TREAT CANCER

Having cancer doesn't mean you have to lose hope. The good news is that cancer is now increasingly treatable. With the advancements made in cancer research many cancers can now be cured while many others can be controlled. If cancer can’t be controlled, symptoms can be relieved to make life more comfortable.

The best form of treatment will be decided based on the type of cancer and how far it has progressed in the body. A combination of treatment options could also be used if it is believed that it will help in the treatment process. Each person undergoing treatment must have a detailed discussion with their doctor(s) about treatment options applicable to her.

Cancer Treatment

Cancer is now increasingly treatable. The appropriate form of treatment for an individual depends on the type of cancer and how far it has progressed in the body. Some forms of cancer treatment are:

Surgery

Surgery is a treatment option which leads to the removal of the tumour and surrounding tissue during an operation. It is the primary treatment method for many types of cancer, and some cancers can be completely removed with surgery alone.

Surgery offers the greatest chance for cure for many types of cancer, especially those that are in the early stages and have not spread to other parts of the body. Most people with cancer are likely to have some type of surgery. Surgery today is aimed at removing tumours while saving as much normal tissue and function as possible. Surgeries are therefore less invasive and less damaging to nearby tissues and organs. Doctors that treat cancer with surgery are called surgical oncologists.

There are several types of surgery depending on the purpose for which they are undertaken.

Preventive surgery
Preventive or prophylactic surgery, as the name suggests, is done to remove body tissue that might become cancerous in the future, even though there may not be any signs of cancer at the time of surgery. Preventive surgery can sometimes be undertaken to remove an entire organ if a person has an inherited condition that puts them at a high risk of having cancer someday. For example, some women with a strong family history of breast cancer are found to have a change (mutation) in the DNA of a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is extremely high, these women may choose to have both their breasts removed surgically. This procedure is called a prophylactic mastectomy.

Curative surgery
Curative surgery is done when cancer is localised i.e. found in only one area, and its likely that the entire cancer can be removed. In this case, curative surgery can be the main treatment option. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation.

Palliative surgery
Palliative surgery is used to treat problems caused by advanced forms of cancer. This type of surgery is not done to cure cancer but to manage its symptoms that might be causing discomfort and disability. For example, some cancers in one organ may grow large enough to block off the function of another organ. If this happens, surgery can be used to remove the blockage. Palliative surgery may also be used to manage pain when the pain might be hard to control by other means.

Reconstructive surgery
Reconstructive surgery is used to restore the function of an organ or body part after surgery or to improve the way a person looks after a surgical procedure. For example, breast reconstruction after mastectomy is a common form of reconstructive surgery. Other examples include bone grafts and prosthetics for various types of cancer surgery.

Chemotherapy

Chemotherapy is a treatment option that uses drugs to kill cancer cells or make them less active. Chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body to limit the cells’ ability to grow and divide.

While surgery is used to remove the primary tumour when the cancer is still localised, chemotherapy is used to treat cancer when cancer cells are found in multiple areas in the body. This normally occurs when either the cancer has not been detected early enough and has spread to multiple organs or when the cancer cells are highly dispersed like in the case of leukaemia. Doctors that treat cancer with chemotherapy are called medical oncologists.

Chemotherapy involves using chemicals that are toxic to cancer cells. The aim is to completely stop or at least slow down the growth of cancer cells in the body that are dividing at a rapid pace. Chemotherapy can be used as the only cancer treatment, but more often it is used together with surgery and radiation. Depending on the type of cancer and how advanced it is, chemotherapy can be used to:

  • Cure cancer - when chemotherapy destroys cancer cells to the point that the cancer can no longer be detected in your body
  • Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body
  • Ease symptoms - when chemotherapy shrinks tumours that are causing pain or pressure.

Chemotherapy can be administered in many ways.

  • Intravenous (IV) - Chemotherapy goes directly into a vein
  • Intra-arterial (IA) - Chemotherapy goes directly into the artery that is feeding the cancer
  • Intraperitoneal (IP) - Chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries)
  • Topically - Chemotherapy comes in a cream that you rub onto your skin
  • Orally - Chemotherapy comes in pills, capsules, or liquids that you swallow.

Chemotherapy is not without side effects. While on the one hand, the chemicals attack cancer cells, they also cause unwanted damage to healthy cells. Some of the common healthy cells that are affected by chemotherapy drugs are those that line your mouth or those that cause your hair to grow. Damage to these healthy cells may cause side effects like hair loss etc. Fertility can also be impacted so men and women must consult their doctor regarding options if they intend to have children in the future. Increased risk of infections can result from damage to blood cells which fight off infection or carry oxygen around the body. Diarrhoea and nausea can also occur, though this can be alleviated using drugs. However as once the course of chemotherapy ends, the side effects begin to wear off.

To better understand these side effects and how best to manage them, please access the managing your treatment section.

Radiation

Radiation therapy is a treatment option that uses high-energy radiation to kill cancer cells and to stop them from spreading. There are various types of radiation like X-rays, gamma rays, and charged particles that are used during cancer treatment.

