During diagnosis, the anatomopathological examination concentrates on small fragments of tissue, called biopsies, obtained during an endoscopy (when a tube is introduced into a cavity such as the stomach, bronchi, colon or bladder and samples are taken with a small pincer located at its end) or from punctures carried out using a needle. Simple brushing or rubbing is sometimes enough to obtain the cells required for a microscope examination, as in gynaecological smears. This illustrates the importance of anatomopathology in the detection of certain cancers.

After a surgical operation, the anatomopathologist receives the surgical sample and conducts a detailed examination of the tumour removed during the operation. After taking suitable samples, he then looks under the microscope to find every important element for allowing the aggression of the cancer to be determined. Finally, an anatomopathological examination determines the quality of surgical treatment before and after the operation: in particular, it allows surgical processes to be properly orientated and helps ensure that no cancer is left behind.

The contribution of anatomopathology to the diagnostic and therapeutic approach to cancer is very significant, indeed a determining factor, at several stages in the course of a cancer.

ORGANISATION

They work closely with doctors who take the organ or tissue samples examined under the microscope (gastroenterologists, pneumologists, gynaecologists etc) and with cancer treatment specialists (surgeons, chemotherapists, radiotherapists etc). At the Cliniques Universitaires Saint-Luc Cancer Centre, this work specifically takes the form of weekly multidisciplinary meetings, in which specialists in various fields pool their knowledge and observations to provide patients with the most suitable care and set up a treatment specific to each case, according to the profile of the tumour described by the pathologist during the meetings.

RESEARCH

As well as macroscopic and microscopic aspects, much research into pathological anatomy is currently aimed at better defining the nature of tumours. This means that ever more effective tools are allowing pathologists to identify, under the microscope, proteins that, when produced by certain genes, are associated with a more or less favourable development of a tumour. Progress in this field has led to the discovery of many proteins or “markers” that have provided a better description of a tumour and led to a better understanding of its nature, behaviour and potential development. Some markers can help with monitoring of other family members; their presence can indicate a possible hereditary nature, leading to a consultation at the Human Genetics Centre. In other cases, markers are used to advantage to predict efficacy of treatment. Identifying them, therefore, also helps optimise patient care. The pathological anatomy laboratory at Cliniques Universitaires Saint-Luc can now identify almost three hundred different markers, mostly connected with the nature and behaviour of tumours.

In the fight against cancer, the pathological anatomy department is also studying the efficacy of new treatments. Such is its involvement in this area that many “residual samples” can be stored in a biobank. If the patient consents, this material can be used in research activity. To find out more about our biobank, click here.

The pathological anatomy department at Cliniques Universitaires Saint-Luc plays an active part in developing national and European recommendations that set required quality standards for an anatomopathological examination. In fact, this examination should be conducted according to a specific standardised procedure, especially in terms of methods, numbers of samples taken, measurements to be made, description of lesions etc. Our pathological anatomy department applies all these recommendations for all types of cancer.

                  - Avoid the sun between 1200 and 1600 hours
                  - Use sun cream with sufficiently high UVB protection and powerful UVA

                    protection, and apply it regularly.

Early detection of a tumour improves the chances of the patient being cured. The medical departments involved in cancer care at our centre offer patients the opportunity to undergo suitable screening examinations using specialised equipment. To find symptoms to watch for and specialities involved in tumour detection, choose a tumour type from the following list.

Genetics is the study of genes, their structure and their functioning. It throws light on the mechanism of certain illnesses, such as cancer, and opens up therapeutic perspectives.

Genetic anomalies and the risk of cancer

The starting point for cancer has always been a mutation of a gene(s).

In hereditary cancers, the anomalies of some genes are present from birth. They form part of your gene pool. In non-hereditary cancers anomalies occur during the course of life. These are known as “acquired” anomalies. Genetics also has an interest in this since the anomalies identified from that time on say a lot about the aggressiveness of the tumour and are predictive of its evolution, enabling a better adapted treatment to be ascertained.

In the case of familial or hereditary disposition, genetic tests are important in identifying the possible presence of the anomaly associated with an increased risk of cancer, as early as possible.

