceration, but has not yet spread to nearby lymph nodes.
• Stage III: This indicates that melanoma has spread to nearby lymph nodes or to tissues just outside the original tumor without affecting the lymph nodes.
• Stage IV: At this advanced stage, melanoma cells have metastasized to other organs, lymph nodes, or distant skin areas.
• Recurrent: Recurrent disease indicates that cancer has returned after treatment, either in the original site or in a new location within the body.

There are various approaches to treating skin cancer, and your oncologist will work closely with you to determine the most effective combination of therapies based on the stage of cancer and your overall health. We at El Portal Comprehensive Cancer Centers are dedicated to providing you with comprehensive care tailored to your needs, ensuring you receive the support, guidance, and treatment necessary for your journey toward recovery.

Nonmelanoma Skin Cancer Treatments

In some cases, the entire nonmelanoma skin cancer may be removed during the biopsy, which means no further treatment is necessary. However, if additional treatment is required, your doctor will outline the available options.

There are six primary types of nonmelanoma skin cancer treatments, which may be used individually or in combination:

1. Surgery
2. Chemotherapy
3. Photodynamic therapy
4. Radiation therapy
5. Biologic therapy
6. Targeted therapy

Melanoma Skin Cancer Treatments

Melanoma treatment encompasses nearly all the same options as nonmelanoma skin cancer, with the exception of photodynamic therapy.

Skin Cancer Treatment Options

Your oncologist can provide detailed explanations of the following surgical techniques:

• Wide-Local Excision (WLE): This common approach involves numbing the area and surgically removing the cancer along with a margin of surrounding healthy skin. The margin is examined microscopically to ensure all cancer cells have been excised, and the required margin size will depend on the tumor’s dimensions. In some cases, nearby lymph nodes may also be removed.
• Mohs Surgery: This technique is particularly beneficial for skin cancer treatment. The surgeon numbs the area and removes thin layers of the tumor, examining each layer under a microscope for cancer cells. The process continues until no cancerous cells are detected, ensuring complete tumor removal while preserving as much healthy tissue as possible.
• Electrodesiccation and Curettage: This method is ideal for small basal cell skin cancers. The doctor numbs the area, removes the cancer using a curette (a spoon-shaped surgical instrument), and then employs an electric current to control bleeding and eliminate any remaining cancer cells. This procedure tends to be quick and straightforward.
• Cryosurgery: This option is suitable for patients who may not tolerate other surgical methods. Cryosurgery employs extreme cold, typically generated from liquid nitrogen, to treat early-stage or very thin skin cancer lesions. While effective, this approach may cause swelling and could damage nerves in the area, leading to temporary loss of sensation.
• Laser Surgery: This technique involves using a focused beam of light to target and destroy cancer cells. It is primarily utilized for superficial growths confined to the outer layer of skin.
• Skin Grafting: Occasionally, grafts are necessary to cover openings left by surgical removal. In this procedure, the surgeon numbs the area and removes a patch of healthy skin from another part of your body, such as the thigh, to cover the excised area. It is important to provide special care to the graft site during the healing process.
• Lymphadenectomy: This surgical procedure may be employed in the case of melanoma, wherein lymph nodes are removed for evaluation. The removed tissue is examined under a microscope for cancer cells.
• Sentinel Lymph Node Biopsy: During this procedure, the sentinel lymph node—the first node likely to receive cancer spread from the tumor—is surgically removed. A radioactive substance and/or blue dye is injected near the tumor site to track the flow to the lymph nodes. If no cancer cells are found in the sentinel node, additional nodes may not need to be excised, making this a useful technique within melanoma treatment plans.

Hodgkin lymphoma (HL) can present with various signs and symptoms, which may evolve over time. Common symptoms include:

1. Swollen Lymph Nodes: The most prominent sign is usually painless swelling of lymph nodes in the neck, armpit, or groin. These nodes may feel firm or rubbery.
2. Fever: Patients may experience persistent fevers without an infectious cause, often referred to as “B symptoms.”
3. Night Sweats: Drenching night sweats that can soak clothing and bedding, often severe and uncomfortable.
4. Unexplained Weight Loss: Significant weight loss (more than 10% of body weight) over a short period without changes in diet or exercise.
5. Fatigue: Persistent fatigue or lack of energy that does not improve with rest.
6. Itching: Generalized itching (pruritus) can occur without a rash and may be bothersome.
7. Chest Pain or Cough: If the lymphoma affects areas in the chest, individuals may experience chest pain, persistent cough, or difficulty breathing.
8. Abdominal Pain or Swelling: Involvement of the abdomen may lead to pain or a sense of fullness due to enlarged lymph nodes or spleen.
9. Alcohol-Induced Pain: Some patients report pain in lymph nodes after consuming alcohol, which is quite specific to Hodgkin lymphoma.

Several factors can increase the risk of developing Hodgkin lymphoma:

1. Age: Hodgkin lymphoma is most commonly diagnosed in young adults aged 15-35 and older adults aged 55 and above.
2. Gender: It is more common in males than females.
3. Family History: A family history of Hodgkin lymphoma or other related cancers may increase risk.
4. Weakened Immune System: Individuals with weakened immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, have an increased risk.
5. Viral Infections: Infections with the Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV) are associated with an elevated risk.
6. Geographic Location: There are geographic variations in HL incidence, with higher rates reported in certain regions.
7. Obesity: Some studies suggest a potential link between obesity and an increased risk of Hodgkin lymphoma.
8. Previous Radiation Therapy: Individuals who received radiation therapy for other cancers, especially during childhood, may have a heightened risk.

The treatment of Hodgkin lymphoma (HL) often depends on the stage of the disease, tumor characteristics, the patient’s age, and overall health. Common treatment options include:

1. Chemotherapy: Chemotherapy is the cornerstone of treatment for Hodgkin lymphoma. Common regimens include ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), which is effective in most patients.
2. Radiation Therapy: Radiation therapy may be used alone or in combination with chemotherapy, especially for localized disease (early-stage HL). It targets specific areas affected by lymphoma.
3. Stem Cell Transplant: For patients with relapsed or refractory Hodgkin lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be considered. This allows for the use of higher doses of chemotherapy to effectively destroy cancer cells.
4. Immunotherapy: Newer targeted therapies, including monoclonal antibodies (like brentuximab vedotin), use the body’s immune system to fight cancer. This option may be used in certain cases of relapsed or refractory HL.
5. Clinical Trials: Participation in clinical trials may provide access to innovative therapies and new treatment approaches that are not yet widely available.
6. Supportive Care: Management of side effects and supportive care to maintain quality of life during treatment are crucial. This may include medication for nausea, pain management, and counseling services.

1. Hodgkin Lymphoma: The overall 5-year survival rate for Hodgkin lymphoma is approximately 87%, with a significant number of patients achieving long-term remission. Cure rates in early-stage HL can be even higher, exceeding 90%with appropriate treatment.
2. Advancements in Treatment: Cutting-edge treatments such as targeted therapies and immunotherapy (including CAR T-cell therapy) have shown promising results. In certain cases of relapsed/refractory NHL, CAR T-cell therapy has achieved response rates surpassing 50%.
3. Chemotherapy Success: First-line chemotherapy regimens for Hodgkin and many types of non-Hodgkin lymphoma, such as R-CHOP (rituximab combined with chemotherapy), lead to high initial response rates, with many patients showing significant reduction or complete disappearance of tumors.
4. Survivorship: Many lymphoma survivors go on to lead healthy, fulfilling lives. Long-term follow-up studies show that most individuals achieve a normal or near-normal quality of life after treatment, especially with supportive care and monitoring.

Treatment Modalities

• Combination Chemotherapy: Most lymphomas are treated with combination chemotherapy, which enhances the effectiveness of treatment and reduces the risk of resistance. Such regimens have improved overall survival rates for various lymphoma types.
• Radiation Therapy: For localized lymphoma, radiation therapy can be highly effective. It often leads to excellent outcomes, especially in early-stage Hodgkin lymphoma, with success rates over 90%.
• Stem Cell Transplants: For patients with relapsed or refractory lymphoma, autologous stem cell transplants can offer a chance of long-term remission. Survival rates post-transplant can be around 50-60%, depending on various factors.

Ongoing Research and Future Prospects

Customized Treatment Approaches: Advances in genetics and molecular biology allow for more personalized treatment approaches, enabling physicians to tailor therapies based on individual patient characteristics and disease profiles.

Non-Hodgkin Lymphoma (NHL) can present with a variety of signs and symptoms, which may vary depending on the subtype of NHL and the areas of the body affected. Common signs and symptoms include:

1. Lymphadenopathy: Swollen lymph nodes, particularly in the neck, armpits, or groin. These may feel rubbery or firm and are often painless.
2. Fever: Persistent fevers without an obvious cause, sometimes with chills.
3. Unexplained Weight Loss: Significant weight loss (more than 10% of body weight) without trying or without an underlying reason.
4. Night Sweats: Drenching night sweats that may soak through clothing and bedding.
5. Fatigue: Chronic fatigue or weakness that doesn’t improve with rest.
6. Abdominal Pain or Swelling: Pain or discomfort in the abdomen, which may also be associated with a swollen abdomen due to enlarged lymph nodes or spleen.
7. Chest Pain: If lymphoma affects the chest area, it can cause chest pain, coughing, or difficulty breathing.
8. Itching: Generalized itching (pruritus) without a rash, which can be quite bothersome.
9. Skin Changes: In some cases, NHL can present with skin rashes, lesions, or lumps.

