Medical Oncologists play a major role in cancer care, managing treatment plans and therapies, and monitoring and evaluating progress. They consult with patients regarding choices and any temporary side effects one may experience during treatments. Treatments can include:

Chemotherapy
Chemotherapy treats cancerous diseases with drugs that interfere with cancer cell growth and reproduction. Because the cancer-fighting drugs circulate in a patient’s blood, they can kill or eliminate cancer cells that may have spread to other parts of the body far away from the original tumor. Our medical oncologists and oncology nurses work closely with highly-trained pharmacists to manage dosages and to monitor patient progress to ensure the best formulas and treatment plans to fight specific diseases.

Immunotherapy
Immunotherapy is the use of treatments that promote or support the body’s immune system response to a disease such as cancer. Examples include Interferon, Interleukin and Vaccines.

Targeted Therapy
Targeted therapy is the use of genetically engineered agents specific to cancer cell receptors that interrupt processes that allow cancer cells to grow/spread. Examples include agents ending with "nib" or "mab."

Hormone Therapy
Hormone therapy is treatment with hormones, drugs that interfere with hormone production or hormone action, or surgical removal of hormone-producing glands to kill cancer cells or slow their growth.

Most women are at risk for developing a gynecologic cancer. Because early detection is vital to the success of treatment and the prevention of further development of the disease, annual PAP and pelvic exams, in conjunction with sharing information about risk factors, are the first lines of defense.

Women diagnosed with cancer of the female reproductive tract want advanced care from physicians who focus on gynecologic cancer. VOA’s Gynecologic Oncologists specialize in cancers of the female organs. We treat cancer in the breast, ovaries, endometrium, cervix, vulva and vagina.

We are dedicated to providing women battling cancer with advanced and personalized care. There are many treatment options for gynecologic cancer, including surgery, radiation therapy and chemotherapy. With a unique depth of experience, expertise and access to progressive treatment options, we can develop and implement the best treatment plan for each patient.

Today’s radiation therapy is quicker, safer and more precise than ever before. Our Radiation Oncology team uses the most advanced treatment planning systems. State-of-the-art radiation technology is used to deliver internal and external radiation to cancerous cells, which prevents them from growing or dividing. Whether treatment plans include INTRABEAM™, Intensity Modulated Radiation Therapy (IMRT), 3-D Radiation Therapy, or High Dose Rate (HDR) brachytherapy, patients can receive radiation therapy at our Lake Wright, Princess Anne, Obici, Hampton and Elizabeth City locations.

Most importantly, VOA provides world-class cancer care because our team is staffed by highly-skilled and caring professionals who understand the special needs of cancer patients and their families. Our Radiation Oncologists are board-certified and have many years of training and experience caring for cancer patients. They are leaders in the development of new approaches to cancer care, and are supported by friendly and knowledgeable nurses, radiation therapists, dosimetrists, physicists, pharmacists, counselors and other specialists who work together to coordinate complete and compassionate care.

INTRABEAM™
INTRABEAM™ is a simple device, in essence a miniature beam-driven X-ray source, which provides low-energy X-rays at the tip of a 3.2mm diameter tube. The radiation source can be inserted into the area of interest immediately after tumor is removed to provide Intra-operative Radiotherapy (IORT), accurately targeted to the tissues that are at highest risk of local recurrence. The physics, dosimetry and early clinical applications of this soft x-ray device have been well studied and the probe has already been used for treatment of human malignant brain tumors.

IMRT
Intensity Modulated Radiation Therapy (IMRT) is an advanced form of radiation treatment that allows radiation oncologists to precisely target tumor cells. It is a noninvasive therapy that uses Computed Tomography (CT) and often other imaging techniques to build three-dimensional diagnostic images and support treatment planning to deliver tightly-focused radiation beams of varying intensity to cancerous tumors without needles, tubes or catheters. By varying the intensity of these beams, physicians are able to maximize dosage to the tumor and to minimize the amount of radiation distributed to the surrounding healthy tissues.

IGRT
Image-Guided Radiation Therapy (IGRT) combines a new form of scanning technology with the control of IMRT to pinpoint and treat cancerous tumors with varying amounts of radiation. Using imaging modalities to precisely localize the tumor each day adds safety and accuracy.

