Cancer can be treated by surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy (including immunotherapies such as monoclonal antibody therapy) and synthetic lethality. The choice of therapy depends on the location and level of tumor and disease stage, as well as the patient's general condition (performance status). A number of experimental cancer treatments are also being developed. Based on current estimates, two out of five people will have cancer at some point in their lives.
The complete removal of cancer without damaging other parts of the body (ie achieving healing with near-zero side effects) is an ideal goal of care and is often a goal in practice. Sometimes this can be done by surgery, but the cancer's tendency to invade adjacent tissues or spread to distant sites with microscopic metastases often limits their effectiveness; and chemotherapy and radiotherapy can have a negative effect on normal cells. Therefore, healing with undeniable adverse effects can be accepted as a practical goal in some cases; In addition to curative intentions, the practical purpose of the therapy may also include (1) suppressing the cancer to a subclinical state and maintaining it for many years with good quality of life (ie, treating cancer as a chronic disease), and (2) palliative care without intent curative (for advanced stage metastasis cancer).
Since "cancer" refers to a class of illness, it is unlikely that there will be one "cure for cancer" more than there will be a single treatment for all infectious diseases. The angiogenesis inhibitor was once thought to have potential as a "silver bullet" treatment applicable to many types of cancer, but this does not occur in practice.
Video Treatment of cancer
Jenis perawatan
Cancer treatment has undergone evolutionary changes because the understanding of the underlying biological processes has increased. Surgical removal of tumors has been documented in ancient Egypt, hormone therapy and radiation therapy developed in the late 19th century. Chemotherapy, immunotherapy and newer targeted therapies are products of the 20th century. When new information about cancer biology emerges, care will be developed and modified to improve effectiveness, precision, survival, and quality of life.
Surgery
Theoretically, non-haematological cancers can be cured if completely removed by surgery, but this is not always possible. When the cancer has metastasized to other sites in the body prior to surgery, complete surgical excision is usually not possible. In the Halstedian model of cancer development, the tumor grows locally, then spreads to the lymph nodes, then throughout the body. It has spawned the popularity of local treatments just like surgery for small cancers. Even small local tumors are increasingly recognized as having metastatic potential.
Examples of surgical procedures for cancer include mastectomy for breast cancer, prostatectomy for prostate cancer, and lung cancer surgery for non-small cell lung cancer. The goal of surgery can be to remove only a tumor, or an entire organ. A single cancer cell is invisible to the naked eye but can grow back into a new tumor, a process called recurrence. For this reason, the pathologist will examine the surgical specimen to determine whether there is a healthy tissue margin, thereby reducing the likelihood of microscopic cancer cells left behind in the patient.
In addition to primary tumor removal, surgery is often necessary for staging, eg determining the extent of the disease and whether it has metastasized to regional lymph nodes. Staging is a major determinant of prognosis and the need for adjuvant therapy. Sometimes, surgery is needed to control symptoms, such as spinal cord compression or bowel obstruction. This is called palliative treatment.
Surgery may be performed before or after any other form of treatment. Preoperative care is often described as neoadjuvant. In breast cancer, survival rates of patients receiving neoadjuvant chemotherapy are no different from those treated after surgery. Previous chemotherapy allows the oncologist to evaluate the effectiveness of the therapy, and may facilitate the removal of the tumor. However, the survival benefit of neoadjuvant treatment in lung cancer is less clear.
Radiation therapy
Radiation therapy (also called radiotherapy, X-ray therapy, or radiation) is the use of ionizing radiation to kill cancer cells and shrink tumors. Radiation therapy can be administered externally via external beam radiotherapy (EBRT) or internally via brachytherapy. The effects of radiation therapy are localized and limited to the treated area. Radiation therapy injures or destroys cells in the treated area ("target tissue") by damaging their genetic material, making it impossible for these cells to continue growing and dividing. Although radiation damages cancerous cells and normal cells, most normal cells can recover from the effects of radiation and function properly. The goal of radiation therapy is to destroy as much of the cancer cells as possible, while limiting damage to nearby healthy tissue. Therefore, it is given in many fractions, allowing healthy tissue to recover among fractions.
