Table Of Content

Cancer Treatment

Treatments for cancer involves various techniques like surgery, radiation therapy, drugs therapy, and other therapies to cure or shrink a tumor or stop the progression of cancer. The doctor may recommend different treatments depending on the type of cancer, its stage, and your general health. The initial goal is to cure cancer so that a person diagnosed with cancer can lead a normal life span.

If the cure is not possible, treatment options will help reduce the progression of cancer and symptoms thus improving the quality of life. Patient might receive monotherapy or combination therapy based on the condition.

Types Of Cancer Treatment

1. Surgery:

An operation or procedure to remove a tumor and some cancer cells in the nearby tissue is known as cancer surgery. It is the most traditional form of cancer treatment and is still effective against many cancer forms today. Surgery may be used to entirely remove a tumor, debulk a tumor, or decrease cancer symptoms, depending on the type of cancer and its stage. Debulking is employed when removing an entire tumor that might damage an organ or the body.

There are various cancer surgeries available to aid cancer patients such as-

1. Curative surgery: The cancerous growth or tumor is removed from the body during curative surgery. This surgery is used by surgeons when a malignant tumor is restricted to a certain region of the body. However, this surgery is considered a primary treatment.

2. Preventive or prophylactic surgery: Preventive surgery removes tissue that does not contain cancerous cells but can potentially develop into a tumor. For instance, Polyps in the colon may be considered precancerous tissue and removed through prophylactic surgery.

3. Diagnostic surgery: Diagnostic surgery aids in determining whether cells are malignant. A tissue sample is removed during diagnostic surgery for testing and evaluation (in a laboratory by a pathologist). The tissue samples help confirm a diagnosis, identify the type of cancer, or discover the cancer stage.

4. Staging surgery: It is a more precise type of surgery used to evaluate how far cancer has spread in a patient's body. A prominent example of a staging surgical procedure is a laparoscope (a tiny tube with a video camera or lens put into the body through a small incision to examine inner body components or remove a tissue sample).

5. Debulking surgery: Debulking surgery eliminates a part of a cancerous tumor but not the entire tumor. It is utilized in cases where removing the entire tumor might cause damage to an organ or the body. Further cancer treatments, including chemotherapy and radiation, may be employed after debulking surgery.

6. Palliative surgery: Advanced cancer stages are treated with palliative surgery. It does not work to cure cancer but to alleviate pain or to correct other issues.

7. Supportive surgery: It is the same as palliative surgery because it does not cure cancer; instead, it enhances the efficacy of other cancer therapies. A catheter insertion to aid with chemotherapy is an example of supportive surgery.

8. Restorative or reconstructive surgery: Restorative surgery is done after curative or other procedures to improve or restore a person appearance or the function of a body part. For instance, breast reconstruction surgery may be necessary for some breast cancer patients to restore the physical shape of the affected breasts.

9. Cryosurgery: To eliminate cancer cells during this procedure, liquid nitrogen or argon is given through needle like applicator called cryoprobe. This produces intense cold which freeze and destroy cancer cells. Typically, cryosurgery is used to treat skin cancer or cervical cancer. It has been assessed as a potential surgical cure for various malignancies.

10. Laser surgery: Laser surgery uses light energy beams to remove cancerous cells (without damaging the nearby tissues). This therapy is used to either destroy, activate, or shrink tiny cancer cells. Laser surgery is an accurate and precise treatment for healing body parts that are difficult to reach, such as the rectum, cervix, skin, and larynx.

11. Electrosurgery: It can be used to treat skin cancer and oral cancer. This treatment eliminates cancer cells by using an electrical current which removes abnormal cells.

12. Microscopically controlled surgery: This cancer surgery is performed to treat certain types of skin cancer, soft tissue sarcoma and cancer of penis. Layers of skin is removed and examined under microscope for the presence of cancer, and this process is repeated till all the cancerous cells has been removed.

Side Effects of Surgical treatments:

  • Damage to organs in the body
  • Blood loss or clots
  • Pain or discomfort
  • Infections
  • Other illnesses, such as pneumonia

2. Chemotherapy:

Chemotherapy is one of the major treatments for cancer in which drugs are used to destroy cancer cells or inhibit them from proliferating and spreading throughout the body. It is also referred to as standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.

Types of Chemotherapy:
The main types of chemotherapy include -

1. Alkylating agents: These substances harm DNA and prevent mitosis. It is used to treat cancers like lung, breast, and ovarian cancers, leukemia, lymphomas, multiple myeloma, and sarcoma. Some examples of this agents include chlorambucil, cyclophosphamide, busulfan, streptozotocin, dacarbazine, thiotepa, cisplatin, carboplatin, and oxalaplatin.