HDR
High Dose Rate (HDR) brachytherapy is an advanced treatment that allows physicians to directly deliver precise radiation treatment to a patient’s cancerous tumors through the use of catheters, thin flexible needles, or applicators inserted into a body cavity or directly into the tissue. It is frequently used in the treatment of cervical and uterine cancers, intraluminal treatment of certain lung cancers causing bronchial obstructions, and obstructing esophageal cancers. It has also recently been shown to be effective for the treatment of early stage prostate cancer.

SEED BRACHYTHERAPY
Seed Brachytherapy is a one-time, minimally invasive procedure usually performed in an outpatient setting. The procedure involves the placement of tiny seeds that contain a radioactive isotope inside the prostate via the guidance of ultrasonic equipment. Patients are given local or general anesthesia to block pain and help with relaxation. On average the treatment takes just under one hour from start to finish. Data show shorter recovery time, fewer long-term complications and excellent long-term survival rates.

At VOA, Hematology is a top priority. We deliver high quality patient care, research, and leading-edge treatment for our hematology patients with either malignant or benign diseases of the blood. Twenty of our physicians are board certified hematologists, caring for patients with blood disorders. As such, we can offer patients care in two major realms of medicine, which are closely related. Many cancer patients develop reduced red blood cell counts, or anemia. If patients are symptomatic with anemia, VOA physicians are experienced and trained to treat it. We serve Hampton Roads communities to improve the quality of life of patients with immunologic disorders, hypercoagulable states (blood clots), coagulative disorders, such as hemophilia or Von Willebrand’s disease, as well as blood and bone marrow problems.

On average, our physicians treat approximately 8,500 patients with hematological disorders annually - 11% leukemia & lymphoma, 64% anemia, 10% hypercoagulable states, 15% bleeding disorders. Comparative to academic institutions, like Duke University, these numbers are impressive! Participation in annual hematology meetings and continuing medical education (CME) activities, as well as ongoing training and mentorship, helps VOA physicians maintain the cutting edge and use of advanced tests and treatments. VOA physicians partner with Eastern Virginia Medical School (EVMS) to assist in the education of young doctors in the field of Hematology via classroom lectures and on-the-job training in the office/hospital. VOA also works closely with the Children’s Hospital Kings Daughters (CHKD) hematology program, allowing children the best continuity of care as they move from a pediatric to an adult hematologist.

Oncology Clinical Nurses (OCNs) possess indepth expertise in oncology nursing and on the human needs of people experiencing cancer. The practice of oncology clinical nursing extends to all settings where patients receive health care, education, and counseling for cancer prevention, screening and detection.

OCNs are adept with patient assessments, anticipating complications, monitoring progress, interpreting clinical signs and observations, and minimizing side effects. OCNs have well-developed technical skills in the delivery of chemotherapies, the care of radiotherapy patients, and in the management of central venous access devices.

At VOA, OCNs know the purpose of all treatments: curative, palliative, and adjuvant. They know the principles of staging, as well as common sites for metastatic disease. Moreover, they believe in being there, caring holistically for all parts of the patient.

Clinical trials are an important step in finding new and better ways of treating cancer. VOA is dedicated to advancing cancer care by leading and participating in many clinical trials that test the safety and efficiency of new or modified treatments in cancer patients. These trials are important because they help uncover new treatment options, and give many of our patients the opportunity to receive newly developed treatments or investigational drugs not yet available outside the study.

Today, there are more cancer therapies in development than ever before. This dramatic increase means that for many patients, there is more hope for a favorable outcome in their battle with cancer. Our progressive oncologists and research team are proud to be a part of this effort, providing access to the latest therapies, right here in our community.

Now we are on the threshold of a new paradigm for cancer research – that of individualized treatment based on genomic and molecular predictors of an individual patient’s response. Through our collaboration with the National Cancer Institute Cooperative Groups, US Oncology, Eastern Virginia Medical School, the Duke Oncology Network, and other major cancer centers, we are investigating ways to use molecular profiling to tailor treatment management.

Targeted therapies are the direction of many major clinical trials. Such trials enable physicians to customize drug treatment for a particular cancer by focusing on a precise target at the molecular level of a patient’s tumor. The tumor is analyzed to determine how it grows and differs from other cancers in the same diagnosis.

