PRINCIPLES OF CANCER

TREATMENT

Rakesh KumarGroup :- 3rd Course :-5th

Goals of cancer treatment1- Primary goal Cure the patient Render him clinically and pathologically

free of disease and return their life expectancy to that of healthy individuals of the same age and sex.

Current therapies do not offer cures for all patients

Goals of cancer treatment2- The best alternative goal To prolong survival while maintaining

the patient's functional status and quality of life.

3- The 3rd goal Relive symptoms such as pain for

patients in whom the likehood of cure or prolonged survival is very low

Modalities of cancer treatmentThe Major Modalities Surgery Radiation Chemotherapy Biological therapy

Modalities of cancer treatmentThe most appropriate type of therapy for

each individual patient is determined by Type and extent of tumor involvement Treatment goals Performance status Age Concomitant disease Many patient receive 2 or 3 of these modalities

together

I-Surgery The oldest cancer treatment The most invasive method Requires patient be able to tolerate

physical challenges of surgery Was only method that could produce cures Still provides the best chance of cure for

most patients with solid tumors.

I-Surgery Uses

…Treat the primary cancer…To remove isolated metastatic masses…To make other methods of treatment

possible e.g. providing access for chemotherapy delivery (implanted infusion pumps)

I-SURGERY Diagnosis and Staging Reconstruct anatomical defects to

improve function, cosmetic appearance, and quality of life

Prevention… Permitting the removal of precancerous

lesions such as abnormal moles or colon polyps.

I-SURGERY Treat complication

… Hemorrhage… Perforation… Bowel obstruction… Spinal cord compression

I-SURGERY

Debulking …Reduce the size of the tumor even though the entire tumor cannot be resected

1ry to relive pain or other symptoms Increase effectiveness of radiation or

chemotherapy

I-SURGERY

Surgical removal of a source of hormone…A form of hormonal therapy…Used in to treat tumors whose growth depends on those hormones…Most common type: removal of testes in prostate cancer and removal of ovaries in breast cancer.

II- Radiation

It is the destruction of cancer cells by ionizing radiation

A component of treatment for ½-2/3 of all patients with cancer

Radiation is usually generated by machines outside the patient (external beam radiation)

II- Radiation

Less commonly radiation sources are placed close to the body surface or within the body cavity (brachy-therapy)

Sometimes radiation sources are implanted into or around cancerous tissue (interstitial brachytherapy)

II- Radiation

Usually administered in small doses over several weeks (fractionating)

fractionating permits the administration of levels of radiation sufficient to kill tumor cells while allowing normal surrounding tissue to recover from damage

II- RadiationSide Effects Radiation can never be directed only at tumor

and normal cells and tissue are also damaged The most sensitive tissues are those that

undergo continuous cell renewal such as the skin, hair , GI mucosa, bone marrow, reproductive tissue, and sweat glands

In slowly growing tissue such as lungs, effects of radiation is seen much later

II- RADIATIONSide effects: the ability to produce a cure with

radiation will depend on the capacity of normal tissues surrounding the tumor to withstand the toxic effects… if the normal tissue are very sensitive,

the range of radiation doses used may be limited

II- Radiation Radiocurability: ability to cure by

radiation Depends on

… The size and location of the tumor… Type of tumor… Tumor’s radiosensitivity

Curative radiation is limited to localized tumors like surgery

II- RadiationUses Curative for localized tumors Total body radiation to prepare for bone

marrow transplant , but highly toxic As supplement to surgery

To destroy micro metasitasis

II- RadiationUses Palliatively

… the most common used is to relive pain caused by skeletal bone metastases

… such as seizures associated with brain metastases

… spinal cord compression caused by growth of tumors on the spine

III-CHEMOTHERAPY

refers to the use of conventional cytotoxic drugs in addition to hormonal and endocrine therapy.

Originally started in 1941, when Goodman and Gilman first administered nitrogen mustard to patients with lymphoma

III-CHEMOTHERAPY

Now there are > 50 conventional cytotoxic agents and > 15 hormonal agents for cancer treatment

III-CHEMOTHERAPY

Cancer chemotherapy may be Primary Palliative Adjuvant neoadjuvant

Chemotherapy used alone with curative intent 

Acute lymphocytic leukemia Acute myelogenous leukemia

Chemotherapy used as adjuvant therapy with curative intent 

Breast cancer Colorectal cancer

Chemotherapy used as neoadjuvant therapy 

Anal carcinoma  Bladder cancer

Chemotherapy used to palliate symptoms in advanced disease 

Bladder cancer  Brain tumors

Chemotherapy has little or no effect on palliation 

Hepatocellular cancer Renal cell carcinoma