Oncology & Chemotherapy — Town Hospital

Oncology & Chemotherapy at Town Hospital: an overview

Town Hospital's Oncology & Chemotherapy department in the Fifth Settlement, New Cairo, diagnoses tumours, plans their treatment and follows patients during and after it. It also sees people with no diagnosis yet, when a new lump, a lasting change in bowel habit, unexplained weight loss or an unclear scan or blood test needs explaining. Its doctors specialise in oncology and chemotherapy, one with a particular interest in breast tumours and their early detection; you will find them in the list of doctors below. Chemotherapy is given in the hospital under the oncologist's supervision.

The laboratory and the radiology department, with a 3 Tesla MRI and a 128-slice CT scanner, are open 24 hours a day. Cancer surgery is among the operations of the hospital's General Surgery department. The outpatient clinics are open every day from 10 am to 10 pm; each oncologist's clinic days and times are shown in the up-to-date clinic schedule.

Conditions the department looks after

The oncologist decides on the diagnosis and treatment after the consultation, the tests and the biopsy result; these are the cancers patients ask about most often.

Colon and rectal (colorectal) cancer

Colorectal cancer usually begins as a small growth (a polyp) on the lining of the large bowel and grows slowly over years, so early on it may cause no symptoms. Signs worth having checked include a change in bowel habit lasting more than a few weeks, such as new constipation, looser stools or stools narrower than usual; red or dark blood in or on the stool; a feeling that the bowel has not emptied completely; abdominal pain or bloating that does not settle; unexplained weight loss or tiredness; and iron-deficiency anaemia with no clear cause. Most of these signs have simpler causes, such as piles or irritable bowel syndrome, but if they persist they deserve a check at any age.

The diagnosis is made by colonoscopy, which allows a biopsy of anything suspicious and removes polyps in the same session; it is done in the hospital by the Gastroenterology & Endoscopy department. A CT scan then shows whether the tumour has spread, with an MRI of the pelvis for rectal tumours. Surgery to remove the affected part of the bowel is the main treatment for most tumours found early. At Town Hospital, colon and rectal cancer surgery is done by the General Surgery department. Chemotherapy may follow surgery to lower the chance of the tumour returning, or come before it, with radiotherapy, for some rectal tumours. Screening is recommended for people without symptoms starting at 45 or 50, as the doctor advises, and earlier with a family history of the disease, because colonoscopy can remove polyps before some of them turn into cancer.

Lymphoma (cancer of the lymph glands)

Lymphoma is a cancer of the immune cells in the lymph glands, with two main groups, Hodgkin and non-Hodgkin lymphoma. The usual sign is a painless swollen gland in the neck, armpit or groin that lasts more than a few weeks, sometimes with fevers, drenching night sweats or weight loss, although most swollen glands come from a simple infection and settle within weeks. Lymphoma can also start in the stomach or bowel, where it is found by a biopsy taken during endoscopy. Examining a sample under the microscope identifies the type, and CT scans show how far it extends. Chemotherapy, often with a targeted medicine, is the main treatment for most types; radiotherapy is used in some cases, while some slow-growing types need only close monitoring.

Breast cancer

Breast cancer is the most common cancer in women and can rarely affect men. The usual sign is a lump in the breast or armpit, often painless; others are a change in the size or shape of the breast, skin that puckers or looks like orange peel, and an unusual discharge. Most breast lumps are not cancer, but every new lump needs checking. Assessment starts with an examination and an ultrasound or a mammogram, depending on age, then a needle biopsy that confirms the diagnosis and shows features, such as hormone sensitivity, that guide treatment. Treatment usually combines surgery (removing the tumour alone or the whole breast), chemotherapy before or after it, hormone or targeted therapy for certain types, and radiotherapy after some operations. At Town Hospital, breast cancer surgery is done by the General Surgery department. The oncologist can also advise a woman on the check-up plan that suits her age and family history.

Lung cancer

Smoking, including shisha, is the main cause of lung cancer, and second-hand smoke adds to the risk, though people who have never smoked can also be affected. Signs include a cough lasting more than three weeks or a change in a smoker's usual cough, coughing up blood, breathlessness, chest pain, hoarseness and repeated chest infections. Assessment starts with a chest X-ray and a CT scan, then a biopsy through a bronchoscope or with a needle, and the sample may be tested to see whether targeted therapy suits. Treatment depends on the type and stage and may include surgery for early tumours, chemotherapy, targeted therapy, immunotherapy and radiotherapy. The hospital's Cardiothoracic Surgery department operates on lung tumours. Stopping smoking helps at every stage.

Stomach cancer

Early stomach cancer is easily mistaken for indigestion, so these signs deserve a check: upper abdominal pain or heartburn that does not improve with treatment, feeling full quickly, loss of appetite, weight loss, difficulty swallowing and repeated vomiting. Long-standing H. pylori infection, smoking and a lot of salted food raise the risk. The diagnosis is made by gastroscopy with a biopsy, done in the hospital, and tumours that have not spread are treated mainly with surgery, often with chemotherapy before and after it.