We can quickly bring the latest advances in cancer care to our patients, and are able to provide them with access to the latest clinical trials involving new investigational cancer agents. Not only does this advance cancer treatment, but it gives many of our patients the opportunity to receive promising new therapies or investigational drugs not yet available to patients outside the studies.

See all available trials

To improve human health, scientific discoveries must be translated into practical applications. Such discoveries typically begin with basic research – in which scientists study disease at a molecular or cellular level – then progress to the clinical level and Phase I of trials.

With all that has been achieved, there are still some cancers with only a few effective treatment alternatives. For these patients, VOA is conducting Phase I trials to accelerate the development of totally new agents for cancer care. Translational research has traditionally been found only at larger academic institutions, but we proudly bring it to Hampton Roads communities.

VOA is one of twelve Translational Oncology Program (TOP) sites within the US Oncology Research network participating in leading-edge Phase I clinical trials. VOA’s TOP has dramatically expanded during the past several years, accruing the most new patients in the network for investigational studies. At any given time, approximately 10 Phase I trials are available to patients.

See all available trials

VOA’s autologous stem cell transplant program is on of three in the state of Virginia and 135 nationally. Sanctioned through the Foundation for the Accreditation of Cellular Therapy (FACT), the program adheres to the most stringent clinical standards. FACT accreditation is the gold standard insurance companies often demand. It is the benchmark for quality care.

Autologous transplants, like those performed at VOA, involve the harvesting of patients’ stem cells, cryopreserving (freezing) them, and then returning the cells to the patient after highdose chemotherapy. Transplants are typically used to treat Hodgkin’s disease, lymphomas, multiple myeloma, and some types of leukemia.

Diagnostic imaging tests and scans are vital in accurately diagnosing and staging cancer as well as tracking the progress of treatment. Our in-office imaging center provides advanced imaging services, making access to tests and scans convenient for patients.

Nuclear medicine is a specialty, which uses safe, painless techniques both to image the body and treat disease. Nuclear medicine is unique in that it documents organ function and structure. In contrast, other diagnostic imaging modalities are based on anatomy. We are able to gather information that may otherwise be unavailable, require surgery or necessitate more expensive testing.

Nuclear medicine is an integral part of patient care. It is used in the diagnosis, management, treatment and prevention of serious disease. Nuclear medicine imaging often identifies abnormalities very early in the progression of a disease – long before some medical problems are apparent with other diagnostic tests. This early detection allows a disease to be treated early in its course when there may be a more successful prognosis.

Nuclear medicine uses very small amounts of radioactive materials, or radiopharmaceuticals, to diagnose and treat disease. Radiopharmaceuticals are introduced into the body by injection, inhalation or ingestion. Once in the body they are attracted to specific organs or disease processes. A special type of camera, a gamma camera, is used to take a picture. This picture provides valuable information for your doctor to use in the management of your care.

Nuclear medicine procedures are among the safest diagnostic imaging exams available. A patient only receives an extremely small amount of radiopharmaceutical, just enough to provide sufficient diagnostic information. In fact, the amount of radiation from a nuclear medicine procedure is comparable to or often times less than that of a diagnostic x-ray.

Frequently Performed Examinations

• Bone scans – examines presence of tumors and unexplained bone pain
• Heart scans – analyzes heart function, ensures function in maintained
• Breast scans – in conjunction with mammograms, locates cancerous tissue
• Liver/Spleen scans – analyzes liver/spleen function
• Octreoscans – detects presence and location of tumors
• Gallium scans – analyzes thyroid function, shows gland structure
• Lung scans – evaluates blood flow and movement of air into/out of lungs, identifies clotting

Diagnostic medical ultrasound is a procedure that uses high frequency sound waves (ultrasound) to produce dynamic images (or sonograms) of organs, tissues, or blood flow inside the body. This procedure is often referred to as an ultrasound scan or ultrasound examination. Diagnostic medical ultrasound is used to examine many parts of the body, such as the abdomen, breast, reproductive system, heart, and blood vessels.

An ultrasound examination involves using an instrument called a transducer. The transducer works like a loudspeaker and microphone because it can transmit and receive sound. The transducer sends a stream of high frequency sounds waves into the body and detects their echoes as they bounce off internal structures. Different structures in the body reflect these sound waves differently. A computer translates this information to generate images of the structure(s) on a computer monitor.