It’s important to note that these symptoms can be caused by other health conditions as well; experiencing one or more of these symptoms doesn’t necessarily mean an individual has NHL. However, if symptoms persist or worsen, it is advisable to consult a healthcare professional for further evaluation.

Several factors can increase the risk of developing Non Hodgkin lymphoma (NHL):

1. Age: The risk of NHL increases with age, with most cases diagnosed in adults aged 60 and older.
2. Gender: Men are more likely to develop NHL than women.
3. Weakened Immune System: Individuals with weakened immune systems, such as those with HIV/AIDS, have a higher risk of developing NHL. Immunosuppressive treatments (e.g., for organ transplant patients) also increase risk.
4. Autoimmune Diseases: Conditions such as rheumatoid arthritis, lupus, or Sjögren’s syndrome can increase the risk due to chronic inflammation and immune activation.
5. Infections: Certain viral infections, such as the Epstein-Barr virus (EBV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV), have been linked to an increased risk of developing certain types of NHL.
6. Chemical Exposure: Exposure to certain chemicals, particularly pesticides, herbicides, and solvents such as benzene, may be associated with a higher risk of NHL.
7. Family History: A family history of lymphoma or other blood cancers may increase an individual’s risk.
8. Geographic Location: Some studies suggest that living in certain geographic regions with higher pesticide use or specific environmental exposures may contribute to an increased risk.
9. Obesity: Some research indicates that obesity may be a risk factor for developing various types of lymphoma.
10. Previous Radiation Therapy: Individuals who have received radiation therapy for other cancers may have an increased risk of developing NHL later.

1. Chemotherapy:Chemotherapy is often the first-line treatment for many types of NHL. It involves the use of powerful drugs to kill cancer cells or inhibit their growth. Commonly used chemotherapy regimens include:
   • R-CHOP:A combination of rituximab (a monoclonal antibody) with cyclophosphamide, doxorubicin, vincristine, and prednisone.
   • CHOP:Similar to R-CHOP but does not include rituximab.
2. Targeted Therapy: Targeted therapies are designed to specifically attack cancer cells while minimizing damage to normal cells. Some examples include:
   • Rituximab (Rituxan):A monoclonal antibody targeting CD20-positive B-cell lymphomas.
   • Brentuximab Vedotin (Adcetris):A medication that combines an antibody with a chemotherapy drug, used for specific subtypes of NHL.
3. Immunotherapy: Immunotherapy utilizes the body’s immune system to combat cancer cells. It includes therapies such as:
4. CAR T-Cell Therapy:A groundbreaking treatment that involves modifying a patient’s own T-cells to target and destroy lymphoma cells, showing high effectiveness in certain types of aggressive NHL.
5. Nivolumab (Opdivo) and Pembrolizumab (Keytruda):Immune checkpoint inhibitors that help the immune system recognize and attack cancer cells.
6. Radiation Therapy: Radiation therapy may be used to target specific areas of lymphoma, especially for localized disease. It can be effective in combination with chemotherapy for certain patients.
7. Stem Cell Transplant: For patients with high-risk or relapsed NHL, stem cell transplantation (autologous or allogeneic) may be considered. This approach allows for the use of high-dose chemotherapy to treat the lymphoma, followed by transplanting healthy stem cells to restore the bone marrow.
8. Supportive Care: Throughout treatment, supportive care is essential to manage side effects and improve quality of life. This can include anti-nausea medications, pain management, nutritional support, and counseling services.
9. Observation (Watchful Waiting): In some cases of indolent or slow-growing NHL, especially in asymptomatic patients, a strategy of “watchful waiting” may be recommended, where treatment is delayed until symptoms arise or the disease progresses.

Conclusion

Non-Hodgkin Lymphoma comprises a diverse group of diseases, and treatment plans are personalized based on many factors, including the specific lymphoma subtype and the patient’s overall health. Early diagnosis and access to effective therapies greatly enhance treatment success rates. It’s essential for patients to discuss all available treatment options with their healthcare providers to determine the most appropriate approach for their individual situation.

1. Non Hodgkin Lymphoma:The 5-year survival rate for non-Hodgkin lymphoma varies widely based on the specific type and stage but is generally around 72%. For some aggressive subtypes, advances in treatment have improved survival rates markedly.
2. Advancements in Treatment: Cutting-edge treatments such as targeted therapies and immunotherapy (including CAR T-cell therapy) have shown promising results. In certain cases of relapsed/refractory NHL, CAR T-cell therapy has achieved response rates surpassing 50%.
3. Chemotherapy Success: First-line chemotherapy regimens for Hodgkin and many types of non-Hodgkin lymphoma, such as R-CHOP (rituximab combined with chemotherapy), lead to high initial response rates, with many patients showing significant reduction or complete disappearance of tumors.
4. Survivorship: Many lymphoma survivors go on to lead healthy, fulfilling lives. Long-term follow-up studies show that most individuals achieve a normal or near-normal quality of life after treatment, especially with supportive care and monitoring.

Treatment Modalities

• Combination Chemotherapy: Most lymphomas are treated with combination chemotherapy, which enhances the effectiveness of treatment and reduces the risk of resistance. Such regimens have improved overall survival rates for various lymphoma types.
• Radiation Therapy: For localized lymphoma, radiation therapy can be highly effective. It often leads to excellent outcomes, especially in early-stage Hodgkin lymphoma, with success rates over 90%.
• Stem Cell Transplants: For patients with relapsed or refractory lymphoma, autologous stem cell transplants can offer a chance of long-term remission. Survival rates post-transplant can be around 50-60%, depending on various factors.

Ongoing Research and Future Prospects

Customized Treatment Approaches: Advances in genetics and molecular biology allow for more personalized treatment approaches, enabling physicians to tailor therapies based on individual patient characteristics and disease profiles.

Anemia is the most prevalent benign blood disorder, impacting more than 3 million Americans, according to the National Heart, Lung, and Blood Institute. Anemia occurs when there is a deficiency of red blood cells or hemoglobin in the blood.

Common Symptoms:

• Weakness
• Shortness of breath
• Dizziness
• Pale skin

Anemia can particularly affect women during pregnancy or their childbearing years due to increased iron demands.

Causes of Anemia:

1. Iron Deficiency Anemia: The most common type, usually caused by blood loss from heavy menstrual cycles or gastrointestinal issues, or from inadequate dietary iron. Treatment typically involves iron supplementation, either orally or intravenously.
2. Aplastic Anemia: A rare condition where the bone marrow fails to produce enough blood cells. Causes may include exposure to toxins, medications, or autoimmune disorders. Diagnosis often requires a bone marrow biopsy. Treatment may include immunosuppressive therapies or bone marrow transplantation.
3. Hemolytic Anemia: Occurs when red blood cells are destroyed faster than they can be produced. Causes range from infections to autoimmune disorders, with treatment addressing underlying causes and sometimes using corticosteroids.

Anemia Treatment depends on its cause, severity, and the individual’s overall health. Here are some common treatment options:

1. Dietary Changes: Increasing intake of iron-rich foods (e.g., red meat, beans, lentils, spinach) and foods high in vitamin B12 and folate (e.g., dairy, eggs, leafy greens).

2. Iron Supplements: Oral or intravenous iron supplements may be prescribed, especially for iron-deficiency anemia.

3. Vitamin Supplements: If the anemia is due to vitamin B12 or folate deficiency, supplements or injections may be recommended.

4. Medications: For anemia related to chronic diseases, medications such as erythropoietin-stimulating agents may be used to stimulate red blood cell production.

5. Blood Transfusions: In severe cases, a transfusion of red blood cells may be necessary to quickly increase hemoglobin levels.

6. Managing Underlying Conditions: Treating the underlying cause of anemia, such as chronic kidney disease, can alleviate symptoms.

7. Bone Marrow Stimulants: In certain cases, treatments that stimulate the bone marrow to produce more red blood cells may be indicated.

It’s essential to consult a healthcare provider for a proper diagnosis and treatment plan tailored to the individual’s specific condition and needs.T

Bleeding disorders are conditions in which the blood does not clot properly, leading to excessive bleeding. At El Portal Comprehensive Cancer Centers, our experts specialize in treating various bleeding disorders, including hemophilia and von Willebrand disease.

• Hemophilia: A genetic disorder mainly affecting males, characterized by excessive bleeding from minor injuries. Modern treatments use synthetic concentrated clotting factors administered intravenously, along with vasopressin to manage bleeding.
• Von Willebrand Disease : An inherited condition caused by a deficiency in a protein essential for blood clotting. Treatment focuses on preventing and managing bleeding episodes, often using synthetic hormones similar to vasopressin.

