Cancer Therapy

Treatment of malignant tumors is a very broad issue; I would like to make it comprehensible and easily to understand. First, it should be noted that all treatment options can be divided into curative and palliative therapy. Treatment is usually performed by oncologists, but the approach is rather multidisciplinary, especially with cooperation of surgeons and internal physicians.

Curative treatment

Curative treatment attempts to cure the cancer, but unfortunately, it is not always possible. There are three basic cornerstones of treatment of treatment - surgery, chemotherapy and radiotherapy. In addition, some tumors are sensitive to hormonal therapy and biological treatment.

Surgery

Surgical treatment is the primary curative method in the majority of cancers. The principle is to remove the tumor mass with a certain surrounding area of healthy tissue. Curative surgery has meaning only when there are no distant metastases, unless the surgeons are able to remove them as well.

 

Surgery is carried out to varying extent according to the location and local spread of the tumor (tumor size, growth into surrounding structures and affection of regional lymph nodes). The operations often represent a radical removal of considerable amount of healthy tissue in order to destroy any local metastases. For example, curative surgery of colon cancer is usually associated with the removal of half of the large intestine and local lymph nodes, not just the intestinal section visibly affected by the tumor.

 

Relatively special status has surgical therapy of brain tumors. Accessible tumors are removed by neurosurgical procedures, but deeply located lesions may be inaccessible and this makes them a perfect target for the Leksell gamma knife.

Chemotherapy

Chemotherapy is the main method of treatment of cancers with metastatic spread. In addition, chemotherapy can be used before-, or after the surgical treatment. Chemotherapy may shrink the tumor mass and make the cancer more easily removable by surgical intervention. Chemotherapy performed after the surgery should destroy any remaining cancer cells and micrometastases, i.e. small metastases that can not be found by any imaging method.

Chemotherapy is the treatment of choice for “blood tumors” such as leukemias and the majority of lymphomas. These “blood cancers” do not have a clear primary tumor site, which could be surgically removed.

The principle of chemotherapy is in fact very brutal and simple. We use various toxic substances that damage body cells. The thing is that chemotherapeutic agents are more effective against rapidly dividing cells such as the tumor cells. While the majority of healthy cells recover, the tumor cells die in a process called cell necrosis.

Radiotherapy

Radiotherapy is usually carried out in combination with another treatment method (surgery, chemotherapy).  Radiotherapy allows targeting a specific area of the body, but the general philosophy is similar to chemotherapy. Radiation damages all cells, but the tumor cells are damaged more.

Hormonal therapy

Hormonal therapy is used only in those cancers, whose growth is dependent on the level of certain hormones in the body. These include some (not all!) types of breast cancer in women and prostate cancer in men. Hormonal therapy aims to suppress the hormonal influence of growth of the tumor. One possibility is administration of a drug that directly inhibits the effect of the particular hormone on tumor tissue, which is the case of tamoxifen used in some breast cancers. Other possibility is a drug that suppresses production of the particular hormone in patient's body. Great examples are drugs suppressing production of testosterone in men with prostate cancer.

Biological treatment

Biological therapy is increasingly used in the treatment of cancers. It is a completely new approach, which reflects increasing knowledge of molecular processes in the body, both physiological and pathological. Biological therapy uses special drugs that change certain biological processes in our favor. Some drugs block the ability of tumors to create their own blood vessels, leading to decreased delivery of nutrients to tumor cells. Other drugs block the intracellular signals in tumor cell and thereby suppressing their multiplication. See details in the text dedicated to biological treatment.

Palliative treatment

Palliative treatment aims not to cure the patient. Its task is “only” to improve the quality of life. Some physicians tend to ignore the palliative treatment, but this is a big mistake. Quality of life is an important thing and in the terminally ill patients this is valid as well.

 

Palliative treatment options are very wide and depend on the actual tumor and patient's symptoms. The cornerstone of the therapy is adequate management of pain, supported with proper hydration and adequate nutrition.

 

Palliative therapy may include surgical and endoscopic interventions that are usually aimed at ensuring continuity of a hollow organ, which is compressed by the tumor. Typical palliative procedure is removal of a section of the intestine, which is significantly narrowed by the colon cancer. This procedure can be performed even in patients with present metastases. We regard the procedure as life-saving from a short-term perspective, because it prevents dangerous intestinal obstruction. Of course, the overall prognosis is not significantly changed.

 

Typical palliative endoscopic procedure is associated with insertion of a hollow tube-shaped stent into the bile duct, when the bile duct is compressed by growth of local tumor (in pancreatic cancer, gallbladder cancer, etc.). The stent allows the bile outflow, which improves the overall condition of the patient, although the tumor itself is not affected by the procedure at all.

 

Many lung cancers (and rarer mesotheliomas) are accompanied with pleural effusion (i.e. fluid in pleural space). The fluid compresses the lung and causes shortness of breath. This can be solved by palliative talc pleurodesis. Talc (or other irritant) is applied into the pleural cavity and causes local chemical inflammation (accompanied with temporary annoying pain and fever). The inflamed lung surface tightly connects with the chest wall, resulting in disappearance of the pleural cavity. The procedure is not very pleasant, but it prevents further formation of pleural fluid and greatly improves patient's respiratory conditions.

 

Even the radiotherapy can be palliative – typically, it is irradiation of bone metastases, which has a great analgesic effect and belongs among important approaches in pain management.

Alternative Treatment

Alternative medicine, in my opinion, has its place in the therapy of cancer diseases, of course with certain objections. Alternative therapy has no studies to confirm its effect, and therefore it must be considered only a supporting option to the traditional therapy. There is no doubt that it can give people hope and its placebo effect alone can improve the way they struggle with the disease. On the other hand, there are also methods of alternative medicine that could be directly harmful to patients with malignant disease (such as so-called Breuss diet). Similarly, it is very difficult to say what happens, when the patient combines various herbal preparations used in alternative medicine with chemotherapy. It can not be ruled out that the herbs may inadequately increase or decrease the effect of chemotherapy. Increased effect may be very dangerous as well as it can directly threaten the patient's life.