Radiation therapy can be used to treat virtually any type of solid tumor, including brain, breast, cervical, laryngeal, liver, lung, pancreatic, prostate, skin, abdominal, uterine, or soft tissue soft tissue. Radiation is also used to treat leukemia and lymphoma. The radiation dose to each site depends on a number of factors, including the radio sensitivity of each type of cancer and whether there are nearby tissues and organs that may be damaged by radiation. Thus, as with any form of treatment, radiation therapy is not without its side effects. Radiation therapy kills cancer cells by destroying their DNA (molecules in cells carrying genetic information and passing it from one generation to the next) (1). Radiation therapy can damage DNA directly or create charged particles (free radicals) in cells that can in turn damage DNA. (2) Radiation therapy can cause dry mouth from exposure of salivary glands to radiation. The salivary glands lubricate the mouth with moisture or saliva. Post-therapy, the salivary glands will function again but rarely in the same way. Dry mouth caused by radiation can be a lifelong problem. The specific plan of radiation therapy for your brain cancer will be based on several factors, including the type and size of brain tumor and disease level. External beam radiation is commonly used for brain cancer. The emitted area usually includes the tumor and the area around the tumor. For metastatic brain tumors, radiation is sometimes given throughout the brain. Radiation therapy uses special equipment to send high doses of radiation to cancer cells. Most of the cells in the body grow and divide to form new cells. But cancer cells grow and divide faster than many normal cells around them. Radiation works by making small breaks inside the DNA inside the cell. Radiation may not be a treatment option if a tumor is diagnosed at an advanced stage or in a vulnerable place. In addition, radiation causes significant side effects when used in children aged 0-14 years. Defined to be a useful treatment but causing significant side effects that affect the lifestyle of young patients. Radiotherapy is the use of high-energy rays, usually x-rays and the same light (such as electrons) to treat disease. It works by destroying cancer cells in the treated area. Although normal cells can also be damaged by radiotherapy, they can usually repair themselves, but cancer cells can not. If the tumor is found in the late stages, it requires the patient to have a higher radiation exposure that may be harmful to the organ. Radiotherapy is determined to be an effective treatment in adults but it causes significant side effects that can affect the daily life of the patient. In children most radiotherapy causes long-term side effects such as hearing loss and blindness. Children who have received cranial radiotherapy are considered at high risk for academic failure and cognitive delay. Study by Reddy A.T. determining a significant reduction in IQ with higher radiation doses, especially for children with brain tumors. Radiation therapy is not the best treatment for brain tumors, especially in children because it causes significant damage. There are alternative treatments available for young patients such as surgical resection to reduce the occurrence of side effects.
Chemotherapy
Chemotherapy is a cancer treatment with drugs ("anticancer drugs") that can destroy cancer cells. In current use, the term "chemotherapy" usually refers to a cytotoxic drug that affects cells that divide in general, in contrast to targeted therapy (see below). Chemotherapy drugs interfere with cell division in various ways possible, for example by DNA duplication or newly formed chromosomal separations. Most forms of chemotherapy target all cells that divide rapidly and are not specific to cancer cells, although some degree of specificity may come from the inability of many cancer cells to repair DNA damage, while normal cells can generally. Therefore, chemotherapy potentially damages healthy tissue, especially tissues that have high levels of replacement (eg intestinal lining). These cells usually repair themselves after chemotherapy.
Because some drugs work together better than alone, two or more drugs are often given at the same time. This is called "a combination of chemotherapy"; most chemotherapy regimens are given in combination.
Treatment of some leukemia and lymphoma requires the use of high-dose chemotherapy, and total body irradiation (TBI). This treatment restricts the bone marrow, and hence the body's ability to recover and replenish blood. For this reason, bone marrow, or peripheral blood stem cell removal is done before the ablative part of the therapy, to allow "rescue" after treatment is given. This is known as autologous stem cell transplantation.
Targeted therapies
The targeted therapy, which was first available in the late 1990s, had a significant impact in the treatment of some cancers, and is currently a very active research area. This is the use of a special agent for cancer-regulated proteins. Drug therapy targeting small molecules is generally an enzymatic domain inhibitor on mutated, overexpressed, or critical proteins in cancer cells. Prominent examples are imatinib tyrosine kinase inhibitors (Gleevec/Glivec) and gefitinib (Iressa).
Monoclonal antibody therapy is another strategy in which therapeutic agents are antibodies that specifically bind proteins to the surface of cancer cells. Examples include the anti-HER2/neast antibody trastuzumab (Herceptin) used in breast cancer, and rituximab anti-CD20 antibody, used in various B-cell malignancies.
Targeted therapy may also involve small peptides as "homing devices" that can bind to cell surface receptors or affect the extracellular matrix surrounding the tumor. Radionuclides attached to these peptides (eg RGD) eventually kill cancer cells if nuclides decay around the cells. Especially oligo or multimer of this binding motif is very interesting, as this can lead to increased specificity and avidity of the tumor.