Treatment options for bleeding disorders like hemophilia and von Willebrand disease (vWD) focus on managing and preventing bleeding episodes. Here are common approaches for each:

Hemophilia:

1. Factor Replacement Therapy:
   • Prophylactic Treatment: Regular infusions of clotting factor concentrates (Factor VIII for Hemophilia A and Factor IX for Hemophilia B) to prevent bleeding episodes.
   • On-Demand Treatment: Administering clotting factors when a bleeding episode occurs.
2. Desmopressin (DDAVP):
   • Used for mild cases of Hemophilia A to stimulate the release of stored Factor VIII from blood vessel lining.
3. Gene Therapy:
   • Investigational treatments aim to provide a functional copy of the missing clotting factor gene, potentially offering a long-term solution.
4. Supportive Treatments:
   • Pain management and rehabilitation for joint health, along with lifestyle adjustments to prevent injury.

von Willebrand Disease (vWD):

1. Desmopressin (DDAVP):
   • The first line of treatment for many with type 1 vWD and some with type 2, as it helps increase von Willebrand factor (vWF) and Factor VIII levels in the blood.
2. Factor Replacement Therapy:
   • Concentrates containing von Willebrand factor and Factor VIII may be used for severe cases or during surgery.
3. Antifibrinolytic Agents:
   • Medications like tranexamic acid may be used to help prevent bleeding during dental procedures or other situations.
4. Avoiding Medications That Affect Clotting:
   • Recommendations to avoid aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) that can increase bleeding risk.
5. Lifestyle and Preventive Measures:
   • Education on avoiding injuries and managing heavy menstrual bleeding in women.

It’s crucial for individuals with bleeding disorders to work closely with a healthcare provider or a specialized hematologist to tailor treatment plans based on their specific needs and to manage their condition effectively.

Treatment options for blood clotting disorders aim to prevent clots from forming, manage existing clots, and reduce the risk of complications. Here are some common approaches based on different types of clotting disorders:

1. Anticoagulant Medications:

– Warfarin (Coumadin): A vitamin K antagonist used to prevent the formation of new clots and to keep existing clots from growing.

– Direct Oral Anticoagulants (DOACs): Medications such as apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa) that directly inhibit specific clotting factors.

2. Antiplatelet Medications:

– Aspirin: Often used to prevent clot formation in arteries, particularly in individuals with a history of heart attacks or stroke.

– Clopidogrel (Plavix): Another antiplatelet medication that may be used alone or in combination with aspirin.

3. Thrombolytics:

– Clot Busters: Medications like alteplase (Activase) are used in emergency situations to dissolve large clots quickly, such as those causing strokes or pulmonary embolisms.

4. Compression Therapy:

– Compression Stockings: Used to improve blood flow and reduce swelling in individuals with venous thromboembolism (VTE) or chronic venous insufficiency.

5. Surgery:

– Thrombectomy: Surgical removal of a blood clot may be necessary in severe cases.

– Placement of Inferior Vena Cava (IVC) Filters: A filter may be placed in the IVC to catch clots that may travel from the legs to the lungs, particularly in patients with recurrent clots.

6. Lifestyle and Preventive Measures:

– Dietary Changes: Monitoring vitamin K intake (for patients on warfarin) and maintaining a balanced diet.

– Regular Exercise: Encouraging activity that enhances blood flow, while ensuring safety to avoid injury.

– Hydration: Staying well-hydrated to help maintain proper blood viscosity.

7. Management of Underlying Conditions:

Treating conditions that contribute to clotting disorders, such as atrial fibrillation, hormonal imbalances, or certain types of cancer.

Genetic Counseling:

For hereditary clotting disorders, genetic counseling may be beneficial for affected individuals and their families to understand risks and management strategies.

It’s essential for individuals with blood clotting disorders to work closely with a healthcare provider to develop a tailored treatment plan and to monitor their condition effectively. Regular follow-up and education about the disorder are also crucial parts of effective management.

Myelodysplastic syndromes represent a group of disorders where the bone marrow fails to produce healthy blood cells, leading to insufficient white blood cells, red blood cells, and platelets. Patients with MDS may experience:

• Increased risk of infections due to low white blood cell counts.
• Fatigue and shortness of breath from anemia.
• Excessive bleeding due to low platelet levels.

Treatment options may include blood transfusions, medications to stimulate blood cell production, or immune-suppressive therapies.

Pros of Concurrent Treatment:

• Enhanced Effectiveness: Research indicates that combining chemotherapy with radiation therapy can enhance the overall effectiveness of treatment. This is particularly true for certain cancers, including brain, head and neck, gastrointestinal, bladder, and lung cancers. When these cancers are located in challenging areas of the body, concurrent treatment can improve the chances of successful outcomes.
• Coordinated Care: At El Portal Comprehensive Cancer Centers (EPCCC), our experienced team of board-certified medical oncologists and radiation oncologists work closely together to ensure that your treatment is well-coordinated. This collaborative approach helps to minimize potential interactions between therapies.

Cons of Concurrent Treatment:

• Increased Side Effects: While concurrent treatment can be more effective against cancer, it can also place added stress on your body. Patients often experience intensified side effects such as nausea, fatigue, pain, and hair loss. These heightened reactions can be challenging and require careful management.
• More Frequent Appointments: Receiving both chemotherapy and radiation at the same time typically involves more appointments in a shorter timeframe. This means additional monitoring, including scans and blood draws, which can add to the overall stress of the treatment process.

Given the potential challenges associated with concurrent treatment, many patients may find that their treatment plan recommends therapies to be administered sequentially rather than simultaneously. A comprehensive approach may include surgery, chemotherapy, radiation therapy, immunotherapy, or targeted therapy—either alone or in combination.

Neoadjuvant Therapy: When chemotherapy or radiation is administered before surgery, the goal is to shrink the tumor or eliminate cancer cells outside the primary tumor site. This is known as neoadjuvant therapy and can enhance the effectiveness of surgical intervention.

Adjuvant Therapy: Conversely, if chemotherapy or radiation is administered after surgery, it serves the purpose of targeting any residual cancer cells that may remain, thus reducing the risk of recurrence. This approach is called adjuvant therapy.

By spacing out treatments, your body has the opportunity to recover between therapies, often resulting in fewer and less severe side effects.

Conclusion

Navigating cancer treatment options can be overwhelming, and each patient’s circumstances are unique. It’s important to discuss your individual situation with your healthcare team to determine the best approach tailored to your needs. Understanding the pros and cons of concurrent treatment, as well as the benefits of sequential therapies, can empower you to make informed decisions about your care. Remember, you are not alone in this journey, and a supportive team is here to help guide you every step of the way.

As you process this life-changing news, know that El Portal Cancer Centers and our staff stand with you, offering strength and compassionate encouragement as you navigate treatment and beyond. You can count on us to help you regain control and move forward with hope and resilience. Together, we are dedicated to supporting you through every phase of your cancer journey.

After a breast cancer diagnosis, here are several important steps to follow to ensure comprehensive care and support. This outline will help you to navigate what happens next.

1. Consultation: Meet with your oncologist and other specialists to discuss the diagnosis, staging of the cancer, and available treatment options. This may include surgical options, radiation therapy, chemotherapy, targeted therapy, or hormone therapy.

2. Treatment Planning: Work with your medical team to develop a personalized treatment plan based on the type of breast cancer, its stage, and your overall health. This plan should outline the proposed treatments, timelines, and potential side effects.

3. Second Opinion: Consider seeking a second opinion from another healthcare professional or cancer center. This can provide additional perspectives on your treatment options and help you feel more confident in your decisions.

4. Learn About Your Diagnosis: Educate yourself about your specific type of breast cancer, treatment options, and potential side effects. Understanding your condition can empower you to make informed decisions.

5. Emotional Support: Reach out for emotional support from family, friends, or support groups. Talking with others who have gone through similar experiences can help you cope with the emotional challenges of a cancer diagnosis.

6. Nutrition and Wellness: Focus on maintaining a healthy diet and lifestyle. A nutritionist may help you develop a meal plan that supports your treatment and overall health. Incorporating physical activity, if possible, can also be beneficial.

7. Regular Monitoring and Follow-Up: Schedule regular follow-up appointments with your healthcare team to monitor your progress and manage any side effects of treatment. Follow-up care is important for detecting any potential recurrence of cancer.

8. Explore Support Services: Many hospitals and cancer centers offer resources such as counseling, financial assistance, and educational programs. Explore these services to help navigate your journey.

9. Consider Long-Term Planning: Discuss potential long-term effects of treatment with your doctor, including hormonal changes, fertility issues, and menopause. Planning for these aspects can help you prepare emotionally and physically.

10. Celebrate Milestones: Acknowledge and celebrate milestones along your journey, whether it’s completing treatment, receiving positive test results, or simply reaching personal goals.

Every person’s journey is unique, and it’s essential to communicate openly with your healthcare team and loved ones throughout the process. Prioritize self-care, seek support, and remember that it’s okay to ask for help when needed.

How is Lung Cancer Diagnosed?

The path to effective treatment begins with an accurate diagnosis of lung cancer. Understanding the tests involved in determining lung cancer type, stage, and whether the disease has spread to other areas of the body is essential.

Lung Cancer Detection and Diagnosis

Early detection is key to successfully treating lung cancer. This is why it is critical for smokers and former smokers to have annual lung screenings, as symptoms often do not manifest until the cancer has reached an advanced stage.