2. Anti-tumor antibiotics: These substances stop the replication of cancer cells by uncoiling DNA strands inside cancer cells. It is used to treat cancers such as lung, colorectal, ovarian, and prostate cancer. Some examples of this class of drugs are mitoxantrone, doxorubicin, and bleomycin.

3. Antimetabolites: These substances disrupt the S phase and replace healthy DNA and RNA with other amino acids, preventing cell replication and growth. Leukemia, breast, and ovarian malignancies are all treated using antimetabolites. 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP), cytarabine, capecitabine, fludarabine, gemcitabine, methotrexate, and thioguanine are a few examples of medications in this class.

4. Plant alkaloids: It is also known as mitotic inhibitors that stop the cell cycle M phase and prevent mitosis. They are used to treat myeloma, lymphoma, leukemia, and breast and lung cancer. Taxanes like paclitaxel and docetaxel, as well as vinca alkaloids like vinblastine, vincristine, and vinorelbine, are examples of medications in this class.

5. Topoisomerase inhibitors: These substances block the activity of the enzyme topoisomerase, which normally aids in untangling DNA strands to allow for replication. It is used to treat leukemia, as well as lung, ovarian, and stomach cancer. Topotecan, irinotecan, etoposide, and teniposide are a few examples.

Side Effects of Chemotherapy:

  • Fatigue (Tiredness)
  • Feeling and being sick
  • Hair loss
  • Nausea
  • Infections
  • Anaemia
  • Bruising and bleeding
  • Sore mouth
  • Loss of appetite
  • Skin and nail changes
  • Memory and concentration problems
  • Sleep problems
  • Infertility
  • Diarrhoea and constipation
  • Emotional disturbances

3. Immunotherapy:

It is a cancer treatment that engages your immune system to fight against the disease. The treatment is also called biological therapy. It functions by enhancing the immune system to produce more disease-fighting immune cells and facilitates the immune system to determine and target cancer cells.

Types of Immunotherapy:
The main types of chemotherapy include -

1. Immune checkpoint inhibitors: Checkpoint inhibitors stop cancer cells from inhibiting the immune system. These inhibitors commonly target the PD-1/PD-L1 and CTLA-4 pathways.

2. Monoclonal antibodies: Monoclonal antibodies are made in the laboratory to supplement or replace the body's natural antibodies. It can help to fight against cancer. For instance, they can be employed to stop the activity of abnormal proteins in cancer cells.

3. T cell therapy: T cells are immune cells that fight infection. T cells are drawn out of the patient's blood during T-cell treatment. Then, in a lab, the cells are given particular proteins, known as receptors. These T cells can identify cancer cells due to the receptor.

4. Cancer vaccines: Cancer vaccines can also assist your body in fighting sickness. A vaccine exposes immune system to a foreign protein known as an antigen, and this prompts the immune system to identify and eliminate that antigen or related compounds.

5. Non-specific immunotherapies: Cancer cells are destroyed by non-specific immunotherapies, often known as non-specific immunomodulating drugs.

6. Oncolytic virus therapy: Oncolytic viruses are a type of immunotherapy that employs viruses to infect and kill cancer cells.

Side Effects of Immunotherapy:

  • Severe skin reactions
  • Flu-like symptoms
  • Fatigue
  • Fever and chills
  • Nausea and vomiting
  • Swelling and weight gain from retaining fluid
  • Heart palpitations
  • Sinus congestion
  • Diarrhea
  • Infection
  • Organ inflammation

4. Hormonal Therapy:

Hormone therapy is one of the cancer treatments that slows or stops the growth of cancer that depends on hormones to grow. It is also called endocrine therapy, hormonal therapy, or hormone treatment. This therapy treats cancer by slowing the progression of the disease and lowering the likelihood that it will come back. It is also used to lessen or prevent symptoms of cancer.

Types of Hormone Therapy:
Types of hormone therapy are categorized based on the function and type of hormone affected. It includes -

1. Adrenal steroid inhibitors: This type of hormone therapy interferes with adrenal gland hormone production. Reduced estrogens and androgens prevent tumors affected by these hormones from being stimulated to grow malignancy.

2. Androgens: Androgens are hormones that either produce or enhance the growth of male characteristics. Examples of androgens include testosterone and androsterone, and these hormones can be changed into estrogen in females. In cancer treatment, androgens are utilized to inhibit estrogen effect and slow the spread of cancer.

3. Antiandrogens: Antiandrogens are compounds that inhibit the effects of testosterone. The male hormone testosterone is essential for the development of prostate cancer. It can decrease the malignancy if the testosterone level is reduced.

4. Antiestrogens: Antiestrogens attach to the estrogen receptor site on cancer cells, preventing the cancer cell from absorbing estrogen. This inhibits cell proliferation and results in cell death.

5. Aromatase inhibitors: Aromatase inhibitors prevent the enzyme aromatase from converting androgens (hormones produced by the adrenal glands), which are found in the body's muscles, skin, breast, and fat, into estrogen. Tumors that depend on estrogen for growth will shrink without the hormone.