Radiation therapy kills or damages cancer cells by using high doses of radiation to damage the DNA (genetic material) of these cells. Radiation therapy either damages DNA directly or creates charged particles within the cells that can in turn damage the DNA. When the DNA of these cells is damaged beyond repair, they stop dividing or die and are eliminated by the body’s natural processes. Doctors that treat cancer with radiation are called radiation oncologists.

Whether or not radiation therapy is appropriate depends on several factors such as the type, size and location of the cancer. Radiation cannot be used if the tumours are not well defined. Radiation therefore may not be effective for cancers such as Leukaemia. Radiation could be used as the sole treatment option for a cancer or together with surgery and chemotherapy. Depending on the type of cancer radiation can be used to:

  • Cure cancer - when radiation destroys cancer cells to the point that the cancer can no longer be detected in your body
  • Control cancer - when radiation keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body
  • Ease symptoms - when radiation shrinks tumours that are causing pain or pressure.

Radiation may be delivered in two ways. External beam radiation is when a machine outside your body aims radiation at cancer cells. Internal beam radiation is when radiation is out inside the body in or near the cancer cells.

External beam radiation
This radiation therapy comes from a machine that aims radiation at the cancer. The person lies on a flat bed while the machine rotates around the person sending radiation from many directions. External beam radiation therapy is a local treatment, i.e. the radiation is aimed only at a specific part of the body. For example, if you have lung cancer, you will get radiation to your chest only and not the rest of your body.

Internal beam radiation
This radiation is delivered when a source of radiation is put inside the body. One form of internal radiation therapy is called brachytherapy. In brachytherapy, the radiation source is a solid in the form of seeds, ribbons, or capsules, which are placed in the body in or near the cancer cells. This allows treatment with a high dose of radiation to a smaller part of the body. Internal radiation can also be in a liquid form. Liquid radiation is given by drinking it, by swallowing a pill, or through an IV. Liquid radiation travels throughout your body, seeking out and killing cancer cells.

Each form of radiation could be given with other types of treatment, including other forms of radiation, chemotherapy, or surgery.

Like chemotherapy, radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. The healthy cells almost always recover after treatment is over. But sometimes people may have side effects that do not get better or are severe. To better understand these side effects and how best to manage them, please access the managing your treatment section.

In order to protect healthy cells, radiation is given using as low dose of radiation as possible, spreading the treatment out over time, aiming radiation at a precise part of the body.

Targeted therapy

Targeted therapy is a treatment option that uses drugs or other substances that block the spread of cancer by interfering with specific molecules involved in the growth of cancer cells.

Targeted cancer therapies are drugs or other substances that block the spread of cancer by interfering with specific molecules involved in the growth of tumours. These substances focus on molecular and cellular changes that are specific to cancer and therefore may be more effective than other types of treatment. They are also likely to be less harmful to normal cells than other forms of treatment like radiation and chemotherapy.

Targeted therapies work by interfering with cancer cell division in many ways. Each cancer cell uses certain proteins to create a communication network within and between cells that allows it to divide and grow. Targeted therapies focus on blocking these signals and help the cancer cell to stop growing. Targeted therapies might even induce cancer cell death by either triggering programmed cell death or by stimulating the immune system to recognise and destroy cancer cells. This form of therapy is also called biological therapy.

Each country has their list of approved targeted therapies and the list of targeted therapies under clinical trials. While exploring options of which treatment option might be best for you, please have a detailed discussion with your doctor to understand the targeted therapies that might be relevant and available to you. Some of the common targeted therapies used in India are:

Trastuzumab: Trastuzumab is available in the market under the name of Herceptin. This targeted therapy is used to treat breast cancer that is HER2-positive and is also used with other drugs to treat HER2-positive stomach cancers. Some breast cancer cells make too many copies of a particular gene known as HER2. The HER2 gene makes a protein known as a HER2 receptor. Breast cancer cells that make too many copies of the HER2 gene are said to be HER2-positive. Herceptin works by attaching itself to the HER2 receptors on the surface of breast cancer cells and blocking them from receiving growth signals. By blocking the signals, Herceptin can slow or stop the growth of the breast cancer. In addition to blocking HER2 receptors, Herceptin can also help fight breast cancer by alerting the immune system to destroy cancer cells onto which it is attached.

Imatinib: Imatinib is available in the market under the name of Gleevec. This targeted therapy is used to treat certain types of leukaemia especially chronic myelogenous leukemia (CML) and certain types of adult acute lymphocytic leukemia (ALL). It is also used for gastrointestinal stromal tumours. It is used to treat a number of other cancers and non-cancerous conditions as well. Imatinib targets a certain type of protein called tyrosine kinase proteins in the body. These abnormal proteins are found at the surface of certain cancer cells and send constant signals telling the cells to divide and stay alive. By blocking these signals, Imatinib can stop the cells from growing and cause them to die.

Some other forms of treatment are:

Hormone therapy
This treatment method adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. This method is sometimes also referred to as endocrine therapy.

Transplantation
This treatment procedure restores stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy. Some common transplantation procedures are bone marrow transplantation and peripheral blood stem cell transplantation.

It is also advisable to discuss any alternative therapy you might be considering instead of or in addition to the primary treatment option being suggested.