Announcing our new Lung Cancer Program at Pomona Valley Hospital Medical Center!

Lung cancer has been the third highest incidence of cancer diagnosed at PVHMC (after breast and prostate) for the past 10 years. We formed a new multi-disciplinary specialized team in January of this year to improve early diagnosis and treatment of lung cancer,.  Our program will offer assistance for patients to expedite and coordinate diagnosis.  It will also streamline access to the most advanced treatment options, while offering support services and a dedicated Patient Care Coordinator.  This coordinator will provide assistance to patients and their families through the entire diagnosis, treatment and recovery process.  This team is being chaired by Dr. Rohit Trivedi and Dr. Sarika Jain.

The three main goals for this team are:

• Improve clinical care (resulting in better outcomes)
• Improve lung cancer awareness and prevention in the region
• Enhance the patient experience and retain more patients in our community

Lung cancer treatments have improved over the last few years, but we are still striving to improve the outcome for those diagnosed. This new team consists of primary care physicians, radiologists, cardiothoracic surgeons, pulmonologists, medical oncologists, radiation oncologists, pathologists, nursing, research and administration. They will collaborate on each case to expedite diagnosis and treatment along with the highest level of care focusing on the best outcomes.

We plan to bring you more news about the benefits and successes of this team in the near future!

The Lung Cancer Program Team

We are excited to announce the new Medical Director Leadership team for the Oncology Program. To enhance collaboration, Dr. Y.S. Ram Rao, our Medical Director since September 2004, will be joined by Keith Kusunis, M.D., F.A.A.F.P., and Lori Lee Vanyo, M.D., F.A.C.S.

Dr. Rao completed his Residency in Radiation Oncology in 1978 at Michael Reese Medical Center in Chicago, Illinois. He moved to California in 1978 and was a Radiation Oncologist at the University of California in Irvine. He came to Pomona Valley Medical Center in 1983, serving as the Director of Radiation Oncology. "I welcome my co-director colleagues to participate in our efforts to continue to grow the Cancer Program," said Dr. Rao.

Keith Kusunis, M.D., F.A.A.F.P., completed his Residency in Family Practice in 1985 at Resurrection Hospital in Chicago, Illinois. He began his practice in 1986 in La Verne and came to Pomona Valley Hospital’s Family Health Center in November of 1998. He has served as the Chairman of the Family Practice Department and was the Chief of the Medical Staff at PVHMC in 2005. "The Cancer Program at PVHMC is already the premier site of cancer care in the Pomona Valley. I look forward to helping the continued improvement of this fine organization," said Dr. Kusunis.

She is currently the Chief of Surgery at PVHMC. Dr. Vanyo said "I look forward to working as a team to help deliver state-of-the-art cancer care/treatment in a loving and supportive environment."

These doctors will work in collaboration with Shellee Reese, RN, BSN, MHA, OCN, and Administrative Director to support the oncology service line development, refinement and growth. Their leadership will have primary responsibility for all clinically related activities within the Cancer Center, supporting inpatient services, supportive care programs, and services. Also, they will contribute to administrative functions such as Tumor Registry, clinical research, outcomes reporting, etc., including quality control and problem-solving for clinical concerns.

Additionally, they will monitor financial performance and intervene to assure the attainment of utilization management objectives. They also serve as primary communicators to physicians who are current or potential users of oncology services.

Our new GE Lightspeed 14RT dedicated treatment planning CT scanner began clinical use in Radiation Oncology in February. It allows patients to come to the Center to get this necessary scan which is part of the treatment planning process, making it quicker and more convenient than having to go to the Hospital to have this done.

This wide bore CT unit has a larger diameter opening to allow patients more room for improved positioning over what was available with the narrow bore CT scanners at the hospital. Special computer controlled lasers are also part of the new GE CT Simulation Scanner. The lasers are used to more accurately determine the exact center of where the radiation needs to be delivered and are directed by the treatment planning systems. While the new GE CT Simulation Scanner was being installed, GE provided a mobile CT scanner in a truck that we used to do this CT treatment planning.