There are several areas of specialization in the field of diagnostic medical ultrasound, including vascular ultrasound. Vascular ultrasound is of primary interest to oncologists because cancer patients are at greater risk for developing blood clots while undergoing treatment.

At VOA, a highly skilled, ARDMS-certified sonographer performs all ultrasound examinations using specialized equipment to produce high-quality images. After examination, the sonographer reviews the images and the patient’s history with a physician trained in the interpretation of ultrasound.

Several methods are available to measure bone density, but currently the most widely used technique is DEXA (Dual Energy Xray Absorptiometry). This is the method used to determine efficacy in the recent large clinical trials, and to characterize fracture risk in large epidemiological studies. Older methods such as single photon absorptiometry do not predict hip fractures as well as DEXA. Three companies manufacture these densitometers: Hologic, Norland, and Lunar.

Newer techniques, such as ultrasound, appear to offer a more cost-effective method of screening bone mass. Ultrasound measurements are usually performed at the calcaneous and it is not possible to measure sites of osteoporotic fracture such as the hip or spine. Adding an ultrasound measurement to a DEXA does not improve the prediction of fractures. Although some have said that ultrasound measures the "quality" of bone, more careful studies suggest that it mainly measures the bone mass.

Several techniques can measure bone density at the hand, radius or ankle. These include single energy absorptiometry, metacarpal width or density from hand xrays. Magnetic resonance imaging is a new method of measuring bone density.

Our primary mission is to provide our patients with access to advanced, high quality cancer care. To that end, we have taken extraordinary steps to assure that our pharmacy meets, and exceeds, the highest quality standards in the country.

Electronic Medical Records
We have an electronic medical record (EMR) system, in which all patient orders are written and retained. In the EMR, we maintain a fully referenced, up-to-date library of the latest regimens for the treatment of cancer. From that library, physician orders are selected and printed so that no opportunity exists for mistakes or misinterpretations of handwriting.

Environmental Controls
In the facilities where chemotherapy is prepared, environmental controls provide for a pressure gradient designed to assure sterility of intravenous doses. Chemotherapy preparation adheres to the standards set by the US compendia. Clinical staff who prepare chemotherapy are certified annually in the safe handling and aseptic preparation of chemotherapy. Every step in preparing a dose is double-checked by a second clinician.

Drug Authenticity
We have taken significant steps to assure the authenticity of the drugs we provide. Today, drug counterfeiting is a growing concern, and it has affected some of the largest drug suppliers in the country. Oncology pharmaceuticals are a prime target due to their high prices and, in fact, have been the subject of several counterfeiting incidents. We take this issue very seriously. As a member of the US Oncology network, we were able to contribute to the development of a state-of- the-art distribution center that utilizes sophisticated e-pedigree technology to efficiently and securely scan and track, from the doors of the manufacturer to the patient, every drug that comes into our practice.

We are able to view, in real-time, the pedigree information for each drug we order, throughout the supply chain, and verify the drug has not been altered. The innovation and sophistication of this distribution system has also been recognized by the National Association of the Board of Pharmacy. Our distribution system was one of the first two to earn the coveted Verified-Accredited Wholesale Distributors (VAWD) accreditation.

Laboratory testing is a key component of detection, diagnosis and treatment of cancer. Our in-house laboratory provides quick results for many routine tests, helping physicians prescribe the appropriate treatments as soon as possible. Testing that does require processing at an outside laboratory will be reviewed by our physicians as soon as the results are available.

The National Cancer Institute defines a Tumor Board as a treatment planning approach in which a number of doctors who are experts in different specialties review and discuss the medical condition and treatment options of a patient. In cancer treatment, a Tumor Board review may include that of a medical oncologist (a doctor who provides cancer treatment with drugs), a surgical oncologist (a doctor who provides cancer treatment with surgery), and a radiation oncologist (a doctor who provides cancer treatment with radiation). The ultimate goal of the Tumor Board is to review and discuss a patient's medical condition and to identify the best possible treatment plans available. Ultimately, the physician who presents his or her patient's circumstances to the Tumor Board can share that information with the patient and develop a suitable treatment plan.

Every week, VOA hosts Tumor Board meetings, during which local clinicians discuss several complex cancer cases. Our Tumor Boards provide multidisciplinary care perspectives for patients with an emphasis on new developments in treatment and participation in clinical trials. They also provide a forum to educate physicians, fellows, residents, nurses and other healthcare providers and to share relevant research findings.

