Central Maine Healthcare

Where You are the Center

Bridgton Hospital

Brain and Spinal Cancer

At Central Maine Healthcare we understand that a brain or spinal tumor diagnosis can be alarming. That’s why we offer the services of the cancer care team at Central Maine Comprehensive Cancer Center, an exceptionally skilled neurological oncology group to design your treatment plan and give you the best possible care, including the most effective approaches to combatting these diseases.

Brain and Spinal Tumors

A tumor is a mass of abnormal cells. These can be benign (non-cancerous) or malignant (cancerous). With most cancers, benign tumors are much less of a concern than malignant ones. Benign tumors in the brain or spine are riskier to remove, and as they grow they may begin to press on and damage normal brain tissue or spinal nerves.

Prognosis will depend on your age, the type of tumor, and its location, not by how early it is discovered. As with any disease, early detection and treatment is likely to be helpful.

Prevention

Thanks to the blood-brain barrier, our bodies protect our brains from toxins that may affect other areas, so unlike many cancers, lifestyle choices like diet and exercise appear to have little impact on prevention of brain or spinal tumors. If you’ve been exposed to radiation, this may increase your chances of contracting the disease. According to the American Cancer Society, there is no known way to protect against these tumors. The good news is that they are not common.

Detection and Diagnosis

Brain tumors are often discovered when a patient begins to have headaches, seizures or other symptoms of pressure inside the skull (also known as intracranial pressure). It’s important to note however that the majority of headaches and seizures are not caused by a brain tumor.

If you have a spinal cord tumor, symptoms may include numbness, weakness, or lack of coordination in the arms and/or legs (usually on both sides of the body), as well as bladder or bowel problems. Again, these symptoms don’t mean you have spinal cancer but if you have any of these symptoms, see your doctor promptly.

The process for detecting brain or spinal cancer starts with your doctor getting your medical history and completing a physical exam. If she discovers anything abnormal, she may refer you to a neurologist or neurosurgeon who will do a more detailed neurologic exam or other tests, which may include imaging tests like magnetic resonance imaging (MRI), computed tomography (CT) scan, positron emission tomography (PET) scan, or x-ray. These tests may show an abnormality but often they can’t tell the type of tumor. To make this determination, the doctor may recommend a biopsy, which involves removing a bit of the tumor to further test it.

Treatment

CMH is committed to providing compassionate, high-quality brain and spine care. If you are in the process of being evaluated for or have received a brain or spinal cancer diagnosis, your physician will refer you to the appropriate specialist.

Our health system offers experienced doctors who specialize in treating cancer of the brain and spine, including:

  • Radiation oncologists, who use high-energy beams or small particles to kill cancer cells
  • Medical oncologists, who administer anti-cancer drugs, usually given into a vein or taken by mouth
  • Neurosurgeons, who remove cancerous tumors, lesions and tissues

Support

Fighting cancer is a tough job and we’re here to take it on with you. Our oncology nurses and oncology social workers know your treatment plan and help you get the support you need, whether it’s educational, emotionally supportive and wellness programs at The Patrick Dempsey Center for Cancer Hope & Healing, or a place for your loved ones to rest at the Arbor House, a free residential space on the CMMC campus.

Screenings and Diagnosis

If you’re concerned you may have brain or spinal cancer, you want to know your diagnosis as soon as possible. Central Maine Healthcare understands that knowing the first step, so we strive to provide the most accurate diagnoses as quickly as possible. Our pathologists and radiologists use state-of-the-art assessments to determine the cause of your symptoms and provide the best treatment.

Screening for Brain or Spinal Cancer

Brain or spinal cancer is usually detected by the symptoms it causes, which include headaches, seizures, back pain and numbness in the limbs. While patients with these symptoms usually don’t have brain or spinal cancer, talk to your doctor promptly if you are experiencing any of them.

There are no widely recommended tests at this time that can detect brain or spinal cancer before symptoms appear. (“Screening” is the term for these types of tests.) But as with any cancer, early detection puts you at an advantage so be sure to share any and all symptoms you have with your doctor.

Diagnosis of Brain and Spinal Cancer

A number of technologies and sciences are used to help your doctor determine whether you have a tumor, whether it is benign (non-cancerous) or malignant (cancerous) and, if it is malignant, the type of cancer it may be.

A neurological exam may be ordered if you’re experiencing problems with your strength, reflexes, vision, coordination, hearing, or balance. Checking these areas helps your doctor understand more about what areas of your brain or spine may be affected.

