Oncology

Ospedale San Raffaele

The San Raffaele Research Hospital is one of the top list hospitals for cancer care in the nation and is an active part of a world-broad network against cancer. This is possible because patient care is always its top priority and because it is a Hospital known as one of the top facilities in the nation, also in other medical fields, thus offering highly specialized professional and holistic approaches and global care for its patients. The doctors have great expertise in diagnosing and treating all types of cancers, but in treatment of specific cancers they may offer largely unparalleled opportunities. All the latest technology and the most innovative, advanced therapies are used to increase the chances for cure. The close collaboration between doctors and clinical research scientists involved in the cure of cancer patients also means that new drugs and therapies can be moved quickly to the bedside, offering patients improved treatment options.

The Department’s mission is that of providing Individualized expert treatment. This is achieved through Iinterdisciplinary discussions for optimal therapeutic management in the context of Disease-specific Units. The Institution is recognized as a National Research Institute with a specific mission to promote Molecular Medicine.

Therefore, it is believed that each patient is unique and each type of cancer is different. There is always a suitable treatment for every patient and the team of experts have to assure that the treatment recommended at the Hospital is the most accurate. 

Getting the Correct Diagnosis and Treatment depends on personnel expertise and the Department may offer that. It has a unified approach to care: a team of doctors with different complementary specialties work together to guide each patient through diagnosis, treatment, and recovery. Thus, the treatment plans reflect the combined expertise of many ultra-specialized doctors — surgeons, medical oncologists, radiologists, radiation oncologists, pathologists, internal medicine specialist and cardiologist. Multidisciplinary approach is applied when dealing with the malignancies of the Breast, Lung, Gastrointestinal (oesophageal, gastric and colon), Genitourinary (kidney, testicular and bladder), Gynaecologic Oncology that reach between 800-1000 new cases per year. It is worth highlighting the expertise in Pancreatic cancer (national expert centre) and particular focus on Biliary tract, Liver, Brain, Otolaryngology-Head and Neck (ear, nose, throat, thyroid) malignancies, Cutaneous and Uveal Melanoma, Neuroendocrine tumours and Mesothelioma which notably requires highly specialized skills, advanced technologies and long-term experience.

In each disease-specific Unit, a group of Physicians is dedicated to the treatment and follow-up of patients according to guidelines or to approved protocols for experimental treatment.

The teams have an in-depth, documented and ultra-specialized experience. This approach also ensures that patients who need several different therapies to treat their cancer will receive the ideal combination. Considering that in the hospital there are several other areas of expertise in a wide range of medical fields, such as cardiovascular/ neurology/ infective disorders/ immunological disorders and so on, the team is able to offer the best suitable therapy also for the patients with different comorbidities that might be seen as an obstacle to cancer care.

Moreover, the medical oncologists are leaders in developing new chemotherapy, immunotherapy and bio-targeted agents that are safer and more effective than standard therapies. They can also help patients manage the side effects of chemotherapy so that patients can lead relatively normal lives while receiving any cancer specific therapy. Increasingly, the medical oncologists employ sophisticated technologies, such as immunotherapies and recently developed bio target-oriented agents also in combination with chemotherapy, to more effectively treat cancer.

The nurses work together with the doctors and are an essential part of the healthcare team. Their support, encouragement, and deep sense of caring bring tremendous comfort to patients and their loved ones. The Department’s specially trained oncology nurses care for patients before, during, and after surgery; help manage clinical trials, and educate patients about what to expect when they go home from the hospital. They also communicate with family members to address their needs and concerns. To help ensure a continuum of care, patients are typically cared for by the same nurses throughout their stay.

Genetic Counseling, Controlling Cancer Pain and Psychologic Support

The San Raffaele Hospital has notable activity on genetic analysis and counseling to evaluate, diagnose and support high-risk individuals. This activity is considered extremely important for patients and their families.      

The psychological effects of genetic counseling or cancer diagnosis can be overwhelming. Therefore, the Department has a specially trained psychiatrists and psychologists who can help individuals considered at risk or cancer patients and families deal with the stress, anxiety, and depression that can accompany a diagnosis of cancer and its treatment. Easing patients' distress can greatly improve the quality of their lives.

At the Institute, it is strongly believed that no cancer patient should suffer unmanageable cancer pain. The pain experts continue the use of new drugs and novel methods of drug delivery. There is a center-wide program to ensure that patients who have pain are identified and treated appropriately and effectively.