Photodynamic therapy (PDT) is a ternary treatment for cancers involving photosensitizers, tissue oxygen, and light (often using lasers). PDT can be used as a treatment for basal cell carcinoma (BCC) or lung cancer; PDT can also be useful in removing traces of malignant tissue after surgical removal of large tumors.
High-energy therapeutic ultrasound can increase the burden of higher anti-cancer and nanomedicine drugs to target tumor sites 20x higher than traditional targeted cancer treatments.
Immunotherapy
Cancer immunotherapy refers to a variety of therapeutic strategies designed to induce the patient's own immune system to fight the tumor. Contemporary methods for generating immune responses to tumors include intravesical BCG immunotherapy for shallow bladder cancer, and use of interferon and other cytokines to induce an immune response in renal cell carcinoma and melanoma patients. Cancer vaccine to produce a specific immune response is the subject of intensive research for a number of tumors, especially malignant melanoma and renal cell carcinoma. Sipuleucel-T is a vaccine-like strategy in the final clinical trial for prostate cancer in which dendritic cells of the patient are loaded with prostatic acid phosphatase peptides to induce a specific immune response against prostate-derived cells.
Allogenic hematopoietic stem cell transplantation ("bone marrow transplant" from a genetically non-identical donor) may be considered as a form of immunotherapy, since donor immune cells will often attack the tumor in a phenomenon known as the graft-versus-tumor effect. For this reason, allogeneic HSCT leads to a higher cure rate than autologous transplantation for some cancers, although the side effects are also more severe.
Cell-based immunotherapy in which patients have Natural Killer (NK) cells and Cytotoxic T-Lymphocytes (CTL) used has been practiced in Japan since 1990. NK cells and CTLs primarily kill cancer cells as they are developed. This treatment is given along with other treatment modes such as Surgery, Radiotherapy or Chemotherapy and is called Autologous Improvement Therapy (AIET)
Hormonal therapy
Growth of some cancers can be inhibited by giving or blocking certain hormones. Common examples of hormone sensitive tumors include certain types of breast and prostate cancers. Removing or blocking estrogen or testosterone is often an important additional treatment. In certain cancers, agonist hormone administration, such as progestogens, may be useful therapeutically.
angiogenesis inhibitors
The angiogenesis inhibitor prevents the vast growth of blood vessels (angiogenesis) that the tumor needs to survive. Some, such as bevacizumab, have been approved and used clinically. One of the main problems with anti-angiogenesis drugs are many factors that stimulate the growth of blood vessels in normal cells or cancer. Anti-angiogenesis drugs only target one factor, so other factors continue to stimulate the growth of blood vessels. Other problems include route administration, maintenance of stability and activity and targeting of tumor vasculature.
Synthetic letters
Synthetic lethality arises when a combination of deficiencies in the expression of two or more genes leads to cell death, whereas a deficiency of only one of these genes is not. Deficiency can arise through mutations, epigenetic changes or inhibitors of one or both genes.
Cancer cells are often deficient in DNA repair genes. (Also see DNA repair deficiency in cancer.) This DNA repair defect may be caused by mutations or, often, epigenetic sucking (see epigenetic detachment from DNA repair). If this DNA repair defect is in one of seven DNA repair pathways (see DNA repair path), and the path of DNA compensation repair is inhibited, then tumor cells can be killed by synthetic lethality. Non-tumorous cells, with a complete initial pathway, can survive.
Ovarian cancer
Mutations in DNA repair genes BRCA1 or BRCA2 (active in homologous recombination repair) are synthetically lethal by inhibition of DNA repair gene PARP1 (active in excision repair base and at the microhomology-mediated end join the DNA repair path).
Ovarian cancer has a mutation defect in BRCA1 in about 18% of patients (13% germline mutation and 5% somatic mutation) (see BRCA1). Olaparib, a PARP inhibitor, was approved in 2014 by the US FDA for use in BRCA-related ovarian cancer that had previously been treated with chemotherapy. The FDA, by 2016, also approves PARP rucaparib inhibitors to treat women with advanced ovarian cancer who have been treated with at least two chemotherapies and have BRCA1 or BRCA2 mutated gene.
Colon cancer
In colon cancer, the epigenetic defect of the WRN genes appears synthetically lethal by inactivation TOP1 . Specifically, the irinotecan inactivation of TOP1 is synthetic with lethal expression of deficiency of the DNA repair gene WRN in patients with colon cancer. In a 2006 study, 45 patients had colon tumors with hypermethylated WRN (silenced expression WRN ) promoters, and 43 patients had unmethylated WRN gene promoter, resulting in high WRN protein expression. Irinotecan was stronger for patients with hypermethylated WRN promoters (39.4 months survival) than for those with unmet methylated (RNN) unrenewable [i] WRN promoters. Gene promoter WRN is hypermethylated in about 38% of colorectal cancers.