Tests Used for Lung Cancer Diagnosis

A variety of tests help in detecting, diagnosing, and staging lung cancer, as well as in understanding whether the cancer has metastasized to other parts of the body. A biopsy remains the most definitive method for diagnosis, involving the collection of a small tissue sample for laboratory testing. Your doctor will consider several factors when selecting the appropriate diagnostic tests, including the size and location of the suspected cancer, your symptoms, overall health, and prior test results.

Common diagnostic tests include:

• Chest X-ray:Provides images of the organs and bones in the chest.
• CT Scan:Offers detailed cross-sectional images of the chest, abdomen, and brain, often with a contrast dye.
• MRI:Utilizes magnets and radio waves to create detailed images of internal structures.
• PET Scan:Detects malignant cells by using radioactive glucose, highlighting areas of increased activity.
• Radionuclide Bone Scan:Identifies cancer cells in the bones through a small injection of radioactive material.

Specific Diagnostic Procedures

Procedures to confirm the diagnosis of lung cancer may include:

• Fine-Needle Aspiration (FNA) Biopsy:Targets abnormal lung tissue to collect samples for testing.
• Thoracentesis:Removes fluid to check for cancer cells in the space surrounding the lung.
• Sputum Cytology:An examination of mucus from the lungs for cancer cells.

Molecular Testing for Non-Small Cell Lung Cancer

Genetic testing is critical for understanding mutations within the cancerous tissue that may respond to targeted therapies. Biomarker testing, such as PD-L1 evaluation, can inform immunotherapy options.

If you’ve recently received a lung cancer diagnosis, the EPCC team is here to support you every step of the way. We offer access to advanced treatment options and resources designed for you and your loved ones.

Personalized Lung Cancer Treatment Plans

Each treatment plan is individualized based on the type and stage of lung cancer as well as your overall health. Our lung cancer care team collaborates closely to offer the best protocols and recommend a comprehensive treatment plan tailored specifically for you.

Understanding Your Treatment Options

Having open conversations with your oncologist is crucial. We want to ensure you fully comprehend your lung cancer treatment plan, the expected timeline, and how we will monitor its effectiveness. Our lung cancer specialists at EPCC are committed to helping you feel comfortable and confident in your treatment decisions, working alongside you to develop a plan suited to your unique situation.

Together, we can take meaningful steps toward effectively managing lung cancer and improving your quality of life.

Expert Lung Cancer Treatment, Close to Home

At El Portal Cancer Centers, we understand that a lung cancer diagnosis can be a daunting experience. Fortunately, many treatment options are available, and we are dedicated to tailoring these solutions to meet your individual needs and preferences. Our approach is grounded in the specific type and stage of your lung cancer, ensuring that you receive the most effective care possible.

Chemotherapy for Lung Cancer

Chemotherapy is a cornerstone of cancer treatment that utilizes powerful medications to halt the growth of cancer cells, whether by destroying them or preventing their division. Given that lung cancer often spreads rapidly, chemotherapy plays a critical role in many treatment plans, aimed at eradicating these cells.

The administration of chemotherapy can vary based on your specific situation:

• Systemic Chemotherapy:When the medication is taken orally or injected into a vein or muscle, it enters the bloodstream, reaching cancer cells throughout the body.
• Regional Chemotherapy:If injected directly into the spinal column, an organ, or a body cavity like the abdomen, this method targets cancer cells in those localized areas.

Chemotherapy Approaches for Small Cell Lung Cancer (SCLC)

Chemotherapy often forms an integral part of the treatment for SCLC, administered in various ways:

• Chemoradiation:Combining chemotherapy with radiation therapy is commonly recommended for patients with limited-stage SCLC.
• Primary Treatment:For some patients with advanced SCLC, chemotherapy may serve as the main treatment option.

Chemotherapy for Non-Small Cell Lung Cancer (NSCLC)

For patients with NSCLC, chemotherapy may not always be included in the treatment plan, but it can be appropriate in certain scenarios:

• Before Surgery:Chemotherapy may be utilized to shrink a tumor, paving the way for less extensive surgical intervention.
• After Surgery:To eliminate any remaining cancer cells that may not be visible through imaging technology, chemotherapy may follow surgical procedures.
• For Advanced NSCLC:If the cancer has invaded surrounding areas, chemotherapy combined with radiation can be a critical treatment approach, particularly for tumors that have not yet spread to distant organs.

Radiation Therapy for Lung Cancer

There are two primary types of radiation therapy used in lung cancer treatment:

• External Radiation Therapy:This method employs a machine to direct radiation toward the cancer from outside the body.
• Internal Radiation Therapy:This involves placing a radioactive substance directly into or near the tumor through sealed needles, seeds, or catheters. Prophylactic cranial irradiation may also be utilized to prevent the cancer from spreading to the brain.

External beam radiation therapy (EBRT) is the most common form used in lung cancer treatment. This procedure targets high-energy beams at the tumor from outside your body, allowing for a treatment experience similar to receiving an X-ray.

Typically, patients undergo radiation sessions once or twice a day, five days a week, over a period of five to seven weeks, depending on the specific goals and stage of treatment.

Advanced Technologies in External Beam Radiation Therapy

At El Portal Cancer Centers, we utilize cutting-edge external beam radiation therapies to enhance treatment effectiveness while minimizing damage to surrounding healthy tissue. Our techniques include:

• 3-Dimensional Conformal or Intensity-Modulated Radiation Therapy (IMRT):This advanced system uses specialized equipment to break radiation beams into smaller, adjustable segments, ensuring a precise delivery aimed directly at the tumor while sparing healthy areas.
• Stereotactic Body Radiation Therapy (SBRT):Using advanced imaging techniques, SBRT targets lung tumors with pinpoint accuracy, delivering high doses of radiation in just one to five treatments, ideal for patients who cannot undergo surgery.

Surgery for Lung Cancer

Small Cell Lung Cancer Surgery

Although less common, surgical options may be considered for small cell lung cancer in select cases where the cancer is localized to one lung and nearby lymph nodes. However, due to the nature of SCLC’s rapid spread, surgical intervention is less frequently utilized.

Non-Small Cell Lung Cancer Surgery

Patients diagnosed with early-stage NSCLC are more likely to undergo surgery to remove tumors. As the cancer advances, surgical options may become more complex due to the potential spread throughout the lung(s).

Post-Surgery Considerations

Even if all visible cancer is removed during surgery, your oncologist may recommend chemotherapy or radiation therapy afterward to target any remaining cancer cells. This follow-up treatment is referred to as adjuvant therapy and is essential for reducing the risk of recurrence.

Lung Cancer Treatments by Stage

Understanding your treatment options based on your lung cancer stage is vital. The approach differs significantly between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). 

Non-Small Cell Lung Cancer: Tailored Treatments by Stage

Understanding the stages of non-small cell lung cancer (NSCLC) is crucial for determining the most effective treatment approach. Each stage presents unique characteristics that guide treatment decisions.

• Stage 0 In Stage 0, cancer cells are present on the lining of the airway but have not yet invaded the lung tissue. This early stage is highly treatable, often requiring surgery alone to remove the affected tissue. Additionally, laser therapy may be employed to destroy these cancer cells.
• Stage 1 Stage 1 NSCLC indicates that the cancer has been detected very early, potentially through a lung cancer screening test. Surgical intervention is typically performed to remove the nodule(s). Following surgery, the removed cells undergo testing to determine whether chemotherapy or immunotherapy is needed based on the specific characteristics of the cancer.
• Stage 2 For patients in Stage 2, surgery is generally recommended to excise the tumor, followed by chemotherapy to eliminate any remaining cancer cells. Depending on the individual case, immunotherapy and targeted drug therapy may also be introduced during this stage, particularly for patients with certain EGFR gene mutations.
• Stage 3 At Stage 3, surgical options may still be considered; however, the presence of multiple nodules throughout the lungs can complicate effective surgical intervention. In these cases, alternative treatments such as chemotherapy, radiation therapy, immunotherapy, or targeted therapies may serve as first-line options to manage the disease.
• Stage 4A In Stage 4, cancer has spread beyond the lungs to another part of the body, such as the brain. However, if the cancer has only metastasized to one additional area, surgery may still be an option to remove the tumor from that location. Radiation therapy may also be utilized to address and destroy any remaining cancer cells.
• Stage 4B Stage 4B indicates that cancer has often disseminated throughout the body or to various sites. In such cases, biomarker testing becomes a valuable tool to identify specific genetic mutations, guiding the use of targeted therapies aimed at halting cancer growth.

A cancer diagnosis can profoundly impact family dynamics, routines, and relationships. Family members may experience their own emotional stresses, worry about the patient’s health, and take on new caregiving roles. Communication can become more open or strained, and adjusting to changes in roles—such as caregiver, supporter, or decision-maker—requires flexibility and understanding. Supporting the emotional needs of each family member and seeking family counseling or support groups can help the entire family navigate this challenging time together.

Returning to work after cancer treatment often requires adjustments to accommodate ongoing health needs, fatigue, or emotional changes. Many survivors find they need to modify their schedules, work part-time, or explore flexible work arrangements. Open communication with employers about your needs can foster understanding and support. Establishing a new routine that balances recovery with professional responsibilities helps rebuild confidence and maintain a sense of purpose.