INNOVATIVE THERAPIES AND RESEARCH

Innovative strategies aimed to improve care of cancer patients are still urgently needed in the areas of diagnosis, tumour biology knowledge, patient risk stratification and treatment. The Department is committed to conduct studies involved in new drugs development including Phase I studies and it cooperates with teams of laboratory researchers at national and international level with the aim of identifying molecular prognostic or predictive biomarkers in biological material to better address personalised therapies. In all these fields they have already reached relevant results. A number of new trials are open to investigate the role the most advanced agents in cancer field. They have already generated analyses of gene expression profiles derived from archived tumour biopsies of patients. New treatment strategies examples being immunotherapy, antibody-based treatments, anti-angiogenesis and anti-vascular therapies, and the use of tomotherapy in specific types of cancer is routinely performed. All this research efforts are recognised at a national and international level thought the routine presentations of their research production on national and World relevant Congresses.

 

treatmentS

Colon-rectum-hepatocellular & Unknown Primary Cancer Area

The progress of knowledge in this field is very rapid and this requires an internal organization based on a multidisciplinary comparison consistent with the goal of adopting shared operational guidelines. For this reason, and to respond to the clinical needs of a growing number of patients with these pathologies, a multidisciplinary approach has been developed. This Unit’s group is national referral centre for hepatocarcinoma.

Main Tumours Treated:

  • Anal cancer
  • Carcinoma of unknown primary
  • Colon cancer
  • Hepatocellular (liver) cancer
  • Rectal cancer

Top Treatments:

  • Chemotherapy, targeted agents

Biliary Duct and Gallbladder Cancer Area

Cancers of the bile duct and of the gallbladder are rare types of tumours that often require a multidisciplinary approach to treat the disease or relieve the symptoms caused by the disease.

Our centre is a national referral centre for biliary duct cancer and the therapeutic and diagnostic approaches are discussed by a multidisciplinary team including oncologists, radiologists, radiotherapists, pathologists and endoscopists.

Main Tumours Treated:

  • Bile duct cancer
  • Gallbladder cancer

Top treatments:

  • Chemotherapy

Genito-urinary Cancer Area

The genitourinary tract is a composite system that includes kidneys, ureters, bladder, urethra and, in men, testicles and prostate. Different types of cancer can arise from each one of these organs and each one deserves a distinct diagnostic and therapeutic approach. Multidisciplinarity is therefore a cardinal requisite and a specialized dedicated team, including oncologists, pathologists, radiologists, radiotherapists and surgeons, works in concert to grant the best possible outcome for each patient.

Main Tumours Treated:

  • Bladder cancer
  • Extragonadal germ cell tumours
  • Kidney (renal cell) cancer
  • Transitional cell cancer of the renal pelvis and ureter
  • Penile cancer
  • Prostate cancer
  • Testicular cancer
  • Urethral cancer

Top Treatments:

  • Chemotherapy
  • Immunotherapy
  • Hormonal therapy
  • Targeted agents

Central Nervous System Cancer Area

Due to the peculiar localization of these types of tumours and the complexity of the central nervous system a multidisciplinary approach is always crucial to attain the best possible outcome. Therefore, the Unit’s oncologists work inside a team including neurosurgeons, neurologists, pathologists, radiologists and radiotherapists.

The medical team in the last twenty years has been involved in clinical research on malignant brain malignancies through the promotion and participation in dedicated clinical trials, to explore the adoption of new therapeutic strategies and the use of new drugs, through close collaboration with the "brain tumour group" of the European organization for research and treatment of cancer (EORTC) and the Italian cooperative group of neuro-oncology (GICNO).

Main Tumours Treated:

  • Brain tumours of the adult
  • Pituitary tumours

Top treatments:

  • Chemotherapy
  • Targeted agents

Breast cancer area

Breast cancer oncologists work inside San Raffaele’s breast Unit to offer a multidisciplinary and multi-professional approach for the cure and care of patient affected by breast cancer. Medical oncologists work closely to dedicated surgeons, radiotherapists, radiologists, nuclear medicine physicians, gynaecologists, endocrinologists, plastic surgeons, physiotherapists, geneticists and psychologists to ensure breast cancer patients fast diagnosis, rapid implementation of surgical and medical treatments and the highest quality level of care at all stages of the disease.

Main Tumours Treated:

  • Female breast cancer
  • Male breast cancer

Top Treatments:

  • Chemotherapy
  • Hormonal therapy
  • Targeted agents

Gastric and Oesophageal Cancer Area

The group of medical oncologists dedicated to this type of neoplasm collaborates with colleagues from other operative Units (including pathologists, radiologists, radiotherapists and endoscopists) within a multidisciplinary team in order to define the best diagnostic and therapeutic approach and with particular regard to the most update national and international guidelines and scientific evidence available in the literature. The multidisciplinary team including oncologists, pathologists, radiologists, radiotherapists and surgeons.