Pathology is another tool used to understand diseases, including brain and spinal tumors. If your doctor suspects you may have one of these tumors, she may order pathology tests to examine the cells, tissues and/or fluids of your body. These samples are captured using the following techniques:

  • Blood tests
  • Resection, a technique for surgically removing areas suspected to be cancerous
  • Biopsies, which involve removing cells and tissue

Any of these tests are available onsite at Central Maine Medical Center (CMMC) although some samples are sent to an outside testing lab. Your doctor can answer any questions you have about the process and will let you know when you can expect results.

Radiology uses pain-free X-rays and other high-energy radiation to produce accurate images of internal body structures, allowing radiologists to detect the presence or absence of most tumors. CMMC’s Cynthia A. Rydholm Cancer Treatment Center is staffed with experienced radiologists who use a number of radiology scans to help doctors find the cause of your symptoms, and if it’s a tumor, determine its type and best possible treatments. Radiology testing includes:

  • X-rays
  • Computed Tomography (CT) Scans
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET)

Treatment

If you or a loved one has received a brain or spinal tumor diagnosis, we understand it can be upsetting and even frightening news. At Central Maine Healthcare (CMH), we want to provide everything we possibly can to make the treatment process reassuring. The information below is a general overview of the types of treatments your doctor may recommend, but we hope you’ll do further research, including asking your care providers any questions you have.

Surgical Oncology

A surgeon who has expertise in removing cancerous tumors, lesions and tissues from the body is known as a surgical oncologist. This is often the first step in the treatment of brain or spinal cancer and in some cases will involve removing as much of the tumor as possible without affecting normal function and then following up with radiation treatments. Used together, these treatments may control or cure many tumors.

Radiation Oncology at the Cancer Care Cancer Center

A doctor who specializes in using radiation to treat cancer is called a radiation oncologist. He or she will use high energy rays or small particles to kill cancer cells. When a tumor is on or near your spinal cord or brain, the radiation needs to be aimed very precisely to avoid damaging these important organs.

The radiation team at Central Maine Medical Center’s Cancer Care Center, will determine the best angle and the lowest possible dose of radiation, with the goal of damaging the tumor while minimizing harm to your healthy tissue. Doctors at the Cancer Care Center have advanced training and years of experience using radiation to help patients fight brain and spinal cancer.

One or more of the techniques below may be used to focus the radiation in the most therapeutic way possible:

  • IMRT (intensity-modulated radiation therapy)
  • IGRT (image-guided radiation therapy)
  • Rapid arc / VMAT (Volumetric-modulated arc therapy)
  • Hexapod table movement
  • CT simulation
  • SBRT (stereotactic body radiation therapy)
  • 3D-conformal radiation therapy

Medical Oncology

A medical oncologist treats cancer using chemotherapy, hormonal therapy and biological therapy to weaken the brain or spinal tumor. These drugs are delivered either intravenously (through a needle in the vein) or via a pill and are used to reduce a tumor’s size before surgery, to kill cancer cells remaining after surgery or radiation, or to treat tumors that have developed in other areas.

Medical oncologists undergo advanced training in the use of these drugs and create a plan to guide treatment. Patients at Central Maine Healthcare have peace of mind thanks to our relationship with the Hematology-Oncology Associates practice, which offers medical oncology specialists and a commitment to compassionate care. The practice features a state-of-the-art infusion center, as well as hydration, antibiotic, therapy and blood product transfusion services.

Bile Duct Cancer

Central Maine Healthcare works to bring the best available bile duct cancer care to our Central Maine community.

What is Bile Duct Cancer?

Your bile ducts are thin tubes that carry bile from the liver, gallbladder, and pancreas into your small intestine to help digest the fats in food. Bile duct cancer happens when cells in the bile ducts divide without stopping and spread into surrounding tissue.

Because bile duct cancer occurs deep in the body, it is difficult to detect and there are no screening tests that can find it before it produces symptoms. The good news is that it is very rare, with only 8,000 people per year diagnosed with the disease.

Detection and Diagnosis 

Symptoms of bile cancer can include pain in the belly, nausea and vomiting, fever, weakness and dark urine. But experiencing these symptoms does not mean you have the disease – it is quite rare.

If you’re concerned about your risk of bile duct cancer, you want a diagnosis or to know the disease has been ruled out quickly. Central Maine Healthcare’s cancer care team is focused on providing fast, accurate testing, along with compassionate care. 

Treatment 

Bile duct cancer is usually treated with either surgery or radiation and often with a combination of the two.