Psychological resilience plays a crucial role in survivorship. Many survivors face emotional challenges such as anxiety, depression, or fear of recurrence. Prioritizing mental health through counseling, support groups, mindfulness practices, or relaxation techniques can foster emotional well-being. Recognizing that emotional healing is part of the journey encourages survivors to seek help when needed and to nurture a positive outlook.

Receiving a prostate cancer diagnosis can be overwhelming, and there are important decisions to be made. It’s natural to have questions, and we are here to help you navigate your options and understand what lies ahead. You’ll learn about your cancer care team and what to expect as you embark on this journey.

What Type of Doctor Should You See First After a Prostate Cancer Diagnosis?

Typically, a urologist will perform the biopsy that confirms the presence of prostate cancer and assesses its aggressiveness. Following this initial diagnosis, we recommend scheduling a consultation with an oncologist. Our dedicated oncologists are well-versed in the latest treatment options, ensuring you receive therapies tailored specifically for you.

Your oncologist will help you understand the growth pattern of the cancer and how it may evolve moving forward. The biopsy results, combined with other diagnostic tests, will provide the necessary information to determine both the stage and grade of your prostate cancer.

Staging Prostate Cancer

Using the results from your biopsy and additional diagnostic tests, your oncologist will ascertain the stage of your prostate cancer. Further imaging or scans may be required to identify whether cancer cells have extended beyond the prostate.

Gleason Score and Grading

The Gleason score, included in your biopsy report, indicates how much the cancer cells have altered in various parts of the prostate. This grading aids in determining whether immediate treatment is necessary.

The Gleason score is a system used to grade prostate cancer based on how aggressive and likely it is to spread. It is determined by examining cancer cells under a microscope and assigning them a score from 1 to 5.

Grading:
1-2: Well-differentiated, least aggressive
3-4: Moderately differentiated
5: Poorly differentiated, most aggressive

Gleason scores are subject to interpretation and may vary slightly between pathologists. It is important to discuss your Gleason score with your healthcare provider to understand its implications and treatment options.

Preparing for Your First Oncology Appointment

Your first oncology appointment is essential for gathering important information, but it can be overwhelming. We suggest bringing a notebook or using your smartphone to take notes during the appointment. This will help you keep track of important details and any questions that arise.

We strongly encourage you to bring a friend or loved one for support. They can take notes, ask questions that might be on your mind, and provide reassurance.

Additionally, please bring your health records, including any prostate cancer test results, recent imaging scans, your insurance card, and a list of medications or supplements you’re currently taking.

Questions to Discuss with Your Oncologist

• How soon do I need to decide on a treatment plan?
• If “watchful waiting” is recommended, how often should I return for follow-up testing?
• What treatment options do you suggest when the time comes to proceed?
• What should I expect during future appointments?
• Are there lifestyle changes (in diet, exercise, rest, or stress management) I should consider?
• How should I manage any symptoms affecting my daily life?
• Are there any activities I should avoid or incorporate into my routine?
• Can I take nutritional supplements or vitamins to support my prostate health?
• Should my family and I consider genetic testing to check for hereditary risk?
• What supportive care resources are available through your practice or community organizations?

Feeling confident about your prostate cancer diagnosis and treatment plan is vital, even if it begins with watchful waiting. Many patients choose to seek a second opinion, and our oncologists are completely supportive of this decision. Insurance coverage for second opinions is often available, so we recommend contacting your insurance provider to verify your benefits before scheduling an appointment.

You Are Not Alone on Your Prostate Cancer Journey

At El Portal Comprehensive Cancer Centers, we are committed to supporting you throughout your entire journey. With convenient locations across Central California, we are here to offer you compassionate care and guidance every step of the way. Together, we will navigate this path to achieve the best possible outcome for your health and well-being.

During Treatment

Receiving a cancer diagnosis can evoke feelings of shock, fear, anger, or uncertainty. The stress of treatment side effects, hospital visits, and lifestyle changes can lead to anxiety and depression. It is normal to experience a wide range of emotions during this time. Maintaining open communication with your healthcare team about your emotional well-being is essential. Psychological support or counseling can provide tools to manage anxiety, depressive symptoms, and emotional distress.

Surviving Cancer

While completing treatment brings relief, many survivors face ongoing emotional challenges such as fear of recurrence, adapting to physical changes, or reintegrating into daily life. Feelings of vulnerability, grief, or identity shifts are common. Building a support network, engaging in self-care, and participating in survivorship programs can foster resilience and emotional strength. Remember, healing is not only physical but also mental and emotional.

Supporting mental health throughout the cancer journey involves accessing appropriate resources:

• Counseling and Therapy: Licensed mental health professionals, including psychologists and social workers, specialize in addressing cancer-related emotional issues. Sessions can offer coping strategies, emotional processing, and support for anxiety or depression.
• Support Groups: Connecting with others who have similar experiences provides comfort, shared knowledge, and a sense of community. Many organizations offer in-person and virtual support groups for patients and caregivers.
• Mind-Body Techniques: Practices such as meditation, yoga, relaxation exercises, or journaling can reduce stress and promote emotional balance.
• Educational Resources: Learning about common emotional reactions to cancer can normalize your experience and provide helpful coping tips. Many cancer centers and organizations offer educational materials or workshops.
• Emergency Support: If you experience severe depression, thoughts of self-harm, or suicidal feelings, seek immediate help by contacting emergency services or going to the nearest emergency room.

Where to Get Help:

• Talk to your healthcare team about mental health concerns; they can refer you to mental health specialists experienced in oncology.
• Contact local mental health clinics or community organizations offering counseling services.
• Utilize national resources like the American Cancer Society’s Reach To Recovery program or the National Alliance on Mental Illness (NAMI).

Even after beating cancer, returning to work can feel overwhelming. You might wonder whether your ability to perform has changed or if colleagues will treat you differently. Preparing ahead of time by assessing your energy levels, discussing accommodations, and setting a manageable schedule can make the process smoother. Consider starting part-time or remote work if possible, and communicate openly with your supervisor about your needs. Remember, it’s okay to take things slow—your recovery and comfort come first.

Talking with Coworkers
Deciding what to share about your cancer journey is personal. You may choose to keep details private or share only with close colleagues. If you do decide to disclose, explaining your absence as due to treatment can foster understanding and support. Be honest about what you’re comfortable sharing, and set boundaries if questions become too personal. Most coworkers will respect your privacy and support your needs once they understand your situation. Remember, you control your story—only share what feels right for you.

Laws like the Americans with Disabilities Act provide protections against discrimination and require reasonable accommodations, such as flexible schedules or workplace modifications. You are entitled to support and fair treatment, and it’s important to understand these rights. If needed, the Family and Medical Leave Act offers job protection for up to 12 weeks of leave for illness-related reasons. If you face discrimination or unfair treatment, consulting legal resources or an employment lawyer can help you understand your options.

While the precise causes of leukemia remain unclear, certain factors have been identified that may increase the likelihood of developing the disease.

Known Risk Factors for Leukemia Include:

• Genetic Factors: Individuals with certain genetic syndromes, such as Down syndrome, are at higher risk for leukemia. Specific inherited genes may also predispose individuals to developing the disease.
• Environmental Exposure: Long-term exposure to high levels of radiation—such as that from nuclear accidents—or exposure to chemicals like benzene (found in cigarette smoke and industrial emissions) has been linked to an increased risk of leukemia.
• Age: The incidence of leukemia increases with age, though acute forms can occur in children as well.
• Family History: Individuals with a family history of leukemia or other blood cancers are at a higher risk, indicating a potential genetic component.
• Previous Cancer Treatment: Those who have undergone chemotherapy or radiation for other cancers may have an elevated risk of developing leukemia later on.

Leukemia can present with a variety of symptoms, which may vary based on the type but commonly include:

• Fatigue or Weakness: A significant drop in red blood cells can lead to anemia, causing chronic fatigue, dizziness, and weakness.
• Frequent Infections: Abnormal white blood cells can interfere with the immune system, resulting in increased susceptibility to infections.
• Easy Bruising or Bleeding: Low platelet counts can impair the blood’s ability to clot, leading to excessive bruising, nosebleeds, or gum bleeding.
• Unexplained Weight Loss: Many patients experience unintentional weight loss as a result of the body’s heightened metabolic need in response to the disease.
• Night Sweats: Some individuals experience drenching sweats at night, often accompanying fever and chills.
• Pain in the Bones or Joints: Some forms of leukemia.

Diagnosis of Leukemia

Diagnosing leukemia typically involves a combination of medical history, physical examination, and specific tests, including:

• Blood Tests:To look for abnormal levels of white blood cells, red blood cells, and platelets.
• Bone Marrow Biopsy:A definitive test to confirm leukemia and identify its type.
• Imaging Tests:Such as CT scans or MRIs, to assess any organ involvement.

Leukemia Treatment Options

Treatment for leukemia is tailored to the type and stage of the disease but may include:

• Chemotherapy:The primary treatment for most types of leukemia, aiming to kill cancer cells.
• Radiation Therapy:Used to target specific areas and relieve symptoms.
• Targeted Therapy:Drugs that specifically target cancer cell growth signals.
• Stem Cell Transplant:Harvesting healthy stem cells to replace diseased bone marrow.

Staging is an essential process that helps determine the extent of the disease and guide treatment options.