Hereditary cancers represent 5% of all cancers. They are characterised by their early manifestation, that is, around the age of 25 or 30, and become manifest in several people from the same familial branch. The most frequent are breast and colon cancers.

Genetic advisory consultations provide patients suffering from a hereditary cancer or members of their family with all the information on the risk of developing, or passing on the illness, as well as possible preventative measures. In our centre - and this is one of our specificities - genetic advisory consultations are provided for families at risk of breast cancer and colon cancer. They thus benefit from close monitoring, which is intended to detect the occurrence of a possible cancer as quickly as possible.

The most frequent form of hereditary colorectal cancer is Lynch syndrome or HNPCC. Familial polyposis adenomatous syndromes and multiple adenoma syndromes are rarer, as are the various hamartomatous polyposis syndromes. Click here to learn more.

In hereditary breast cancers, the most frequent mutations are those of the BRCA-1 and BRCA-2 genes.

Dans les cancers du sein héréditaires, les mutations les plus fréquentes sont celles des gènes BRCA-1 et BRCA-2.

 Représentation schématique d'un arbre généalogique: les carrés illustrent les hommes, les ronds les femmes, la couleur noire le statut clinique de polypose adénomateuse familiale. Le génotype correspondant à la mutation germinale du gène APC, dont les électrophérogrammes accompagnent la généalogie, est représenté par le sigle - : l'allèle normale du gène APC étant associé au caractère +.

Genetic Anomalies and diagnostic interest

Genetics are of diagnostic interest. In some cancers they turn out to be just as efficient as other examinations. This is the case particularly for sarcoma and blood cancers.

The identification of possible genetic anomalies associated with sarcoma enables them to be better differentiated and, meaning the treatment which is most suited can be opted for: genetic modifications are in effect predictive of the evolution of the tumour, of its behaviour. It is therefore important to share, in the context of pluridisciplinary meetings, information provided by genetics and that which results from other examinations (radiology, examination of the diseased tissue under the microscope …).

In blood cancers, genetic factors may play an important role in the emergence of the illness or in its evolution from a dormant form, to a more active form.

These cancers were previously diagnosed by being based principally on the morphology of blood cells.

Analysis of some markers, or antigens, shown on the surface of these cells then allows the diagnosis to be refined. Today the examination of genetic anomalies means that cancers of the blood can be better differentiated, allowing a treatment which is best suited to be chosen, and identifying potential targets within the cancerous cells for new medications. These therapies, which are called “targeted” therapies, act in a specific way on anomalies, without having an effect on the whole body, as is the case with chemotherapy. They are thus better tolerated. Targeted therapies are the subject of international studies in which reference centres, such as ours, take part.

Finally, in blood cancers, genetics enable a residual illness to be detected: cancerous cells which are not identified by standard examinations linger in the body after treatment. It is important to be able to detect these cells, which are known as “residuals” since they sometimes require supplementary treatment.

A necessary complementarity

In our Cancer Centre the progress made in the genetics of cancer is put to good use in the pluridisciplinary meetings in which geneticists and doctors in charge of diagnosis and of cancer treatment take part. This conjunction of knowledge thus allows the most appropriate approach to be determined for the patient, the type of cancer, the extent of its spread and its genetic characteristics.

Research

During the last decade, a great deal of progress has been made in genetics, thanks to the development of DNA chips, a real identity card of the human gene pool, at very high resolution. This tool is now accessible at the centre for genetics and is used in characterising cancers which are at times difficult to categorize.

Research on genetic anomalies associated with certain cancers requires state of the art surgical appliances. Tools at the reference centres today allow the composition of genes to be studied in a very detailed manner.

Advances in knowledge in the area of the genetics of cancers require collaboration with other large international centres. Our Centre for Human Genetics is therefore a part of European associations, which allow a high number of observations to be built up and validated.

Caryotype 24 - couleurs

The Centre for Applied Molecular Technology (CTMA), which works together with the Cancer Centre at Saint-Luc Clinics, is interested in the gene pool of cancerous cells. Cancer is in effect linked to deterioration which occurs within some of the genes which are present even within the cells of our body.