6. Estrogens: Estrogens are female hormones that compete for androgen receptor sites, reducing the influence of androgens (testosterone and androsterone) on prostate cancer.

7. LHRH (Luteinizing hormone-releasing hormone) agonists: LHRH agonists function by instructing the brain's pituitary gland to stop generating luteinizing hormone, which (in men) stimulates the release of testosterone from the testicles and (in women) stimulates the release of estrogen from the ovaries. Only the testicles or ovaries are affected by the medication; the malignancy is not directly affected. The absence of testosterone (in men) and estrogen (in women) makes it difficult for cancer cells that depend on either hormone to proliferate.

8. Progestational agent: Progestational agents are a man-made form of the female hormone progesterone, and it has anti-estrogenic effects.

9. Selective Estrogen Receptor Modulators (SERMs): Drugs that behave like estrogen in some organs while acting as an antiestrogen in others are referred to as SERMs. Raloxifene acts like estrogen to improve lipid profiles and prevent bone loss, but it has the potential to inhibit some estrogen effects that lead to breast cancer and uterine cancer.

Side Effects of Hormonal Therapy:

  • Hot flashes
  • Loss of interest in sex
  • Diarrhea
  • Nausea
  • Fatigue
  • Weakened bones
  • Increased risk of other health problems
  • Vaginal dryness
  • Pain in muscles and joints
  • Changes in your periods if you have not yet reached menopause

5. Radiation Therapy

Radiotherapy is another major treatment that uses high-energy rays to destroy cancer cells while causing as little injury to normal cells as feasible. When the beams reach the tumor, they damage the cancer cell's DNA and kills them.

Types of Radiation Therapy:
The type of radiation therapy depends on cancer type, tumor size, location, and general health and medical history. It includes
(a) External beam radiation therapy
(b) Internal radiation therapy

A. External Beam Radiation Therapy:

The most common type of radiotherapy is external-beam radiation therapy. It delivers radiation from a machine outside the body and can be used to treat large areas of the body if needed.

1. Intensity-modulated Radiation Therapy (IMRT): IMRT is a special kind of external beam radiation therapy. Advanced technology is used in IMRT to precisely aim radiation beams at the tumor, reducing the damage to nearby healthy cells and potentially resulting in fewer side effects.

2. Tomotherapy: It uses detailed, three-dimensional maps of the size and location of a tumor. The equipment then emits small beamlets of radiation at tumors from varied angles, enabling exceptional accuracy for targeting malignancies.

3. Proton Therapy: Targeted radiation therapy, known as proton therapy, uses proton beams rather than photon beams to treat patients. Protons do not cross the tumor as photons do. Because of this, proton therapy lowers the possibility of adverse effects such as harming healthy tissue.

4. Stereotactic Radiosurgery: It is a non-surgical radiation therapy that can be used instead of invasive surgery. The technology emits several radiation beams at various angles and in multiple planes. The precise location of the tumor is determined by using three-dimensional imaging.

5. Image-guided Radiotherapy (IGRT): Imaging tests like CT, MRI, or PET scans are used in image-guided radiotherapy (IGRT). These are combined with specialized computer software to optimize the real-time delivery of radiation to the treatment area.

6. 3D Conformal Radiation Therapy: In this method, the radiation beam is shaped to match the size and shape of the tumor. It precisely focuses on the tumor and thus the damage to healthy surrounding tissues is avoided.

B. Internal Radiation Therapy:

A source of radiation is inserted into your body during internal radiation therapy. The radiation source could be either liquid or solid, and internal radiation therapy with a solid source is called brachytherapy.
1. Brachytherapy: Internal radiation employs radiation to kill cancer cells and reduce tumor size. The radiation frequently manifests as wires, ribbons, or seeds, which are put into or near cancer in your body.

2. Intraoperative Radiation Therapy (IORT): This procedure uses internal or external beam radiation therapy to administer radiation therapy to the tumor while it is surgically removed. IORT enables surgeons to remove healthy tissue from the path of radiation therapy to prevent damage to it. When crucial organs are close to the tumor, this treatment is beneficial.

3. Stereotactic Body Radiotherapy (SBRT):
It combines IGRT (Image-guided radiotherapy) with more advanced treatments. While minimizing the quantity of radiation reaching neighbouring healthy tissue, it can deliver significant doses of radiation to a tumor. Typically, it requires fewer treatments than other types of radiation therapy, and SBRT has the potential to produce better outcomes with fewer side effects than conventional radiation therapy.

Side Effects of Radiation Therapy:

  • Fatigue
  • Hair loss
  • Memory or concentration problems
  • Nausea and vomiting
  • Skin changes
  • Headache
  • Blurry vision
  • Swelling (edema)
  • Shortness of breath
  • Sexual problems