Chronic Lymphocytic Leukemia (CLL) Stages

CLL is typically classified into the following stages:

1. Stage 0: Low-risk; increased lymphocyte count without symptoms.
2. Stage I: Enlarged lymph nodes.
3. Stage II: Enlarged lymph nodes and spleen or liver.
4. Stage III: Anemia due to low red blood cell counts.
5. Stage IV: Low platelet counts and significant complications.

Rai Staging System

The Rai Staging System is a common method to categorize CLL, based on physical examination and blood test results, including the number of lymphocytes and the presence of anemia or low platelet levels.

Chronic Myeloid Leukemia (CML) Stages

CML has three phases:

1. Chronic Phase: Slow growth, often asymptomatic at diagnosis.
2. Accelerated Phase: Disease begins to evolve, with signs of progression.
3. Blastic Phase: Rapid growth, resembling acute leukemia and requiring urgent treatment.

Medical History Review: The hematologist will ask detailed questions regarding your medical history, family history, and any symptoms you’ve been experiencing. Be prepared to provide information on previous illnesses, medications, and treatments you have received.

Physical Examination: A physical exam will often be performed to assess your overall health and identify any signs of hematologic disorders. This may include checking for signs of anemia, swelling in lymph nodes, or other related symptoms.

Diagnostic Tests: You may undergo blood tests or, in some cases, a bone marrow biopsy to determine the nature of your condition. If you already have recent test results, bring copies.

Discussion of Symptoms: You’ll have the opportunity to discuss any symptoms you have been experiencing, such as fatigue, infections, or bleeding. Be specific about the duration and severity of each symptom.

Treatment Plan Discussion: Based on your diagnostic results, the hematologist will discuss potential treatment options, including the benefits and risks associated with each.

Referrals and Additional Tests: If needed, you may be referred to other specialists, or additional diagnostic tests may be scheduled.

When meeting with the hematologist, it’s essential to have your questions ready. Here are some key questions that can guide the conversation:

Diagnosis Clarification:

• What specific type of hematologic condition do I have?
• How was this diagnosis determined?

Implications of Diagnosis:

• What does my diagnosis mean for my health?
• Are there any associated risks or complications?

Symptoms and Management:

• What symptoms should I watch for that would require immediate medical attention?
• Are there any lifestyle changes I should consider to manage my condition?

Treatment Options:

• What treatments are available for my condition, and which do you recommend?
• What are the potential side effects of each treatment option?
• How long will treatment last, and what does it involve?

Prognosis:

• What is the prognosis for my condition?
• How often will I need follow-up appointments or tests?

Support Resources:

• Are there support groups or resources you recommend for patients with similar diagnoses?
• How can I get in touch with a nutritionist or mental health professional if needed?

Questions Regarding Future Visits:

• How frequently will I need to return for follow-ups?
• What tests or evaluations will be conducted during future visits?

Additional Tips for Your Appointment

• Bring a Support Person: Consider bringing a family member or friend for support. They can help take notes and remember information discussed during the appointment.
• Prepare a List: Write down your symptoms, concerns, and any medications you are currently taking. This preparation can ensure that you don’t forget important details during the visit.
• Be Honest: Feel free to share your emotional state or any fears you may have regarding your health. Hematologists are trained to address both physical and emotional aspects of care.
• Follow-up Questions: Don’t hesitate to ask for clarification if you don’t understand something. It’s essential to have a clear understanding of your diagnosis and treatment plan.

By preparing thoughtfully for your first hematologic oncology appointment and asking the right questions, you’ll be better positioned to address your health concerns and collaborate effectively with your healthcare team.

Treatment can be demanding, making it easy to forget everyday tasks. To manage this, consider making a list of your daily and weekly responsibilities. Keep a notebook handy to jot down additional tasks as they come to mind. Examples of items to include are:

• Grocery shopping
• Preparing school lunches
• Transportation for children to school and extracurricular activities
• Walking pets
• Meal preparation
• Laundry tasks

Also, create a separate list detailing the support you might need, such as rides to appointments. Utilize tools like calendars or digital apps to stay organized, and feel free to post updates or requests for assistance from friends and family.

Building a reliable support network is vital during your cancer journey. Both emotional and practical support can make a significant difference as you navigate treatment. Friends and family can be invaluable—don’t hesitate to reach out and seek their help. Consider EPCCC’s support groups as a resource to connect with others facing similar challenges. Having additional eyes to help with planning and logistics can alleviate the burden, whether it involves household chores, meal preparation, or transportation. If necessary, hiring a caregiver can provide you with consistent assistance for medication management and activities of daily living.

Remember, asking for help is not a burden; many people genuinely want to support you but might not know how unless you tell them what you need.

Maintaining your mental and physical health is essential during this time.

Prior to starting treatment, focus on nourishing your body with healthy foods and engaging in regular exercise, as permitted. Explore activities that support your mental well-being, such as yoga, meditation, or counseling with a professional. Remember, your emotional state as you enter treatment can significantly impact how you feel during the process, so aim to cultivate healthy habits now.

If chemotherapy is part of your treatment plan, preparing a chemo bag can help ease anxiety and make your experience more comfortable. Consider including items that promote relaxation, nourishment, and entertainment, such as:

• Electronics and headphones for music or movies
• Books, magazines, or journals for personal reflection
• Activity books (like coloring books or crossword puzzles)
• A cozy blanket or pillow
• Headwear options like hats or scarves
• A reusable water bottle to stay hydrated
• Healthy snacks that you enjoy
• Nausea relief items, including ginger chews or mints
• Personal care products, such as fragrance-free lotion and lip balm

Remember that your care team at EPCCC is here to support you every step of the way. Don’t hesitate to discuss your concerns and questions with your oncologist or cancer care team so you can prepare in the best way possible for your unique situation.

Difficulty Sleeping – Sleep disturbances can occur during treatment, which may exacerbate fatigue. Consider these strategies to improve sleep:

• Create a calming bedtime routine.
• Keep your sleeping environment dark, cool, and quiet.
• Go to bed and wake up at consistent times.
• Limit screen time before bed and reduce caffeine intake.
• Discuss melatonin or other sleep aids with your healthcare provider.

Fatigue – Fatigue can be overwhelming and may affect your mental health as well. Strategies for managing fatigue include:

• Engaging in regular, light exercise to boost energy levels.
• Practicing yoga or meditation to alleviate emotional stresses.
• Consulting with a counselor or social worker for additional support.

Hair Loss – While hair loss is often associated with cancer treatment, not every patient will experience it. To manage hair loss:

• Be gentle with your hair care routine and consider head coverings or wigs to boost your confidence.
• Use cooling caps, if recommended, to possibly reduce hair loss during chemotherapy.
• Connect with support groups to share experiences and feelings surrounding hair loss.

Skin Problems – Treatments can lead to various skin changes. To care for your skin during treatment:

• Keep affected areas clean and moisturized with gentle, fragrance-free products.
• Wear loose-fitting clothing and use sunscreen to protect sensitive skin.

Loss of Appetite – Maintaining proper nutrition is vital during treatment. If you experience appetite changes:

• Opt for smaller, more frequent meals packed with protein.
• Stay hydrated and ask about anti-nausea medications that can improve your eating experience.
• Consider discussing dietary changes with a nutritionist.

Nausea and Vomiting – These are common effects of many cancer treatments. To mitigate nausea:

• Avoid strong scents and stick to bland foods.
• Maintain hydration, especially with electrolyte drinks if vomiting occurs.
• Take prescribed anti-nausea medications as directed.

Lymphedema – This condition may result from surgery or radiation impacting the lymphatic system. To manage lymphedema:

• Wear compression garments and consult with a certified lymphedema therapist for specialized care.
• Regular exercise and gentle stretching can improve lymph fluid drainage.

Pain – Managing pain effectively is crucial to your overall well-being. Strategies include:

• Taking prescribed medications consistently and discussing pain management options with your doctor.
• Applying heat or ice to areas of discomfort, depending on what provides relief.

During radiation therapy, a team led by a radiation oncologist—a specialist in this treatment—will carefully plan and supervise your treatment. Each session typically involves directing high-energy radiation toward the cancer cells using specialized equipment. This targeted exposure fractures the DNA within the cancer cells, making it difficult for them to grow and multiply. While healthy surrounding cells may also be exposed to some radiation, most can recover and continue functioning normally, whereas cancer cells generally cannot.

At El Portal Comprehensive Cancer Centers, we utilize the latest and most advanced radiation technologies to minimize exposure to healthy cells. Our accredited equipment undergoes daily checks to ensure the highest level of precision in treatment.

There are two main categories of radiation therapy:

External Beam Radiation Therapy

This method delivers radiation from a machine outside the body, directing beams specifically at the cancer site. The equipment does not physically contact the body and can be adjusted to deliver radiation from multiple angles. Treatment typically occurs five days a week for a duration ranging from 1 to 10 weeks.