Techniques known as molecular biology or molecular genetics allow specific deterioration of these genes or molecules (proteins, ARN), which are produced by these genes, to be studied and identified.

Genetics and molecular biology contribute to a better understanding of the innermost mechanisms of how our cells work.

The Centre for Applied Molecular Technology carries out translational research activity: this is aimed at implementing practical applications from findings of fundamental research work carried out in the laboratory, which is useful for patient care.

Several examples illustrate the added value of translational research, in terms of diagnosis and treatment. Therefore, work at the Centre for Applied Molecular Technology has lead to the clinical implementation of a test to detect cancerous cells in the prostate in urine. This test is an important aid in diagnosing prostate cancer and identifying indolent or aggressive modes of presentation. The Centre for Applied Molecular Technology is the only university centre in Belgium to do this, and has become a point of reference in this sector on a European level.

In cancer of the colon, we are witnessing the emergence of new medication which is very efficient - tyrosine kinase inhibitors which target and block cellular proteins (Ki-ras) whose deregulated activity is directly involved in the development of cancer. In cancer of the colon, these medications sometimes only work in non-mutated forms of these deregulated proteins. Innovative techniques developed by the Centre for Applied Molecular Technology mean that the presence, or absence, of mutation in these proteins can be detected at speed in patients’ tumourous samples, so the patients who will benefit from the effects of these medications can be selected quickly.

Thanks to the Centre for Applied Molecular Technology, findings by researchers have an immediate impact on the quality of care given to patients.

Several state of the art tools are improving research of genetic anomalies which are involved in the appearance of cancers in leaps and bounds. Therefore, molecular microarrays with high and low density techniques are leading to simultaneous study of several hundred to several thousand constituent molecules of the gene pool. They are based on the use of probes of different configurations which are capable of recognising their own equivalent target within the gene pool and thus determine if the targets present the researched genetic anomaly or not.

The Centre for Applied Molecular Technology endeavours to improve and simplify techniques which are at times highly complex, so that they can be of use in optimising the clinical diagnostic and therapeutic approach of cancers.

Molecular microarrays are part of major progress in the research of genetic anomalies which are involved in the appearance of numerous cancers.

Finally, molecular biology brings about more efficient use of anti-cancerous medication. Indeed, the way in which medications are metabolised in the body is also influenced by genes. Certain medications can have a toxic effect or may, on the contrary, have no effect amongst patients who have a genetic predisposition.

Based on techniques from molecular biology, pharmacogenetics allow subjects who are at risk to be identified quickly and efficiently, thus anticipating the occurrence of undesirable effects, or identifying patients who will be good or bad respondents. These new applications thus permit medications to be selected on an individual basis, according to their efficiency and their toxicity (in this case adapting the dosages or choosing an alternative which is less toxic).

Born of joint progress in genetics and molecular biology, pharmacogenetics lead to a use of anti-cancerous treatments which is more effective and more reliable.

The evolution of technologies is indispensable in opening up medicine to other disciplines such as bio-informatics and bio-statistics, biochemistry, or even engineering. The Centre for Applied Molecular Technology is working in close collaboration with the Cancer Centre and within a consortium which brings together multidisciplinary partnerships. This new approach is evidence of an evolution that cannot be ignored with regard to the complexity of diagnostic and therapeutic approaches to cancer, and the matter of controlling this illness ever more effectively.

Nuclear medicine is a very useful imaging technique in diagnosis of cancer and assessing its extent. It also has a therapeutic aspect.

FROM DIAGNOSIS TO TREATMENT

Cancer cells show changes in their metabolism and function. This means that they are better than normal cells at capturing radioactive substances known as “tracers”, injected into patients and then detected on pictures taken as part of nuclear medicine treatment.
There are a large number of tracers. Some are conventional and regularly used in nuclear medicine departments in most hospitals, while others are more specific and not generally available away from reference centres.
Nuclear medicine is also used for therapeutic purposes: some tracers, in fact, can destroy the cancer cells to which they attach themselves. This approach is being used successfully in new treatments.

Involved in both diagnostic and therapeutic approaches to numerous cancers, nuclear medicine specialists take part in multidisciplinary meetings with the aim of defining the most suitable course of action depending on the characteristics of the disease. For each type of cancer, they also adopt a strategy consistent with the latest scientific data.