There are five different stages of colon cancer, and all five of these stages all have treatment. Stage 0, is the place where patients are required to undergo surgery to remove polyps (American Cancer Society). Stage 1, depending on the location of the cancer in the colon and lymph nodes, the patient underwent an operation like Stage 0. Stage 2 patients had the removal of nearby lymph nodes, but depending on what the doctor said, the patent may have to undergo chemotherapy. after surgery (if cancer is at higher risk for return). Stage 3, is where the cancer has spread throughout the lymph nodes but not yet to other organs or body parts. When it comes to this stage, Surgery is done on the colon and lymph nodes, then the doctor orders Chemotherapy (FOLFOX or CapeOx) to treat colon cancer at the required location (American Cancer Society). The last patient can get is Phase 4. Stage 4 patients just undergo the surgery for cancer prevention, along with pain relief. If the pain continues with both options then the doctor will recommend radiation therapy. The main treatment is Chemotherapy, because how aggressive the cancer becomes at this stage is not only to the colon but to the lymph nodes.
Maps Treatment of cancer
Symptom control and palliative care
Although the control of cancer symptoms is not usually regarded as a treatment directed at cancer, it is an important determinant of the quality of life of cancer patients, and plays an important role in the decision whether the patient is able to undergo other treatments. Although doctors generally have therapeutic skills to relieve pain, nausea and vomiting induced by chemotherapy, diarrhea, bleeding, and other common problems in cancer patients, multidisciplinary expertise of palliative care has emerged specifically in response to the need for symptom control in this patient group..
Pain medications, such as morphine and oxycodone, and antiemetics, a drug for suppressing nausea and vomiting, are very common in patients with cancer-related symptoms. Elevated antiemetics such as ondansetron and analogue, as well as aprepitant have made aggressive treatments much more viable in cancer patients.
Cancer pain can be associated with sustained tissue damage due to disease or treatment processes (ie surgery, radiation, chemotherapy). Although there is always the role of environmental factors and affective disorders in the genesis of painful behavior, this is not usually the dominant etiologic factor in patients with cancer pain. Some patients with severe cancer-related pain are nearing the end of their lives, but in all cases palliative therapy should be used to control pain. Problems such as social stigma using opioids, occupation and functional status, and the consumption of health care can be of concern and may need to be addressed in order for people to feel comfortable taking the medication needed to control their symptoms. A typical strategy for managing cancer pain is to get the patient as comfortable as possible using the fewest drugs but opioids, surgery, and physical measures are often necessary. In the past doctors were reluctant to prescribe narcotics for pain in terminal cancer patients, for fear of contributing to addiction or suppressing respiratory function. The palliative care movement, the newer branch of the nursing home movement, has spawned wider support for the treatment of preemptive pain for cancer patients. The World Health Organization also notes uncontrolled cancer pain as a worldwide problem and sets the "ladder" as a guide for how practitioners should treat pain in patients suffering from cancer.
Cancer-related fatigue is a very common problem for cancer patients, and it has recently become important enough for oncologists to suggest treatment, although it plays an important role in many of the patient's quality of life.
Hospice on cancer
Hospice is a group that provides care in the home of someone who has advanced disease with a probability prognosis of less than 6 months. Since most treatments for cancer involve unpleasant side effects, a patient with little realistic hope of healing or prolonged life can choose to seek only convenient treatment, for more radical treatment in exchange for a prolonged period of normal life. This is a very important aspect of care for patients whose illness is not a good candidate for other forms of treatment. In these patients, the risks associated with chemotherapy may actually be higher than likely to respond to treatment, making further attempts to cure the disease unlikely. Of note, patients at home care can sometimes still get treatments such as radiation therapy if it is used to treat symptoms, not as an attempt to cure cancer.
Research
Clinical trials, also called research, test new treatments in cancer patients. The purpose of this study is to find a better way to treat cancer and help cancer patients. Clinical trials test different types of treatments such as new drugs, new surgical approaches or radiation therapy, new treatment combinations, or new methods such as gene therapy.
Clinical trials are one of the last stages of a long and careful cancer research process. The search for new treatments began in the laboratory, where scientists first developed and tested new ideas. If an approach seems promising, the next step might be testing a cure for animals to see how it affects cancer in living things and whether it has harmful effects. Of course, treatments that work well in the lab or in animals do not always work well in humans. The study was conducted with cancer patients to find out whether promising treatments are safe and effective.