With surgery, your doctor removes as much of the cancer as possible. Sometimes all of it can be removed, curing the cancer. In other cases, the cancer is too advanced but surgery can be done to remove as much as possible in order to relieve symptoms or treat complications.

The other form of treatment is radiation, which uses high-energy rays or particles to kill cancer cells. This approach allows your doctor to try to eliminate cancer that could not be safely removed during surgery. If the cancer can’t be operated on but hasn’t spread to other parts of the body, radiation helps control the disease.

Support

Central Maine Healthcare’s cancer care team includes nurses specially trained for treating cancer patients, nurse navigators who guide patients and their loved ones to a variety of supportive resources, and oncology social workers who help you balance the demands of battling cancer with the rest of your life.

Our residential facility, Arbor House, offers patients and families bedrooms, apartments, laundry facilities and a dining room all on the Central Maine Medical Center campus.

Screening for Bile Duct Cancer 

Your bile ducts are deep inside your liver and gall bladder so detecting cancer in these areas during a physical exam is very difficult. And so far there are no reliable blood tests or other tests that can help doctors discover the disease in its early stages.

Usually bile duct cancer is discovered after tumors have grown large enough to create symptoms. One of the most common is jaundice, a yellowing of the eyes and skin, that’s caused by a blocked duct.

Other symptoms of bile duct cancer include:

  • Pain in your belly or sides, which can come from fluid buildup
  • Nausea and vomiting
  • Fever
  • Loss of appetite/weight loss
  • Weakness
  • Itching
  • Light-colored stools
  • Dark urine

It’s important to note that bile duct cancer is quite rare – only about 8,000 people per year are diagnosed with the disease – so if you’re experiencing any of these symptoms, it’s not likely you have bile duct cancer.

Diagnosis of Bile Duct Cancer

Your doctor will use a combination of methods to diagnose your condition, including:

  • Physical exam
  • Blood tests – in which blood is drawn from your body with a needle and examined in a lab
  • Endoscope ERCP spy glass cholangioscopy
  • Ultrasound – a pain-free imaging tool that uses soundwaves
  • CT scan – which uses powerful x-rays to make an image of the inside of your abdomen
  • MRI – using high powered magnets, it creates an image that a radiologist can use to detect a tumor
  • Endoscopy – lets your doctor see inside your body without surgery by using like a camera on the end of a cable. An endoscope may also be used to inject dye into your bile ducts, which will then be x-rayed in a test referred to as ERCP (endoscopic retrograde cholangiopancreatography) .
  • Laparoscopy – this requires you to be sedated as a small incision is made in your belly. Through this incision, your doctor inserts a thin tube with a light and small video camera so he can see if – and how far – the cancer has spread. This allows him to plan your surgery and treatments.

Treating Bile Duct Cancer

Bile duct cancer is usually treated with surgery, radiation or some mix of the two. Your cancer care team will develop a treatment plan based on how advanced the cancer is, whether tests indicate it can be surgically removed, how well your liver is functioning, your age and general health condition, and a host of other factors.

Surgery for Bile Duct Cancer

Because bile duct cancer is difficult to detect, it’s usually only discovered after surgery could cure the cancer. But if the results of imaging tests or earlier surgeries indicate the cancer has been caught early, a doctor may be able to remove all the cancer, plus a margin of healthy tissue around it. This is referred to as curative surgery because it usually cures the cancer.

In most other cases, the cancer is too advanced or is in a spot where surgery to completely remove the cancer would be very risky for the patient. In these situations, your doctor may consider palliative surgery, which means the procedure is done to relieve symptoms or treat complications, rather than cure the disease. Both curative and palliative surgeries are major operations that can require long recovery times, so you should be sure you’re well informed about the goals of the surgery, its risks and potential side effects.

Palliative endoscopy is often done to unblock a bile duct which can relieve any jaundice or itching that is common with bile duct cancer. While it can help the patient feel better, it is not done to eliminate or cure the cancer. In some cases, a surgeon will rely on the best information available – which may come from imaging tests and/or exploratory surgeries like laparoscopy – to plan a curative surgery but realize when the surgery begins that the cancer is too advanced or widespread to be cured. At this point, he may decide to take palliative measures.

Central Maine Medical Center patients benefit from the world-class cancer research and treatment offered by Massachusetts General Hospital thanks to our partnership with that institution. Your surgeon may consult with sub-specialists at MGH, which offers consultations, evaluations and treatment options if necessary, giving you peace of mind that you’re getting the best possible care.