ADDED VALUE OF THE PET SCAN

The basic examination has, for some time now, been the scintigraph.
This involves injecting an organ with a tracer, which concentrates in a specific kind of tissue, for example iodine in the thyroid gland and phosphate in bones. The tracer gives off radiation, detected by a camera. Problems are shown, depending on the case, through unusually high or low levels of radioactive tracer fixation.

The arrival of the PET scan, and more recently, that of the PET-CT, has led to major progress in several areas. These technologies have refined the initial diagnosis, allowing tumour growth levels to be assessed better and any recurrences to be picked up, and responses to treatment to be assessed earlier.

Diagnosis with finesse

A PET scan allows highly detailed three-dimensional images and information on cell function to be obtained.
It is useful not only in detection of tumours, but in evaluation of their extent. It therefore has an impact on the strategy adopted for the treatment. In lung cancer, therefore, PET scans are more effective than conventional scans in detecting possible involvement of ganglia located close to the organ. This very important parameter determines the need for a surgical procedure without the need for a more invasive exploratory procedure.

Evaluation of response and location of recurrences

A PET scan makes earlier evaluation of the patient’s response to radiotherapy or chemotherapy easier. In fact, the effect of this treatment on tumour volume, when assessed by conventional radiology, is only apparent after several months, while the effect on tumour cell function is more immediate. In a lymphoma, for example, efficacy of chemotherapy is assessed after just two weeks and, where necessary, allows rapid alteration of the treatment. This property of the PET scan is also helpful in assessing the efficacy of new treatments.

Markers, concentration of which is measured in blood, are often used to detect recurrences of cancers. Although increases in levels of these markers do not in themselves indicate the location of the recurrence, a PET scan reveals the site of the recurrence whatever its location in the body, and allows metastatic tumours that escape conventional examinations to be detected. This will affect the treatment strategy.

Finally, PET scans help better define the volume to be irradiated when tumours are treated with radiotherapy. Irradiation is better focussed on the tumour and respects the surrounding healthy tissue, meaning that higher doses can be used.

Consultez la fiche pratique du Pet-Scan.

VARIETY OF TRACERS

Tracers used in nuclear medicine are becoming more and more refined and varied according to the cellular function being investigated The most commonly used tracer is fluorine, combined with a molecule of sugar to form fluorodeoxyglucose or FDG. This tracer is used very frequently in detection, assessment of extent and evaluation of response to cancer treatments.
We also use carbon-marked acetate to assess synthesis of cellular membranes in liver tumours, carbon-marked methionin to assess protein synthesis in brain tumours, sodium fluoride to provide information on bone formation, and others.
Several new tracers have been researched at our centre. Most significantly, they should allow poorly oxygenated zones to be detected in tumours (these zones are often resistant to treatment) and diagnostic approaches to be refined in prostate cancer, a condition for which conventional tracers are not greatly effective.

Although PET scans have existed for several years, new tracers are continually improving their performance. They have been developed in research centres, as they require highly developed infrastructures and research units.
 
Since March 2000, over 11,000 examinations have been carried out on patients with various tumours, principally in the lungs and digestive and lymph systems. In March 2007, we introduced a new camera combining PET scan and CT scan into a single machine. Thanks to this PET-CT, we now benefit both from the PET scab’s high detection sensitivity and its capacity to determine the precise location of tracer-capturing seats. This will help determine a biopsy or a course of treatment.

Installation of the ultramodern PET-CT camera, and the availability of numerous tracers, have made the Cliniques Saint-Luc Cancer Centre a diagnostic platform in the imaging of cancers.

WHAT IS MEDICAL ONCOLOGY? 

Medical oncology is a recent discipline that appeared following development of effective medical treatments for cancer. Medical oncologists specialise in medical treatment for all kinds of tumour, except for malignant haematological tumours (blood cancers).

RESEARCH

An organ specialist doctor is, as the name suggests, a doctor specialising in one or more organs or a specific anatomical region of the body. Patients are referred to this doctor when suspect symptoms arise. This doctor carries out the examination that leads to the diagnosis and, in cases of malignant tumours, an assessment of advancement. Organ specialists are regularly involved in treatment, either surgical (gynaecology, ENT etc) or endoscopy (e.g. gastroenterology) or medical.