During Tumor Boards, facts about a case are presented, which opens the discussion among diagnostic radiology, medical, radiation, and surgical oncology teams. Pathologists (doctors who specialize in interpreting laboratory tests and evaluate cells, tissues, and organs to diagnose disease) may also be present to help round out the discussion.

Questions patients might ask their physician regarding Tumor Boards:

• How many physicians are on your Tumor Board, and do they represent the expert opinions one would seek at your hospital?
• Did my situation bring up widely differing opinions among members of the Tumor Board?
• Was a clinical trial suggested?
• Did the Tumor Board feel that there was enough information presented at the meeting upon which to draw conclusions regarding treatment?
• Did anyone recommend that more diagnostic imaging be performed, or that more tissue samples be obtained for analysis?
• Should I seek a second opinion at a major medical center?
• How soon should I start treatment?

Some people are at higher risk of developing certain types of cancer because they have an inherited gene condition. Understanding your risk of developing cancer can be an important step in making decisions around cancer prevention or about getting regular screenings that can detect cancer early, when it is most treatable.

Genetic Counseling
VOA provides advanced medical and support services, including genetic counseling, for people diagnosed with cancer, as well as those with a high risk of developing cancer. Through genetic counseling, we can help you learn about your inherited risk of developing cancers, such as breast, gastrointestinal, uterine/ovarian and others.

Genetic Testing
Although we cannot predict whether a patient will actually develop cancer, genetic testing is available to identify those at an increased risk due to hereditary predisposition. Patients with a gene mutation may be at higher risk of developing cancer. Genetic testing will allow the patient and their physician to make changes in medical management and surveillance. In addition, genetic
testing may alleviate the need for increased surveillance for some patients.

Our board-certified genetic counselor are trained to navigate the testing process for patients considering genetic testing. During the testing process, we offer support to patients and their families as they are often faced with difficult decisions regarding prevention and treatment options. Deciding whether or not to have genetic testing is a personal choice that can be made at the time of the counseling session or at a future date.

As part of our integrated cancer care team, our counselor will provide information and support to patients and their families through:

• Education about how genetics plays a part in cancer risk
• Assessment of the risk of a genetic disorder by researching family history and evaluating medical records
• Discussion of the medical, social and ethical impact of genetic testing
• Interpretation of genetic testing results and medical data
• Explanation of possible treatments or preventive measures

Is genetic counseling/testing the right choice?

There are several available strategies that reduce the risk of cancer and increase the chances for early detection. Genetic testing may be considered if patients’ personal and/or family history is consistent with a hereditary pattern of cancer.

What to expect
The initial appointment at VOA involves a consult with a medical oncologist. This brief appointment often entails a review of the patient’s personal and family history of cancer, a physical, and recommendations regarding a meeting with the genetic counselor. The medical oncologist will assist in making final recommendations regarding screening and management.

Next, a visit with the genetic counselor is scheduled. This 60- to 90-minute session focuses on questions and concerns pertaining to the patient’s risk for cancer. The genetic counselor will present complex scientific concepts in terms the patient can understand. The goal of cancer genetic counseling is to provide clear and clinically relevant information about genetic risk factors in a supportive
and comfortable environment. If testing is ordered during the initial consult, you can expect to return for a post-test session to review results and recommendations with the genetic counselor.

Genetic Discrimination Concerns

Insurance discrimination concerns may also be addressed. HIPAA and GINA (Genetic Information Nondiscrimination Act of 2008) protect individuals from health insurance discrimination based on genetic test results. If genetic testing is pursued, the genetic counselor will assist with requesting insurance coverage.

One in ten American households now includes a family member who has been diagnosed or treated for cancer within the past five years.

Psychosocial care is comprised of two primary areas – psychological (emotional) and social (resources, support groups). VOA’s program focuses on the patient, before, during and after treatment. Our Licensed Clinical Social Worker (LCSW), who specializes in Oncology Social Work, addresses patients’ psychosocial issues to help alleviate the overall anxiety and/or emotional distress associated with a diagnosis, treatment, survivorship and/or end of life. Because anxiety and emotional distress can lead to depression and fatigue, it is imperative for patients to process information and resolve issues. Addressing such components provides patients the opportunity to more effectively manage their illness and experience a better quality of life.

