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Cancer Treatments

General principles of cancer treatments

Cancer Treatments

General principles of cancer treatments are surgery(operation),chemotherapy
(medicine,immunotherapy,biologic therapy,natural supplements etc),radiation etc.
Each human is unique and so is the cancer in each person.
Everyone needs treatment tailored according to their unique situation .For example ,when deciding about the chemotherapy, medical oncologist needs to think about the disease, age, ,which drug to use when,drug dose,and for how long etc.The cancer doctor also needs to think about side effects ,other medicines the patient is taking ,other diseases the patient has, how is
overall health and functional status of the patient, cost of the treatment and personal preference of the patient etc etc.

Here is some general information about common cancers.Please talk to your oncologist before deciding which treatment will suit you best

Breast Cancer

It is one of the most common cancers..
If diagnosed early ,it is curable in most patients. However, even in advanced stages. It is treatable. Only three to five percent of the breast cancers are genetic and inherited from family .Majority of cancers happen randomly.

Diagnosis and screening
Screening means finding the cancer before it is found by the women themselves or their doctors by examination of the breast.Best method to find cancer early is mammogram (xray of the breast is called mammogram).
For early detection of cancer ,mammogram is usually recommended ,after age 40, in all women on a yearly or every two-year basis.
Majority of the time In our country women feel the lump themselves and come for further testing.
Diagnosis requires a biopsy which means taking a sample of these tumor cells either by an FNA(fine needle aspiration where a syringe is used to suck few cells out of the cancer in breast or armpit) or a core biopsy (where a large thick needle is used to take a piece out of the cancer mass/lump/tumor).
Then the sample is examined by a pathologist who will determine what kind of cancer it is by various tests including finding out if it is;

– hormone positive(estrogen and progesterone receptors on cancer cells) or negative ,
-her-2-neu positive or negative or
-all negative(triple negative)
Breast cancer treatment depends on the type of breast cancer determined by biopsy and pathology.
Every type of cancer has specific treatment protocols which need to be followed for the best outcomes.

Staging
Breast cancer also needs to be staged after diagnosis to make sure you know where the cancer is and whether it has spread to any other place including the armpit or it has spread further to other organs like bones,liver,lung,brain etc. This will help guide your Oncologist to know how best to treat and what medicines to use first to treat it more effectively.

Treatment of breast cancer involves surgery ,chemotherapy and Radiation.

These treatments could be given before surgery or after surgery.
However, there may be some women who will not need any other treatment except surgery especially If the tumor is very very small.
Some women will require all the treatments including chemotherapy ,surgery and radiation therapy, hormonal therapies.

Surgery .

Type of surgery depends on the size of the tumor and the woman’s wishes. Usually removing only the portion of the breast which has the cancer in it is called lumpectomy. Sometimes the whole breast is removed and is called mastectomy. if only the portion which had the tumor in it is removed ,radiation is needed after the operation. It is also very important that your surgeon removes and checks the lymph nodes in the axilla.
That’s the first place where the tumor spreads if it will spread in the future.
Usually only a few lymph nodes need to be removed to check if there is cancer or not. The procedure is called Sentinel lymph node biopsy where the surgeon injects a dye into the cancer in the breast and that dye travels to the lymph nodes in the axilla .The lymph nodes which take up with the dye , are removed and checked to make sure if there is cancer or not.

Chemotherapy Many young women and older women with aggressive cancers will need chemotherapy .chemotherapy helps to stop the cancer from coming back. There are many kinds of chemotherapy treatments.

Radiation therapy
It’s given after the chemotherapy.
It usually lasts for a few days to a few weeks.
Hormonal therapy
The women who have hormone positive cancers, like estrogen positive or progesterone positive cancers will usually require five to ten years of Hormonal therapy.
There are several options. In older women ,for hormonal therapy after the menopause ,drugs like letrozole ,anastrozole ,tamoxifen Etc. are used.
In younger women, tamoxifen is usually used for 5 to 10 years. There are other hormonal therapies, which are also used in some women.
Herceptin is used in women whose cancer is Her-2-Neu positive. In breast cancers about 25 to 30 percent of the women have this type of her-2,nu positive cancer and will benefit from herceptin. This is usually done for six months to a year.
It is an injection form of treatment. It also helps the tumor from coming back.
Treatment of the stage four / metastatic or widespread tumor
It usually involves treatment of the tumor and the tumor related symptoms
If the tumor has spread to the bones, A bone strengthening medicine is also used.
Depending on the type of the breast cancer ,chemotherapy ,hormonal therapy, immunotherapy and biological therapies or other kinds of therapies are utilized to control the cancer from spreading further and helping women to improve their quality of life and live longer.