Radiation for Bile Duct Cancer

Radiation therapy for bile duct cancer isn’t common and doctors disagree about how helpful it is. But your doctor may decide in your case that its benefits outweigh its costs, which can include side effects like skin redness and blistering, nausea, vomiting, diarrhea and fatigue.

There are two main types of radiation therapy for bile duct cancer:

External beam radiation therapy (EBRT) – uses high-energy rays aimed directly at the tumor in order to kill cancer cells. EBRT is the most commonly used radiation therapy for bile duct cancer patients

Brachytherapy – is also known as “internal radiation therapy.” A radiologist places small pellets of radioactive material next to or in to the tumor. Since the source of the radiation is so close, it affects the cancer without causing much harm to nearby healthy tissue.

RFA Endoscopic Treatment – Central Maine Medical Center offers these treatments at The Cynthia A. Rydholm Cancer Treatment Center, which has state-of-the-art radiation therapy services, including EBRT and brachytherapy, and is accredited by the American College of Radiology.

Chemotherapy for Bile Duct Cancer

Chemotherapy is the use of medical drugs to treat cancer. Also known as medical oncology, it involves giving these drugs in the vein (IV) or taking them by mouth. Since they go directly into the bloodstream, they reach all areas of the body.

Like radiation therapy, doctors may not agree on whether chemotherapy is helpful for bile duct cancer. Still, your physician may decide it is useful for your case.

Chemotherapy may be used in one or a combination of several ways to treat bile duct cancer:

  • To shrink tumors before surgery to make them smaller and easier to remove
  • To lessen the odds that cancer will return after surgery has removed the tumors
  • To help people whose cancer can’t be operated on to live longer
  • To slow the growth of or reduce the size of tumors that are creating painful symptoms by pressing on nerves.

Central Maine Comprehensive Cancer Center offers our cancer patients who need medical oncologists the services of Hematology-Oncology Associates practice, which is committed to offering the most current, individualized, compassionate and convenient care for cancer patients and their families.

Cancers We Treat

At Central Maine Healthcare, our cancer care experts specialize in the prevention, early detection and treatment of a wide range of cancers, from the common to the complex.

We understand that no two cancers – and no two people – are the same. Our care focuses on your individual needs—physical, emotional and spiritual.

At every step, you’ll have our dedicated cancer care team by your side, including some of central Maine’s leading medical oncologists, hematologists, cancer surgeons, specially trained nurses and more. These specialists will work closely together and with you to create a personalized plan to wellness and are always available to provide compassionate care for you and your loved ones.

We offer a full range of cancer support services for the whole family, including one-on-one counseling with LCSW’s, dietitians, and therapists, plus ongoing support groups and wellness resources.

Exceptional Cancer Care, Close to Home

Doctors, nurses, and all care providers at Central Maine Medical Center, Bridgton Hospital and Rumford Hospital take pride in bringing high-quality, personalized care to our communities in central, western and mid-coast Maine.

Oncology Clinics Convenient to You

Both Bridgton Hospital, Rumford Hospital and the Topsham Clinic offer oncology services, including medical oncologists, Infusion, and an oncologist always on-call on weekends.

Central Maine Comprehensive Cancer Center

Central Maine Medical Center has been recognized one of America’s Best Hospitals for Cancer Care by the Women’s Choice Award and accredited by the Commission on Cancer (CoC) as a Comprehensive Community Cancer Program and the National Accreditation Program for Breast Centers, so you can have peace of mind about the care you receive.

How to choose a Primary Care Provider

When you select a new primary care physician — whether you’ve just moved, changed insurance plans or simply want a different doctor—it’s the start of an important relationship.

So, how do you make the right choice for you and your family? Use the information below to make your decision with confidence.

What is a Primary Care Provider?

A primary care provider (PCP) is a health care practitioner who sees people with common medical problems. The PCP is most often a doctor, though may be a physician assistant or a nurse practitioner in some cases. Your PCP is often involved in your care for a long time, so it’s important to choose someone you feel comfortable partnering with.

A PCP is your main health care provider in non-emergency situations, and available to:

  • Provide annual wellness visits and routine check-ups
  • Provide preventive care and guide healthy lifestyle choices
  • Identify and treat common medical conditions
  • Make referrals to medical specialists when necessary

Primary care is most often provided in an outpatient setting. However, if you are admitted to the hospital, your PCP may assist in or direct your care.