To find out more on their involvement in the diagnosis or treatment of specific tumours, click here

Breast cancer is still the principal cause of death in women aged between 50 and 69. One woman in 10 can develop breast cancer, and early detection greatly increases the chances of cure and survival.

Detection is achieved in two ways:

-Either by personal screening. This is a breast examination requested by a gynaecologist or general practitioner. It involves an interview, clinical examination and mammogram, and most often an ultrasound, all carried out at a specialist consultation. This examination is recommended for women aged 40 and over, every year until age 50 and then every two years without limit of age.

-Or by the mammotest, a national screening programme free on invitation, given every two years between ages 50 and 69 at an approved centre. It involves a mammogram, interpreted independently by two radiologists (double reading). If these interpretations differ, a third reading is carried out.
We at our centre provide personalised breast examinations at the request of gynaecologists and GPs.
Patients are referred either for screening, surveillance following treatment of breast cancer, examination of an irregularity, or an additional test and a second opinion.

Patients are welcomed at the mammography department by specialist breast examination technicians, who perform the mammogram. This examination requires rigorous techniques and high-performance equipment, which must be regularly examined.
After the mammogram, an experienced breast examination technician will conduct an interview and a physical examination. Most often, an ultrasound follows the mammogram. This will pick up dense tissue lesions that the mammogram may miss. The radiologist uses the most modern ultrasound machinery when conducting the test.

If the clinical examination, mammogram and ultrasound are consistent, a conclusion will be made. The results, usually benign, are sent to the referring doctor following comparison with previous examinations.

If there is an irregularity, additional examinations are performed.

Most often, a simple puncture with a fine needle is enough. It is conducted under ultrasound surveillance, which is rapid and not very painful. It will empty cysts or take cells from inside a nodule. Results are reliable in 90% of cases and can be obtained quickly.

For doubtful lesions, micro or macro biopsies will be taken, either under ultrasound surveillance if the lesion is visible with ultrasound, or using stereotaxis (guided mammogram) with a dedicated table. These will produce a sample of mammary tissue, and the sample can then be analysed histologically.
The only precaution is to stop taking aspirin and Sintrom anticoagulants one week before the procedure.

With ultrasound, samples are taken after a local anaesthetic. The procedure lasts 10-20 minutes and is usually painless.

In stereotaxis, samples relate to lesions not visible with ultrasound, such as micro-calcification seats. The breast examination department at Cliniques Universitaires Saint-Luc purchased a Mammotome, a system that takes samples by suction, a few years ago, and more recently acquired a dedicated stereotaxis table.
Macro biopsies are taken at external consultations, lasting for one hour on average (including installation); the patient can resume normal activity afterwards.
The combination of Mammotome and dedicated stereotaxic table has greatly improved patient care in terms of both diagnosis and comfort. To find out more about this examination, click here (link to “sample taken under stereotaxis”). 

La table stéréotaxique dédiée permet :
- Une amélioration importante du confort de la patiente ; celle-ci est allongée sur le ventre, le sein placé dans une fenêtre et l'équipe médicale travaillant sous la table (la patiente ne voit pas la procédure). Une fois placée dans le sein après repérage stéréotaxique, l'aiguille est laissée en place et tourne sur 360°, permettant la réalisation de plusieurs prélèvements dans différentes directions. La durée moyenne du geste est de 20 minutes.
- Une meilleure accessibilité des lésions, une aspiration permettant le contrôle d'un éventuel hématome.

Table de stéréotaxie dédiée

Mammotome

Radiotherapy is an essential tool in the treatment of many tumours. Radiotherapists are also involved in every multidisciplinary group at the Cliniques Universitaires Saint-Luc Cancer Centre.

They therefore play an active part in treatment of cancer, working alongside surgeons and oncologists specialising in chemotherapy. They can accurately define the benefit of irradiation techniques in each case discussed at the multidisciplinary meetings.