Technologies may include:

• TrueBeam Radiotherapy:Offers advanced options tailored to your specific anatomy and cancer type.
• Image-guided Radiation Therapy (IGRT):Uses imaging (such as CT or ultrasound) to accurately direct radiation.
• Intensity-modulated Radiation Therapy (IMRT):Shapes radiation beams around tumors while sparing surrounding healthy organs.
• Stereotactic Radiosurgery (SRS):A non-invasive approach treating irregularly shaped tumors, particularly in the brain.
• Stereotactic Body Radiation Therapy (SBRT):Similar to SRS, but designed for tumors outside the skull.
• Hypofractionated Radiation Therapy:A specialized technique for breast cancer treatment, depending on individual patient factors.

Internal Radiation Therapy

Internal radiation therapy, or brachytherapy, involves placing radioactive material directly inside or near the tumor. This may include various implants such as pellets, seeds, or tubes, which are inserted using minimally invasive methods.

At El Portal Comprehensive Cancer Centers, we offer:

• High-Dose Rate (HDR) Brachytherapy:Often utilized for uterine or cervical cancers, this approach involves placing radioactive material for short durations multiple times.
• Selective Internal Radiation Therapy (SIRT):An innovative, non-surgical procedure for liver tumors, delivered via tiny radioactive beads inserted directly into blood vessels leading to the tumor.

After a cancer diagnosis, you will likely be referred to a cancer specialist, such as a surgical oncologist or medical oncologist. Your treatment plan, which may include radiation therapy, is tailored uniquely based on:

• Type and grade of cancer
• Size and location of the tumor
• Sensitivity of surrounding tissue
• Genetic components
• Family history
• Age, overall health, and medical background
• Personal treatment goals and preferences

Your doctor will also consider whether you have previously received radiation to that area, as each body part has a safe lifetime dose of radiation. The decision to proceed with radiation for recurrence depends on the location of the tumor, cancer type, and past radiation exposure.

Radiation therapy may be recommended as a standalone treatment or in conjunction with surgeries, chemotherapy, or immunotherapy. At El Portal Comprehensive Cancer Centers, we typically can schedule your first appointment within two days of your referral.

Radiation therapy demands a high degree of skill, precision, and experience. Selecting a provider with state-of-the-art technology and strict protocols ensuring equipment accuracy is essential.

At El Portal Comprehensive Cancer Centers, we have been delivering high-quality radiation therapy for patients across California for over 15 years. Our board-certified radiation oncologists bring expertise and compassion to your care.

Key factors to consider include:

• Technology:Choose a center equipped with the most advanced equipment for optimal treatment.
• Experience:Our dedicated team ensures patients receive knowledgeable and compassionate care.
• Affordability:As the largest community-based cancer center, we strive to provide services in a cost-effective

Physical Activity: Engaging in regular exercise offers numerous benefits such as increased energy, improved mood, weight management, and better cardiovascular health.

• You don’t need to start with intense workouts; even moderate activities like walking, stretching, or gardening can make a difference.
• Aim for at least 150 minutes of moderate exercise per week, broken into manageable sessions.
• Find activities you enjoy to help maintain consistency.

Healthy Eating Habits: Your diet is a cornerstone of good health. Focus on incorporating a variety of nutritious foods:

• Vegetables & Fruits: Rich in vitamins, minerals, and antioxidants that support immune health.
• Whole Grains: Such as brown rice, oats, and whole wheat bread, which provide steady energy and fiber.
• Lean Proteins: Like poultry, fish, beans, and nuts that help repair tissues and build strength.
• Limit processed foods, sugary snacks, fast food, and high-fat items, which can contribute to obesity, type 2 diabetes, heart disease, and other health issues.

Avoid Tobacco & Limit Alcohol: Smoking and vaping pose serious health risks, including increased chances of second cancers.

• Quitting tobacco dramatically improves health outcomes.
• While moderate alcohol consumption might be acceptable, overindulgence can undermine your health. The American Cancer Society recommends no more than one drink per day for women and two for men.

Sun Safety: Prolonged and intense sun exposure increases the risk of skin cancer. To protect yourself:

• Stay indoors during peak sunlight hours (10 a.m. – 4 p.m.).
• Wear protective clothing, wide-brimmed hats, and sunglasses.
• Use a broad-spectrum sunscreen with at least SPF 15, reapplying every two hours.

Medication & Medical Follow-Up: Taking prescribed medicines correctly is crucial for managing health conditions and preventing complications.

• Don’t discontinue medication without your doctor’s approval.
• Regular checkups and screenings—such as mammograms, skin exams, or colonoscopies—are critical for detecting any signs of recurrence or new cancers early.
• Staying vigilant with these appointments is essential, even after completing treatment.

Transitioning to a new, healthier lifestyle can be challenging, but you don’t have to do it alone. Support groups for cancer survivors provide a safe space to share experiences and encouragement. Family and friends can also offer motivation and accountability. Remember, building healthier routines is a journey—be patient with yourself and celebrate small victories along the way.

Achieving & Maintaining a Healthy Weight

Gaining Weight After Treatment: Some treatments cause nausea, taste changes, and loss of appetite, leading to unintended weight loss. Focus on nutrient-dense, appealing foods—like smoothies, soups, or small frequent meals—to help regain strength.

Losing or Managing Weight: Others may experience weight gain due to medications, inactivity, or stress eating. Developing a balanced diet combined with regular physical activity can help manage weight effectively.

Tips for Weight Management:

• Track your food and activity to understand your habits.
• Enlist support from dietitians or healthcare providers for personalized plans.
• Set realistic, achievable goals.

Advance Care Planning (ACP) is an ongoing process that helps you understand your healthcare options and express your preferences. It empowers you to have a say in your future medical care and provides guidance for your medical team should you become unable to communicate. Making these decisions now allows you and your loved ones to focus on quality of life and peace of mind.

Our compassionate counselors will guide you through a thoughtful process to clarify your values, goals, and wishes for care. This includes:

• Reflecting on what matters most to you for a good quality of life
• Learning about different treatment options and how to communicate your goals
• Discussing life-sustaining treatments and your feelings about them
• Choosing a Healthcare Proxy or Surrogate—someone you trust to speak for you
• Putting your wishes into writing through legal documentation
• Exploring your personal values and care goals

Before meeting with an EPCC social worker, it’s helpful to reflect on your values and wishes. Consider questions like:

• What is your understanding of your illness?
• How much do you want to know about your health, and how would you like to receive information?
• What fears or worries do you have?
• Who supports you, and how much do they know about your wishes?
• If you haven’t named a decision maker, who would step in if you’re unconscious or confused?
• What brings you joy and contributes to your quality of life?
• What are your goals for the coming months?

You may also want to think about areas such as:

• Independence and activity level
• Nutrition and sleep
• Sexuality and intimacy
• Spirituality and faith
• Pain management
• Communication with your healthcare team
• Relationships with loved ones
• End-of-life preferences

Why Is This Important?

Even if your health is currently good, discussing your wishes is essential. It ensures your loved ones and healthcare providers understand your values and preferences, preventing unnecessary distress during difficult times. Ongoing conversations and documented wishes serve both as a meaningful gift and a protective measure for you and those you care about.

Reflect on these questions to further inform your plan:

• What would your approach be if you became too weak to get out of bed?
• If at the end of life, you couldn’t improve, would you want life-sustaining machines or prefer comfort and natural death? Are there treatments you would refuse?
• Where would you prefer to receive end-of-life care—at home, in the hospital, or elsewhere?

Your Care Team Supports You

Advance care planning is a standard and important part of your treatment journey, even if your cancer is highly treatable. Knowing that your care team is aware of your wishes offers peace of mind, and it takes the burden off your loved ones during challenging times.

Remember, discussing and documenting your wishes is a caring act—one that respects your dignity and ensures your voice is heard, now and in the future.

AUTHORIZATION REQUIRED: 

• Alignment Health Plan    
• AllCare IPA Merced (HMO/NO DERM)  
• ALLIANCE (CCAH)
• Anthem MediCAL Managed Care Prog.  
• Brand New Day-Universal Care, Inc.- Medicare 
• Calviva Health 
• Community Care IPA
• California Forensic Medical Group, Inc  
• Health Plan of San Joaquin HMO
• Kova Healthcare, Inc. IPA  
• Imperial Health Medical
• MediCAL  
• Central Valley Medical Providers IPA
• Sequoia Health IPA 
• United Healthcare (AARP)
• Sante Community Physicians  
• Tricare TriWest Healthare
• Alliance  
• Western Growers Assurance Trust  
• Central Valley Pace County Medical Services Program 
• Esperanza IPA- Medicare HMO
• Choice Program
• HealthNet CA- First Health Hill Physicians 
• Humana LaSalle Network Management IPA  
• Meritage Medical Network
• Seven Corners 

NO AUTHORIZATION REQUIRED: 

• Aetna
• Anthem
• Blue Cross of CA  
• Blue Shield of CA
• Medicare 
• UMR ACPN Network-America’s Choice PN  
• First Health Network-Cofinity Galaxy Health Network
• HealthSmart 
• CIGNA
• Anthem ACA Plans- Pathway EPO, PPO 
• BS of CA Promise Health Plan
• Medicare
• Railroad Multiplan/PHCS  
• NaphCare NX Health Network LLC d/b/a Valenz Access 
• Provider Network of America (PNOA)
• Wellcare
• WelbeHealth 

• Verify benefits, plan limits, referral, and pre-authorization requirements before your appointment.
• Bring your insurance card(s).
• Notify us of any insurance or personal information changes immediately.
• Understand your financial responsibility for co-pays, deductibles, and non-covered services.