VOA’s Psychosocial Oncology services are an extension of our compassionate treatment protocols, and are intended to provide coping skills, strengthen stress-management skills, and ultimately, provide links to community resources to support treatment, survivorship and bereavement needs. They are available to patients, families and caregivers throughout all phases of treatment, and are offered in individual, family and group settings.

Additionally, our social worker connects patients to services and resources in our communities, such as disability, supplemental Medicaid programs and medication assistance programs.

Our patients are not alone. Battling cancer is a big enough challenge. We are with them every step of the way offering a range of psychosocial and specialty support services.

Our team can provide patients with:

Supportive Counseling to...

• process emotions involving illness and treatment
• provide useful tools to help deflect symptoms of anxiety and depression
• address relationship & caregiver concerns
• support bereavement needs (including family members and friends)
• develop coping strategies

Assistance with...

• management of overall health and illness
• bridging the gap between inpatient and outpatient needs
• stress management & decision making skills
• the completion of the advance directives & power of attorney
• community resource identification and management

The financial aspect of dealing with cancer can be complex and overwhelming. All VOA locations have a Patient Benefit Representative (PBR) who is dedicated to serving the individual needs of every patient. PBRs are an extension of our Business Office and provide guidance through financial issues, and they are available to address patients’ questions and concerns about the cost of treatment and handle insurance inquiries and verifications. For patients whose insurance coverage is inadequate or if the insurance company chooses not to cover services, our PBRs can help identify assistance programs that may help in meeting financial obligations.

As a courtesy to patients, our business office bills all primary and secondary insurances. Each patient is also assigned an Insurance Specialist at the CBO for billing and claims processing concerns. 

VOA participates with over 20 insurance companies, including all major payers. For a list of participating insurances, view our Health Plans page.

Understanding the disease and having the latest information on treatments helps patients succeed. Our cancer care specialists have extensive knowledge of cancer-related challenges and vast information resources about cancer and the treatments. We will help connect patients and their families with the services and programs they need—many of which are offered within our cancer center.

For patients with incurable illnesses, we offer palliative care to maximize the quality of a patient’s life through pain control, breathing and overall comfort. Hospice care is an important part of palliative care and is carefully coordinated by a patient’s physicians and nurses, medical directors, hospice nurses, social workers, clergy and volunteers.

The focus of hospice is maintaining the comfort and quality of life for patients up to the time of death, and providing support for the family during and after a patient’s illness.

We recognize patients’ needs for sharing ideas and experiences in order to draw strength from others facing the same challenges. Our Licensed Clinical Social Worker isavailable to provide emotional guidance for you and your family through individual counseling and support groups. Sharing experiences, feelings, or ideas and drawing strength from others facing the same challenges others might encounter can be a valuable resource. At VOA, we also provide you and your family access to numerous local and nationwide support programs that can provide information, guidance, and an unparalleled understanding of living through cancer.

Are you looking for a forum to express your thoughts and feelings about cancer?

Join us for a Support Group Meeting

VOA hosts monthly General Cancer Support Groups every third week of each month at two locations.

• Lake Wright, Norfolk – Wednesday
• Hampton – Thursday

For more information, please contact Myra Green: (757) 873-9400

Do you have a BRCA gene mutation? Are you looking for a place to meet others with BRCA gene mutations?

Join us for a Hereditary Breast & Ovarian Cancer (HBOC) Resource Group Meeting

A Resource Group for Breast & Ovarian Cancer Previvors & Survivors

HBOC resource group was created especially for patients with hereditary breast and ovarian cancer syndrome. During our meetings, we invite local experts to speak on topics ranging from genetics, nutrition, family support, surveillance, and surgery.

We can help provide answers or recommendations to the following questions:

• What’s next after I receive my genetic test results?
• Who do I tell about my genetic results?
• Should I undergo increased surveillance or do I choose surgery?
• When do I start…Where should I start?
• Does my diet play a role, are there certain foods I should eat…certain foods I should avoid??
• What happens when I enter menopause?
• Is IVF an option for me?
• What are my options for breast reconstruction?

Location:
Virginia Oncology Associates, Lake Wright, Multimedia Room (3rd Floor)

Time:
6:00 PM -8:00 PM

Light refreshments are provided.

Full schedule