Radiotherapy, either alone or in combination with other treatment methods, can cure many tumours. In other cases, it can control various other symptoms, such as pain, and thus improve quality of life.

Appareil Hi-art de Thomotherapy installé dans notre centre

WHAT IS RADIOTHERAPY?

Radiotherapy involves treatment of cancer cells with X-rays. These cells, which have already mutated in several ways because of their malignant nature, do not readily survive exposure to radiation. Radiotherapy provides treatment in the form of small daily doses that are harmless to normal cells but progressively destroy cancer cells. This administering of small doses of rays has considerably reduced both frequency and intensity of side effects. More specifically, radiotherapy is better tolerated; it is now usually given in the outpatients’ department and no longer requires admission to hospital.

There are two distinct radiotherapy techniques:

• Curie treatment, or interstitial radiotherapy

In some cases, especially when small tumours are being treated, a specific irradiation technique is used. It is known as brachytherapy or curie treatment, after Marie Curie, who discovered radium in the late 19th century.
Depending on the zone to be treated, small radioactive grains or thin radioactive plates are injected or inserted and left in contact with the tumour, slowly irradiating it. The application (the term used in brachytherapy) is carried out under general anaesthesia and, if necessary, using a sophisticated ultrasound procedure that views the organ in three dimensions. The dose is calculated during implantation (a process known as dosimetry), thus allowing any necessary changes to be made at any time.
At our centre, brachytherapy is administered in four fields: eye melanoma (and some other tumours), breast cancer, skin cancer and prostate cancer. One other field is the treatment of persistent keloids (abnormal scars) but this is outside the scope of oncology.

• Classical or external radiotherapy

This is the technique most frequently used in the treatment of cancer by radiotherapy, involving treatment of the tumour with linear accelerators.

Our radiotherapy department has three linear accelerators, including the Tomotherapy Hi-Art, recently acquired by our centre and one of the first of its kind in Europe. It allows inaccessible tumours to be irradiated while preserving healthy neighbouring tissue. To find out more about tomotherapy, click here (link to article “tomotherapy from newsletter1»).

To find out more about radiotherapy, click here.

Vue du "pilote" de l'appareil Hi-art

INNOVATION ET EXPERTISE

Irradiation techniques have made huge steps forward in recent years. Computers now allow the tumour to be located and its nature determined with great accuracy. Cancers therefore be irradiated massively while preserving the adjoining healthy structures. And the computer revolution is far from over; no doubt it will lead to further progress in the use of rays.

Our centre’s experience in defining the position of the tumour within the body and its characteristics (shape, extent, location in relation to neighbouring vessels etc) is now internationally recognised (for example: Grégoire V, Scalliet P, Ang KK (publishers). Clinical Target Volume in Conformal and Intensity Modulated Radiation Therapy. Springer-Verlag Berlin Heidelberg New York. 2004). Progress in imaging has been used to maximum benefit to optimise the way in which radiotherapy is administered, thanks to combined efforts from specialists in imaging, radiotherapy and anatomy. The radiotherapy department’s research unit dedicates much of its activity to imaging techniques applied in radiotherapy.

Irradiation of cancer is becoming more and more accurate. Massive doses are fired into the tumour, while adjoining healthy structures are preserved. Our Tomotherapy Hi-Art machine allows these results to be achieved even with tumours difficult to access. Progress in imaging allows the targeting of the rays to be optimised.

In total, about 40 people work in the radiotherapy department.
This number includes medical technicians, almost as numerous as the doctors.
Their role is to monitor the performance of modern equipment constantly, ensure that measuring instruments are properly calibrated, and so on.
This shows the great attention paid to monitoring quality of care: irradiation techniques are becoming more and more complex and require ever more sophisticated equipment.
Irradiation is conducted according to a very rigorous procedure. Initially, it is simulated on screen. Subsequent checks ensure that irradiation of patients is consistent in every way with data calculated during the preparation phase. These very strict verification procedures prevent accidents.

The quality control skills of the Cancer Centre’s radiotherapy specialists are internationally recognised. It is evident in the development and publication of quality control programmes, which are used as references.