• We verify and review your benefits.
• We help obtain necessary referrals and authorizations.
• We provide cost estimates.
• We inform you about financial assistance options.
• We bill your primary and, if authorized, secondary insurance.
• For Medicare patients, supervising physician info will be included on your claims.
• Our Financial Counselors can provide resources for you to help navigate obtaining traditional insurance coverage 

• Present your current insurance card at each visit.
• Keep us updated on insurance info.
• Pay co-pays at the time of service.
• Cover any balances remaining after insurance payments.

Diagnosing Multiple Myeloma typically involves several steps:

1. Medical History and Physical Examination:
   • Your healthcare provider will start by reviewing your medical history, discussing symptoms you’ve experienced, and conducting a thorough physical examination to check for signs of the disease, such as bone tenderness or swelling.
2. Blood Tests:
   • Blood tests are essential in diagnosing Multiple Myeloma. Common tests include:
     • Complete Blood Count (CBC): Monitors levels of red blood cells, white blood cells, and platelets.
     • Blood Chemistry Tests: Assess kidney function and other vital parameters.
     • Serum Protein Electrophoresis (SPEP): Identifies abnormal proteins (monoclonal proteins) produced by myeloma cells.
     • Free Light Chain Assay: Measures the levels of free light chains in the blood and can indicate the presence of myeloma.

3. Urine Tests:
   • A 24-hour urine collection may be performed to check for Bence Jones protein, a type of light chain protein released by myeloma cells.
4. Bone Marrow Biopsy:
   • A definitive diagnosis often requires a bone marrow biopsy, where a small amount of bone marrow (usually from the hipbone) is extracted and analyzed for abnormal plasma cells.
5. Imaging Tests:
   • Imaging techniques such as X-rays, CT scans, or MRIs are used to assess bone damage or lesions caused by myeloma. These tests help identify areas of bone weakening or fractures.

While the exact cause of Multiple Myeloma remains unknown, several factors may increase the risk:

1. Age: The risk of developing Multiple Myeloma increases with age, most commonly affecting individuals over 65.
2. Gender: Men are more likely to develop Multiple Myeloma than women.
3. Race: African Americans have a higher incidence of Multiple Myeloma compared to Caucasian populations.
4. Family History: A family history of Multiple Myeloma or related plasma cell disorders may increase individual risk.
5. Certain Medical Conditions: Conditions such as monoclonal gammopathy of undetermined significance (MGUS) or other blood disorders can predispose individuals to myeloma.
6. Exposure to Chemicals: Long-term exposure to certain chemicals, such as benzene, and agricultural chemicals, may contribute to the development of myeloma.

Recognizing the signs and symptoms of Multiple Myeloma is crucial for early intervention:

1. Bone Pain: Persistent pain, particularly in the back, hips, or ribs, may indicate damage to the bones caused by myeloma lesions.
2. Fatigue: Anemia, caused by reduced red blood cell production, often leads to fatigue and weakness.
3. Frequent Infections: Compromised immune function due to myeloma can make patients more susceptible to infections.
4. Unexplained Weight Loss: Patients may experience unexplained weight loss with no changes in their regular diet or physical activity.

Treatment for Multiple Myeloma is generally tailored to individual patient needs and the disease’s specific characteristics. Here are the primary treatment options:

1. Chemotherapy: Chemotherapy remains a cornerstone of treatment for Multiple Myeloma. Regimens may include combinations such as:
   • Bortezomib (Velcade):A proteasome inhibitor that blocks protein degradation pathways in cancer cells.
   • Dexamethasone:A corticosteroid used in combination with other drugs to reduce inflammation and manage symptoms.
   • Lenalidomide (Revlimid):An immunomodulatory drug that enhances the immune response against myeloma cells.
2. Targeted Therapy: Targeted therapies focus specifically on cancerous cells, minimizing harm to normal cells:
   • Monoclonal Antibodies:Medications like daratumumab (Darzalex) are designed to target specific proteins on myeloma cells, leading to their destruction.
   • Carfilzomib (Kyprolis):A newer proteasome inhibitor used in patients with relapsed or refractory myeloma.
3. Immunotherapy: Immunotherapies use the body’s immune system to fight cancer:
   • Chimeric Antigen Receptor (CAR) T-Cell Therapy:This innovative approach involves modifying a patient’s T-cells to better recognize and attack myeloma cells. It has shown promise for some patients with difficult-to-treat myeloma.
4. Stem Cell Transplant: For eligible patients, stem cell transplant can provide an opportunity for long-term remission:
   • Autologous Stem Cell Transplant:This involves harvesting the patient’s own stem cells, administering high-dose chemotherapy to eliminate cancer cells, and then reinfusing the healthy stem cells.
5. Radiation Therapy: Radiation can be used to relieve pain or target specific areas affected by multiple myeloma, particularly in cases of localized disease or bone lesions.
6. Supportive Care: Supportive care plays a vital role in managing symptoms and improving quality of life. This may include medications for pain relief, management of anemia, hydration support, and nutritional counseling.

Caring for someone with cancer can make maintaining your own health seem difficult. To effectively care for your loved one, it’s vital to schedule time for your own medical appointments and self-care routines. Prioritizing your health ensures you have the strength and energy to continue providing support. Incorporate self-care practices such as maintaining a balanced diet, getting adequate sleep, engaging in regular physical activity, and practicing relaxation techniques like deep breathing or meditation.

There are resources to help you stay physically active and connected to the world around you. If you need help finding services in your area, contact an EPCC social worker.

The emotional toll of caregiving can lead to feelings of isolation and exhaustion. The following resources can help nurture your emotional well-being and provide strategies for maintaining balance while caring for your loved one.

Our social workers are available to offer counseling and connect you with local support services. To speak with a licensed social worker, contact your nearest EPCC location during business hours.

Important: In case of an emergency, do not leave a message—call 911 directly.

Connecting with others and carving out time for yourself can be difficult. Getting assistance with everyday tasks can free up energy and reduce stress.

• Reducing Stress and Anxiety: Share your feelings with family and friends so they understand your needs. Consider designating one or two people as primary contacts to communicate important updates or coordinate help.
• Organizing Support: Organizing support for cancer patients can make a significant difference in their quality of life and treatment experience. Here are some ideas:

• Create a Care Calendar or Schedule: Use tools like Lotsa Helping Hands or a shared online calendar to coordinate tasks such as meal preparation, transportation, errands, and childcare.
• Designate Support Roles: Assign specific responsibilities to friends or family members—e.g., one person manages appointments, another handles meals, and someone else provides emotional support.
• Use Digital Platforms: Set up a private CaringBridge site or Facebook group for updates, sharing needs, and organizing volunteer efforts.
• Meal Train: Organize a meal delivery schedule through services like MealTrain.com to ensure consistent nutritious meals.
• Transportation Assistance: Coordinate rides to treatment appointments through community programs, local volunteer driver services, or rideshare apps.
• Host Support Groups: Establish or join local or virtual support groups for patients and caregivers to share experiences and advice.
• Organize Practical Help: Arrange for cleaning services, home repairs, or pet care through local providers or community resources.
• Spiritual and Emotional Support: Connect with local chaplain services, spiritual care providers, or mental health counselors who can offer guidance and comfort.
• Fundraising and Resources: Set up crowdfunding campaigns or organize community fundraising events to support medical expenses or related needs.
• Encourage Self-Care and Reflection: Support the patient in incorporating activities like meditation, journaling, or nature walks into their routine, and facilitate access to these resources.

Implementing even a few of these strategies can greatly ease the burden on patients and caregivers, fostering a supportive community around their treatment and recovery.

Resources in Your Area:

• Meal Delivery: Meals on Wheels — check their website for local providers.
• Transportation: Local transportation services in the Central Valley, or the American Cancer Society Road to Recovery (800-227-2345).
• Cleaning Services:
  Modesto:
  MaidPro Modesto — Professional cleaning services including residential and light commercial cleaning.
  Sweet Home Cleaning — Offers regular and deep cleaning options for homes.
  
  Merced:
  Maid in Merced — House cleaning services with flexible scheduling.
  Merced Cleaning Service — Residential cleaning, move-in/move-out cleaning, and special deep cleaning.
  
  Manteca:
  Manteca Cleaning Service — Residential and commercial cleaning, including carpet and upholstery cleaning.
  Simply Clean Manteca — Home cleaning services tailored to your needs.

Please note that it’s advisable to verify current availability, reviews, and insurance coverage before hiring any service.

• Home Care Support: Consult your medical team for referrals suitable to your needs, with local providers available in Modesto, Merced, and Manteca.

Spirituality can mean different things to each person, often related to finding purpose and connection in life. As a caregiver, taking time for reflection and nurturing your spirit is essential but can be overlooked.

Resources and practices such as meditation, guided visualization, journaling, spending time in nature, or connecting with a spiritual care provider can be helpful.

Connecting with Spiritual Support:
Start by contacting your local hospital’s pastoral care or chaplain services. They can connect you with a non-denominational chaplain or spiritual counselor who can offer support and guidance aligned with your beliefs or preferences.

If you need additional assistance or specific resources tailored to your area, please contact a social worker at your EPCC location.