Once again, we are always striving to make the cancer experience easier and more convenient for our patients while providing state of the art technology and outstanding radiation medicine.

Positron emission tomography (PET) combined with computed tomography (CT) represent a major advance in the diagnosis, treatment and management of patients with cancer. While the Department of Radiology here at Pomona Valley Hospital Medical Center (PVHMC) has been providing PET imaging since 2001, our installation of a dedicated PET/CT scanner in August 2007 has substantially improved the quality and value of our imaging services to patients with cancer.

To understand why PET is so valuable in cancer care today, we’ll need first to review a little basic biology. Many living cells use glucose and other fuels as their source of energy. Cancer cells, however, have a more "primitive" metabolic system, and use much more glucose, and use it less efficiently, than normal cells. Fluorodeoxyglucose (FDG) is an analog of glucose, and this molecule gets trapped preferentially inside cells with relatively immature metabolic pathways, specifically in cancer cells. Radioactive fluorine 18 is attached to the fluorodeoxyglucose, to make 18-FDG; it is this radiopharmaceutical which is injected into patients to produce their PET images. Because the 18-FDG localizes primarily to cancer cells, our imaging system, the PET scanner can reconstruct in three dimensions the location of concentrations of 18-FDG, and therefore, demonstrate the location of cells with a malignant type of metabolism.

FDG PET is one of the first examples of molecular imaging. However, to enhance the relatively low resolution of these PET imaging, we need to localize potential sites of cancer with high anatomic accuracy as well.

This is where CT comes in. CT has a resolution on the order of millimeters, and when combined with PET localizing areas of cancer cell growth, we can get an excellent image of the patient’s extent, location and activity of disease.

In patients with active tumors, the PET scan shows areas of viable cancer cells as "bright" spots, accumulating FDG. The CT scan assists the radiologist and surgeons to define the exact anatomic location of the abnormal cancer cells. Because the PET scan and the CT scan are performed on each patient at essentially the same time, the correspondence of the PET and CT abnormality is very reliable.

Our PET/CT imager at Pomona Valley Hospital is the Siemens biograph 40, and it’s really two state-of-the-art imaging devices in a single machine. The PET scanner uses the most modern, high response, high sensitivity detector crystals to image the high energy photons liberated by the fluorine-18 FDG. The CT scanner has 40 detector rows, and thus acquires 40 images in each pass of 370 msec; it can perform routine CT scans and CT of the heart as well. At a cost of over $2.1 million, the biograph 40 is a major technology investment by PVHMC in advanced health care for the Pomona community.

PET/CT has been shown useful in a wide variety of common cancers, and is seen as indispensable in the management of some of these dread diseases.

In lung cancer, prior to surgery, it’s important to know if there has been spread to lymph nodes or beyond the chest. PET/CT can demonstrate that there may be value to surgery if no spread is identified, or can avert major surgery if there has been extensive local or distant spread.

In colon, esophageal and pancreatic cancer, PET/CT is useful in evaluating patients with suspected recurrence. Often blood tests may show elevation in tumor markers, suggesting spread of cancer, though a routine CT scan may not identify the location of spread. PET/CT allows oncologists to confidently identify an occult location of spread, or to confirm that there is no spread.

Similarly, in breast cancer, patients with known spread of cancer to distant sites may be effectively and aggressively treated with chemotherapy, surgery or radiotherapy. PET/CT is a reliable and accurate way to assess response of the disease spread to treatment. Lymphoma is another disease which oncologists follow closely during treatment with PET/CT scans.

There will be about 1.4 million new cases of cancer diagnosed in 2007, and about 560,000 deaths.  Each of us has a one in three risk of succumbing to this disease.  The tumors most effectively imaged with PET/CT are among the most common: lung, breast, colorectal, uterus, ovary, thyroid, lymphoma, melanoma, and pancreas.  With PET/CT radiologists and oncologists have new and powerful tools to diagnose and manage this group of diseases.

by Johnson B. Lightfoote, M.D., Medical Director, Department of Radiology