Séance de simulation avec masque

For some years now, significant progress has been made in diagnosis, treatment and surveillance of cancer patients, especially with the spectacular developments in medical imaging. This medical speciality uses both irradiation techniques such as standard X-rays, CT-scanner, angiogram and fluoroscopy, and non-irradiation techniques such as ultrasound and nuclear magnetic resonance. Each of these imaging methods has its characteristics, benefits and drawbacks, which radiologists and clinicians know and choose depending on the clinical context, the organ to be imaged or the type of tumour to be assessed.

 

IRRADIATION METHODS

 

X-rays must be used carefully, as they can damage effect organs examined if misused. In this field, major technological progress has been made in recent years to improve quality of X-ray images produced and reduce X-ray exposure times. The immediate effect of this progress has been a dramatic reduction in the time taken to obtain an image, combined with access to high resolution (with great fineness of detail). As patients have to hold their breath during examinations, these improvements allow much larger areas than before to be examined, with reduced breath-holding time. This means that CT scanner, which use X-rays, can image an entire thorax in a matter of seconds with sections less than 1 mm thick. As recently as 10 years ago, 30 seconds were needed to image the same region with sections about 5 mm thick.

NON-IRRADIATION TECHNIQUES

Non-irradiation imaging techniques also have advantages and drawbacks. Ultrasound is quite harmless, but image quality and diagnosis depend heavily on the experience of the doctor conducting the test. Magnetic resonance imaging (MRI), in contrast to ultrasound, produces global sections of the organ to be studied and makes examination of that organ easy. Images are also obtained at various levels, to point out certain irregularities. The major benefit of this technique, compared with the CT scan, which also produces images in sections, is that it clearly distinguishes certain tissues, such as fat. MRI can be used repeatedly with no danger to the patient. However, patients who carry magnetic devices, such as pacemakers or certain bone-fixing materials, cannot have this type of examination. It should also be remembered that it is quite expensive.

PET CT

A new medical imaging technique known as PET-CT has recently been introduced. This is a scan that combines medical imaging techniques (the CT or X-ray) with positron emission tomography or PET. In just one examination, this new technology gives an idea of the function and morphology of various organs. It is a happy combination, which, thanks to images of outstanding accuracy, provides a better diagnosis of certain conditions. For more details on PET-CT, click here (link to PET-CT).

There are many different medical imaging techniques, each of which has benefits and drawbacks. All, however, help to diagnose cancer and plan specific courses of treatment according to the case.

The decision to use a specific radiological technique to arrive at a diagnosis depends on the type of cancer. The section of the body to be explored will determine the course of action taken. For example, to search for a lung tumour in a smoker, the pneumologist examines the patient and then requests a standard X-ray. If there is a problem, he will request a CT-scan in an effort to determine whether the tumour found is benign or malignant. The scan also reveals any associated problems, such as involvement of ganglia or a bone irregularity. In most cases, the radiologist requests a guided puncture using fluoroscopy, ultrasound, endoscopy or CT scan to determine the type of cancer to be treated. He will also specify an examination to determine the extent of the tumour, using different imaging methods.

OUR SPECIFIC AREAS

To provide the high level of skill and performance needed by the multidisciplinary team caring for our patients, we have a technical centre fully equipped with thoroughly modern apparatus. The imaging specialist group working in this unit is constantly learning, as knowledge and techniques are evolving very fast indeed. Our image archiving system, which contains the patient’s entire history, is also worthy of note. Comparisons can be made between pictures taken at various stages in the disease, for example, to assess effects of treatment.

For radiologists, as for all other medical specialists confronted with cancer, high levels of skill and a team spirit within a multidisciplinary team are essential prerequisites. All radiologists specialise in specific organs, of which they have an in-depth knowledge and to which they dedicate most of their working time.

OTHER CONTRIBUTIONS MADE BY RADIOLOGY

Data obtained from examinations carried out using MRI, CT-scan or PET-CT may be used for planning radiotherapy treatment. In fact, these examinations give an idea on the size and contours of the tumour and of involvement of ganglia. Radiotherapists can thus produce dose profiles in order to treat targeted tumours better.

Radiology can also be used as a means of radio frequency guidance, a technique involving introduction of a probe into affected organs with the aim of eradicating a tumour.