Prostate Cancer

It’s a common cancer in men. In most older men prostate cancer is not very aggressive and sometimes it doesn’t even need any aggressive treatments like operations or radiation therapy, chemotherapy especially if it has spread. If treatment is needed to control the cancer or symptoms related to cancer ,it’s usually hormonal treatment in the form of pills /tablets or hormonal injections on a monthly or three monthly basis.

However, it does need follow-up regularly with the doctor.

Diagnosis of prostate cancer
Requires biopsy and PSA testing and blood tests.
Pathology is very important to determine how aggressive the cancer is .
Surgery removal of the prostate gland by surgery is an option in younger men with Cancers, especially if it has not spread beyond the capsule of the prostate gland.
Radiation therapy Could be effective and safer than surgery for early-stage cancer of the prostate especially in older men.
Hormonal therapy in prostate cancer is very effective and there are several kinds of hormones injections which are given monthly or every three monthly. There are also tablets which help to control the cancer.
Chemotherapy is sometimes used when hormone therapy fails or the cancer progresses or the cancer is very aggressive and spreads rapidly .Chemotherapy does help to slow down the cancer .However, it does not get rid of the cancer. Goal of chemotherapy is to improve symptoms and control the growth of the cancer and improve the life span of the person.

Liver Cancer

Liver cancer is very common in Pakistan because of hepatitis.
Usually if diagnosed early it can be cured with surgery or transplant. However, the majority of the time cancer is diagnosed late and can not be cured with treatments. If the cancer has not spread beyond the liver and it is smaller in size , it can be treated with treatments which include radiation to the tumor , or TACE (trans-arterial chemo embolization)in which medicines/chemotherapy is injected into the liver directly going through the vein from the Inguinal area into the liver and injecting medicine to stop the cancer and choking the cancer.
Treatment with medicines and chemotherapy is sometimes effective. There are several medicines which are approved for liver cancer including sorafenib, chemotherapy and nowadays immunotherapy is also Being used and does help some patients.

Gallbladder cancer

It is usually diagnosed when patients present with pain in the abdomen or jaundice?

If it’s diagnosed early, it can be treated with surgery. However, if it has spread into the liver or beyond ,it is treated with chemotherapy which helps some patients to control the disease.

Pancreatic Cancer

It is one of the most common and difficult to treat cancer .
Surgery is done if it’s diagnosed early .After operation ,chemotherapy or radiation or both are done to prevent the cancer from coming back.However, many times disease is advanced and the surgery is not possible. If the cancer has already spread at the time of diagnosis ,only chemotherapy is an option and helps some patients .

Esophageal Cancer

Patients usually have problem eating or swallowing the food either solid or liqid ,loose weight ,pain in chest ,bleeding ,black stools etc.If it is diagnosed early, It is treated with surgery.
However, if the tumor is spread locally, it is treated with a combination of chemotherapy and radiation therapy, which sometimes is effective . If it has spread the treatment is possible with chemotherapy,immunotherapy and works in some people to control the symptoms and the cancer .

Colon Cancer

This is one of the common cancers. Usually people have constipation ,blood in the stool, abdominal pain etc as symptoms.
The diagnosis requires colonoscopy/endoscopy for the biopsy. If the cancer is diagnosed when it is still localized in the colon ,People can have surgery and get rid of the cancer.
If the cancer spreads to the local lymph nodes/ glands around the colon area, then people do require chemotherapy after the surgery which helps prevent the cancer from coming back.
Majority of the time, unfortunately in Pakistan , colon cancer is diagnosed in late stages when it has already spread. Treatments do help to control the  disease, but do not get rid of the disease.
There are many chemotherapies , biological and immunotherapies which are effective in this situation .
If people, especially in the younger age have had colon cancer, they should have their close blood relatives tested for colon cancer as some of these cancers could be inherited.