Liver tumours

Liver tumours are of two kinds: those that start in the liver itself, which in Egypt are closely linked to long-term hepatitis C or B and cirrhosis, and those that reach it from another organ, such as the colon, whose treatment follows the original tumour. A tumour that starts in the liver rarely causes early symptoms, so an abdominal ultrasound about every six months is advised for people with cirrhosis and for some people with chronic viral hepatitis, as their doctor decides. The diagnosis relies on CT or MRI with contrast, sometimes with a liver biopsy, which is done in the hospital. Treatment depends on the size of the tumour and the state of the liver, and the options include surgery, local treatments aimed at the tumour, and targeted therapy or immunotherapy.

Prostate cancer

Prostate cancer is one of the most common cancers in men over 50, and many prostate tumours grow slowly. It rarely causes early symptoms; a weak urine stream and getting up at night to pass urine are far more often due to benign enlargement of the prostate, which the Urology department looks after. Assessment starts with an examination and a PSA blood test, an MRI may follow, and a biopsy confirms the diagnosis. Some slow-growing tumours need only close monitoring, tumours confined to the prostate may be treated with surgery or radiotherapy, and tumours that have spread are treated with hormone therapy that lowers the male hormone, sometimes with chemotherapy. From about 50, or earlier with a family history, men can ask their doctor whether regular PSA testing suits them.

Tests and treatment in the hospital

• Blood tests: the full blood count and liver and kidney function before each chemotherapy cycle and at follow-up, and tumour markers, which help to follow the response to treatment but cannot on their own diagnose or rule out a tumour, in a laboratory open 24 hours a day.
• Imaging: X-ray, ultrasound, 128-slice CT and 3 Tesla MRI, to locate a tumour, measure its extent and follow its response to treatment, in a radiology department open 24 hours a day.
• Endoscopy and biopsies: colonoscopy and gastroscopy with biopsies and polyp removal in the Gastroenterology & Endoscopy department, and a liver biopsy when needed.
• Image-guided biopsies: a needle sample from a lump or a lymph gland, guided by ultrasound or CT, in the hospital's radiology department.
• Chemotherapy: in the hospital, according to the plan the oncologist sets.

You will find the laboratory tests and imaging on the Diagnostics page.

Chemotherapy and other treatments

Each plan depends on the type and stage of the tumour, the features of its cells, your general health and your wishes, and often combines more than one treatment. From the start, the oncologist explains its aim: to get rid of the tumour, to keep it under control, or to ease symptoms.

Chemotherapy uses medicines that attack fast-dividing cells, cancer cells among them. It is given in cycles with rest periods in between so the body can recover, through a vein over a few hours or as tablets at home, and before each cycle a blood count and liver and kidney tests in the hospital laboratory check that your body is ready. Chemotherapy sessions given through a vein take place in the hospital's day-care unit, where you stay under observation for the session and go home the same day. Side effects depend on the medicines and the person; the more common ones are tiredness, nausea, mouth sores and lower blood counts, which raise the risk of infection, and hair loss happens with some medicines only. Medicines that prevent nausea and ease other symptoms are part of what is called supportive care, and most side effects settle after treatment ends. Tell the team about any new symptom rather than waiting for your next appointment.

Targeted therapy uses medicines aimed at a specific feature of the tumour cells, many of them given only when tests on the biopsy show that feature; immunotherapy helps the immune system recognise cancer cells; and hormone therapy treats hormone-sensitive breast and prostate cancers. Radiotherapy aims high-energy rays at the tumour area, and the oncologist decides when it is needed. When the plan needs radiotherapy, the oncologist refers you to a radiotherapy centre and continues to follow the rest of your plan.

When you need emergency care straight away

Some signs during cancer treatment cannot wait for a clinic appointment. Call an ambulance or go to the nearest emergency department straight away for:

• A temperature of 38°C or higher, shivering, or suddenly feeling very unwell during chemotherapy, even with no other symptoms.
• Sudden or severe breathlessness, or chest pain.
• Pain and swelling in one leg.
• New weakness or numbness in the legs, or loss of bladder or bowel control, especially with back pain.
• Confusion, marked drowsiness or a seizure.
• Vomiting or diarrhoea that stops you keeping fluids down.

Tell the staff your diagnosis and the date of your last treatment. Town Hospital's emergency department is open 24 hours a day. It does not receive digestive (GI) bleeding, such as vomiting blood, black stools or heavy bleeding from the back passage, so for these call an ambulance directly.

Your care, step by step

• Consultation: the doctor asks about your symptoms, other illnesses, medicines and family history, and reviews previous scans, reports and biopsy results, so bring them with you.
• Tests: what is still needed to confirm the diagnosis and the stage; of these, blood tests, CT, MRI, ultrasound and endoscopy are done in the hospital.
• Decision: the doctor explains the type and stage of the tumour, the aim of treatment, the options and their expected side effects; the decision is made with you and your family, and you can take time to think or ask for a second opinion.
• Treatment: chemotherapy in the hospital on the agreed schedule, plus any other treatment the plan needs; the doctor tells you where each one is given.
• Follow-up: regular visits at intervals the doctor sets, with tests and imaging when needed and supportive care for side effects; never stop a medicine or change its dose on your own.

The hospital is contracted with more than 40 payers, including insurance companies, professional syndicates and government bodies, and cover depends on the payer and the terms of the contract.