Know it, to control it
Cancer, as we have learnt, affects different parts of the body and can manifest with different symptoms depending upon the organ affected. Cancer therapies constitute treatments that either
i) Cure ii) Control iii) Palliate iv) Overcome side effects of curative therapies v) Increase the immunity of body to help recover from cancer
Anyone or more than one treatment may be necessitated for a given stage of cancer. Nowadays physicians and surgeons work together in a multimodality setting so that the patients get benefits of either treatment with minimization of toxic side effects.
Examples of such therapies in a combined mode are as follows-
1. Early breast cancer-Patients with tumors detected on mammography, by screening or the tumors that are less than 5 cms in size are offered only lump removal (surgery) followed by radiation to the breast to preserve the complete body form of a woman. The lady may need chemotherapy or hormone therapy based upon her receptor status prior to radiation and after surgery.
2. Head and neck cancers-Combination of radiation and chemotherapy is offered to cancers of larynx and hypo pharynx for organ preservation. Surgery is kept in reserve for progression of disease or disease recurrence.65-70% of patients may not need surgery in this cancer.
3. Lymphomas- Hodgkin’s lymphoma patients with early stage disease are given two to four cycles of chemotherapy with just two weeks of radiation therapy to cure the disease and minimize the side effects of 6-8 cycles of chemotherapy or 4-5 weeks of radiation therapy.
Types of Cancer directed therapies are
1. Surgery-Surgery was the first treatment advocated for removal of cancerous tissues. Surgery remains the cornerstone for identifying the type of cancer/s and is curative in certain cancers like low grade brain gliomas, colon, pancreas and stomach cancer. For most cancers surgery needs to be followed by addition of radiation and /or chemotherapy to prevent a relapse. It is recommended that site specialized surgeons work together with other specialists to prevent the cancers from coming back (relapse). Types of surgery can be open, key hole, laser or robotic. The surgeon will discuss with the patient the need for the type of recommended procedure as well the expected outcomes.
2. Radiation therapy-Radiation treatment involves treating the tumor with wider margins as compared to surgery in a conventional programme. This makes it possible to track and clear any cells that are away from the primary cancer in the local area. At times lymph node basins are also treated to prevent the spread of cancer away from the primary. Radiation can be used before or after surgery, before concurrently or after chemotherapy. Radiation therapy is a curable mode of therapy for cancers of larynx (voice box), lung, cervix. It is used as an adjuvant in high grade brain tumors, breast cancer, sarcomas, stomach cancer and stage four head and neck cancers. It is used for down staging cancers of rectum, oesophagus, stomach, urinary bladder and is used along with chemotherapy in these cancers.
It is used for organ preservation therapy for cancers of head and neck, cure of inoperable lung cancers and palliation of pain due to bone metastases. In recent years radiation therapy has had technological developments that target the tumor with such precision that spares the surrounding normal tissues remarkably. The three dimensional conformal planning techniques with modulation and image guidance make sure that the radiation is delivered precisely where it is needed. Stereotactic body radiotherapy and stereotactic robotic radiosurgery are further refined forms of radiation therapy that reduce the treatment time to a day or a week instead of 6-7 weeks for radiation treatment.
3. Chemotherapy- Chemotherapy are the drugs that target the cancer cells anywhere in the body and need to be given at regular periodicity to clear out the cancer cells, may be over 3-15 months. In blood cancers- leukemia the treatment may be given over 2-3 years. Chemotherapy agents have side effects that can be overcome by good supportive care and adjunct medication. It may be given before or after surgery and or radiation therapy.
4. Monoclonal antibodies- These are medicines available as injections or oral pills that work against the cancer receptors either on the surface or cytoplasm of the cancer and have minimum side effects. Last ten years have given us very good monoclonal targeted medicines that have enhanced the lives of many people where no cure was possible earlier.
5. Immunotherapy/ Dendritic cell therapy- In this therapy the cancer cells are harvested and individualized immune cells are produced against them and injected back into the human body and are programmed to kill the cancer cells. Malignant melanoma and brain tumors are the cancers where active research is ongoing for curative regimens.
6. Complementary and alternative medicines- It has been shown that more than 50% of cancer patients use complementary and alternative therapies while undergoing cancer treatments. In India Ayurvedic, Homeopathic medicines and herbal extracts are used. It is best to discuss with your doctor the complimentary products as they may either enhance the side effects or reduce the active action of the chemotherapy or radiation therapy administered to a cancer patient.