The group also participates in international clinical trials focusing more and more on the use of molecular target drugs for patients with adenocarcinoma of the stomach, oesophagus and gastro-oesophageal junction.

Main Tumours Treated:

  • Gastric cancer
  • Oesophageal cancer
  • Gastrooesophageal junction cancer
  • Gastrointestinal carcinoid tumours
  • Gastrointestinal stromal tumours
  • Small intestine cancer

Top Treatments:

  • Chemotherapy
  • Targeted agents

Head and Neck Cancer Area

More than 100 patients with oncological therapies are treated every year at the institute. The oncological, surgical and/or radiotherapy approaches are discussed and decided among a multidisciplinary team, composed not only by oncologists, surgeons and radiotherapists but also by radiologists, pathologists, nuclear doctors, pain therapists, palliativists, nutritionists, internal medicine specialists, endocrinologists, dentists, physiotherapists, geriatrists, psychologists and endocrinologists that cooperates at the management of head and neck cancer patients and meet at least once per week.

Main Tumours Treated:

  • Nasopharynx
  • Hypopharynx
  • Larynx
  • Oropharynx
  • Oral cavity
  • Thyroid
  • Salivary glands
  • Paranasal sinuses

Top Treatments:

  • Chemotherapy
  • Immunotherapy
  • Biological therapy

Melanoma and Non-melanoma Skin Cancer Area

Approximately 120 patients with a diagnosis of melanoma have access to the hospital every year. The therapeutic and diagnostic approaches are discussed weekly by multidisciplinary team, including oncologists, pathologists, radiologists, radiotherapists and surgeons.

Main tumours treated:

  • Melanoma
  • Skin cancers, non-melanoma
  • Intraocular (eye) melanoma
  • Merkel cell carcinoma

Top treatments:

  • Chemotherapy
  • Immunotherapy
  • Targeted agents

Pancreatic Cancer Area

Our group is involved in several investigator-initiative or industry sponsored clinical trials addressing the role of new antineoplastic drugs and novel treatment strategies; cooperates with biotechnology department in translational research; coordinates the Italian association of medical oncology (AIOM) guidelines and is one of the most important Italian centres for cure of pancreatic cancer thanks to the highly qualified multidisciplinary team.

Main Tumours Treated:

  • Pancreatic cancer
  • Islet cell tumours, pancreatic neuroendocrine tumours

Top Treatments:

  • Chemotherapy

Lung and Thoracic Cancer Area

For more than 20 years the Unit’s working group is dedicated to patients suffering from thoracic cancer which offers innovative diagnostics, broad molecular profiling and therapeutic opportunities (personalized therapies, biological, immunotherapy, antiangiogenic and chemotherapy of new generations). The deep knowledge of the pathology and the specific needs of patients with lung neoplasia that requires a diagnostic/therapeutic approach in a short and coordinated way, has led the group, in close collaboration with other disciplines through multidisciplinary approaches, to define pathways that support patient journey. The group is a leader of Italian national lung program and one of the most important centres for mesothelioma.

Approximately 400 patients access the Unit every year. The therapeutic and diagnostic approaches are discussed weekly by multidisciplinary team, including oncologists, pathologists, radiologists, radiotherapists and surgeons. More than 20 clinical trials, involving the study of experimental drugs, are available. This Unit is the coordinating centre of a clinical trial, financed by the Italian ministry of health, designed with the aim to improve molecular diagnostics in the Italian research centres and to increase the therapeutic opportunities for non-small-cell lung carcinoma patients, particularly for those patients carrying molecular alterations, vulnerable to targeted inhibition.

Main Tumours Treated:

  • Nonsmall-cell lung cancer
  • Small cell lung cancer
  • Mesothelioma
  • Neuroendocrine lung tumours

Top Treatments:

  • Chemotherapy
  • Immunotherapy
  • Targeted agents

New Drugs and Innovative Medicine Area

The Phase I Unit of medical oncology was born in February 2011, as a program for the development of new drugs and innovative therapies in adult patients with solid neoplasms. The research activity takes place in the following areas: develop new drugs, transferring the results of basic research into the clinic, combine new drugs with conventional therapeutic strategies with the aim of improving the efficacy of treatment, offer new treatment options to patients who have exhausted conventional therapies, refused them or for which there are no proven treatments.