Types of PCPs

Having a PCP can give you a trusting, ongoing relationship with one medical professional over time. At Central Maine Healthcare, those relationships are the foundation of our care, and we offer several different types of PCPs to meet your needs:

  • Family Medicine: Family medicine provides primary care for patients of all ages – adults, children and seniors. It includes immunizations and sick visits.
  • Internal Medicine: Internal medicine is only applicable to adults ages 18 and older. Internal medicine includes gynecological exams, minor in-office surgeries and acute illnesses.
  • Pediatrics: Pediatrics serves infants, children and young adults ages 0-21. Among the services available are developmental screenings and special, child-friendly treatment for acute illnesses.
  • Senior Health: Primary care providers can help senior patients effectively manage chronic conditions like diabetes, arthritis and hypertension, as well as prostate and sleep disorders.

About Us

At CMH You Are Central to All We Do

Central Maine Healthcare (CMH) is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast Maine. CMH’s hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Our Provider Team, a primary and specialty care practice organization.

Other system services include the Central Maine Heart and Vascular Institute, the Trauma Center at Central Maine Medical Center, LifeFlight of Maine’s central Maine base, the Central Maine Comprehensive Cancer Center, and other high-quality clinical services.

Whether seeing your primary care provider, a highly-qualified specialist within our healthcare network, or visiting one of our three hospital locations throughout Maine, be assured that with Central Maine Healthcare you’re always receiving accessible, comprehensive, world-class care.

Learn more about Central Maine Healthcare by viewing: “Ready…When it matters most”, the Central Maine Healthcare 2024 Annual Report.

Hospital Medicine Fellowship

CMMC Offers One-Year Hospital Medicine Fellowship

In 2009, Central Maine Hospitalists (CMH), in collaboration with Central Maine Family Medicine Residency (CMFMR), began offering a one-year fellowship for a family medicine or internal medicine graduate interested in pursuing a career as a hospitalist. Based on our highly successful initial experience with this program, in 2012 we expanded the program to include up to two fellows per academic year. We hope you will contact us if you are interested in focusing your career on inpatient medicine.

CMH was established with five experienced physicians in 2004 and has now grown to over thirty board-certified physicians and associate professional staff (NP/PA). We care for over 50% of the inpatient population at Central Maine Medical Center (CMMC), a 250-bed community teaching hospital as well as provide care at our affiliated critical access hospitals. All members of CMH are actively involved in a number of hospital processes including: division and group leadership, quality improvement, guideline development and implementation, patient safety, medical education, palliative care and information technology. We are also involved in the Society of Hospital Medicine (SHM), including Fellows and Senior Fellows of Hospital Medicine. Several of our members have earned a Recognition of Focused Practice in Hospital Medicine (RFPHM). Our group members have been active in and presented at SHM local chapter meetings, as well as national SHM forum leadership, committee membership and leadership.  All members of the group are committed teachers involved in educating the hospitalist fellows, residents, medical and pharmacy students.

CMFMR has been educating family physicians since 1978. We provide care and training to diverse populations and our graduates are regularly hired into the hospital system. The opportunity to partner with the hospitalist group builds on our reputation for excellent inpatient training and our flexibility in establishing programs to meet student and resident needs. The department of family medicine has established a reputation for advanced thinking in organizing for the provision of care and has become a research setting for the rest of the outpatient practices at CMMC. Modeling excellence in interdepartmental cooperation, CMH and CMFMR are exceptionally well-suited to educating Hospitalists Trained in Family Medicine (HTFM).

Dr. Geyer and our program were recently featured in The Hospitalist, August 2019: “We rely heavily on the Core Competencies in Hospital Medicine developed by SHM, which emphasize clinical conditions, medical procedures, and health care systems. Gaining fluency in the latter is really what makes hospital medicine unique,” Dr. Geyer said. Often residency graduates seeking work in hospital medicine are insufficiently prepared for hospital billing and coding, enacting safe transitions of care, providing palliative care, and understanding how to impact their health care systems for quality improvement, patient safety and the like, she added.

Dr. Geyer said her fellowship does not mean just being a poorly paid hospitalist for a year. “The fellows are clearly trainees, getting the full benefit of our supervision and supplemental training focused on enhanced clinical and procedural exposure, but also on academics, quality improvement, leadership, and efficiency,” she said. “All of our fellows join SHM, go to the Annual Conference, propose case studies, do longitudinal quality or safety projects, and learn the other aspects of hospital medicine not well-taught in residency. We train them to be highly functional hospitalists right out of the gate.”