Patients who participate may be personally assisted by the care they receive. They get the latest treatments from cancer experts, and they receive new treatments that are being tested or the best standard treatment available for their cancer. At the same time, new treatments may also have unknown risks, but if new treatments prove to be effective or more effective than standard treatment, the study of patients who receive them may be the first to benefit. There is no guarantee that new treatments being tested or standard care will produce good results. In children with cancer, the trial survey found that those enrolled in the average trial were no more likely to perform better or worse than those who were on standard treatment; this confirms that the success or failure of an experimental treatment is unpredictable.
Exosome research
Exosomes are closed-lipid microvesicles that are shed by solid tumors into body fluids, such as blood and urine. Research is currently being conducted trying to use exosomes as a method of detection and monitoring for various cancers. The hope is to detect cancers with high sensitivity and specificity through detection of specific exosomes in the blood or urine. The same process can also be used to monitor the progress of patient treatment more accurately. Enzymes associated with specific lectin assays or ELLSA have been shown to directly detect melanoma derived exosomes from fluid samples. Previously, exosomes were measured with total protein content in purified samples and by indirect immunomodulatory effects. ELLSA directly measures exosomal particles in complex solutions, and has been found to be able to detect exosomes from other sources, including ovarian cancer and macrophages that are infected with tuberculosis.
Exosomes secreted by the tumor are also believed to be responsible for triggering the death of programmed cells (apoptosis) of immune cells; the T-cell signaling interruption needed to improve the immune response; inhibits the production of anti-cancer cytokines, and implies the spread of metastasis and allows angiogenesis. Studies are currently being conducted with "Lectin affinity plasmapheresis" (LAP), LAP is a blood-filtering method that selectively targets tumor-based exosomes and removes them from the bloodstream. It is believed that the decline of exosomes secreted by tumors in the patient's bloodstream will slow the progression of cancer while at the same time improving the patient's own immune response.
Complementary and alternative
Complementary and alternative medicine (CAM) treatments are a diverse group of medical and health care systems, practices and products that are not part of conventional treatment and have not been proven effective. "Complementary medicine" refers to the methods and substances used in conjunction with conventional medicine, while "alternative medicine" refers to a compound used as a substitute for conventional medicine. CAM usage is common among people with cancer; a 2000 study found that 69% of cancer patients had used at least one CAM therapy as part of their cancer treatment. Most complementary and alternative medicine for cancer has not been studied or rigorously tested. Some of the alternative treatments that have been investigated and proven to be ineffective continue to be marketed and promoted.
Awareness-based interventions appear to facilitate physical and emotional adjustment to survival with cancer through symptom reduction, positive psychological growth, and by bringing beneficial changes in biological outcomes.
Special circumstances
In pregnancy
The incidence of concurrent cancer during pregnancy has been increased due to the increasing age of pregnant women and due to the discovery of incidental maternal tumors during prenatal ultrasound examination.
Cancer treatment should be chosen not to endanger both the woman and her embryo/fetus. In some cases, therapeutic abortion may be recommended.
Radiation therapy is not possible, and chemotherapy always poses a risk of miscarriage and congenital malformation. Little is known about the effects of drugs on children.
Even if the drug has been tested as not crossing the placenta to reach the child, some forms of cancer can harm the placenta and make the drug pass through it anyway. Some forms of skin cancer can even metastasize to a child's body.
Diagnosis also becomes more difficult, because computed tomography is not feasible because of high radiation doses. However, magnetic resonance imaging works normally. However, contrast media can not be used, as they cross the placenta.
As a consequence of the difficulties of diagnosing and treating cancer during pregnancy, a good alternative method for performing a caesarean section when a child is eligible to start a more aggressive cancer treatment, or, if cancer is malignant enough that you can not possibly wait that long, to have an abortion for treat cancer.
In utero
Fetal tumors are sometimes diagnosed while still in the womb. Teratomas are the most common type of fetal tumor, and are usually benign. In some cases this is surgery while the fetus is still in the uterus.
See also
- American Cancer Society
- Cancer and nausea
- Experimental cancer treatment
- Global Task Force on Extended Access to Cancer Care and Control in Developing Countries
- Unproven and unproven list of cancer treatments
- Cancer treatment development time line
References
Bibliography
- "Radiation Therapy for Brain Cancer | CTCA." CancerCenter.com. N.p., Jan. 01. 0001. Web. March 21, 2017.
- "How Do Radiation Therapy Work?" American Cancer Society. N.p., n.d. Web. March 21, 2017.
- "Radiation Therapy for Cancer." National Cancer Institute. N.p., n.d. Web. March 21, 2017.
External links
- Cancer Treatment in Curlie (based on DMOZ)
Source of the article : Wikipedia
0 Comments