Treating Cancer

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Principles of treating cancer and flaws in alternative therapies

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Treating Cancer

  1. 1. Cancer Management How do we decide? Alex J Crandon MB BS (Syd) PhD (Leeds) FRCOG (Lond) FRANZCOG (Melb) CGO Gynaecological Oncologist Mater and Brisbane Private Hospitals Director Qld Centre for Gyn. Cancer
  2. 2. Principles of Cancer Management <ul><li>Make a diagnosis </li></ul><ul><li>Determine disease distribution </li></ul><ul><li>Ask: “What is the aim of treatment?” Cure or palliation </li></ul><ul><li>What does the literature say is the best way to achieve the identified aim of treatment. </li></ul>
  3. 3. Current Treatments <ul><li>These are in no specific order: </li></ul><ul><ul><li>Surgery, </li></ul></ul><ul><ul><li>Radiotherapy, </li></ul></ul><ul><ul><li>Chemotherapy, </li></ul></ul><ul><ul><li>Some combination of above, or </li></ul></ul><ul><ul><li>Do nothing. </li></ul></ul>
  4. 4. Surgery <ul><li>This involves the treatment of a specific region. Generally by removing the offending tumour +/- surrounding tissue and draining lymph nodes. </li></ul>
  5. 5. Radiotherapy <ul><li>Uses x-rays to treat cancer. </li></ul><ul><li>Some cells killed out-right. </li></ul><ul><li>Many more cells damaged and die later trying to reproduce </li></ul>
  6. 6. Chemotherapy <ul><li>Uses chemicals called cytotoxics to damage cells so they die out-right or when they try to reproduce. </li></ul><ul><li>Not all chemo makes you sick-there are over 80 different drugs </li></ul>
  7. 7. Palliative Care <ul><li>Doesn’t mean your about to die. </li></ul><ul><li>Your treatment is no longer aimed at cure but at quality of life </li></ul><ul><li>You may be undergoing palliative care for years. </li></ul>
  8. 8. New Treatments <ul><li>Identify the new treatment </li></ul><ul><li>Test it for: </li></ul><ul><ul><li>Safety – how much to give or do? </li></ul></ul><ul><ul><li>What side-effects? </li></ul></ul><ul><ul><li>Effectiveness? </li></ul></ul><ul><ul><li>Then compare with standard best therapy, i.e., a prospective clinical trial </li></ul></ul>
  9. 9. Phase 1 Trials <ul><li>Phase 1 trials are done to find out </li></ul><ul><ul><li>The safe dose range           </li></ul></ul><ul><ul><li>The side effects           </li></ul></ul><ul><ul><li>How the body copes with the drug  </li></ul></ul><ul><li>  People entering phase 1 trials often have advanced cancer and have usually had all the treatments available to them.  </li></ul>
  10. 10. Phase 2 Trials <ul><li>Phase 2 trials are done to find out </li></ul><ul><ul><li>If the new treatment works well enough to test in a larger phase 3 trial           </li></ul></ul><ul><ul><li>Which types of cancer the treatment works for   </li></ul></ul><ul><ul><li>More about side effects and how to manage them           </li></ul></ul><ul><ul><li>More about the best dose to use </li></ul></ul>
  11. 11. Phase 3 Trials <ul><li>These trials compare new treatments with the best currently available treatment (the standard treatment). They may compare </li></ul><ul><ul><li>A completely new treatment with the standard treatment        </li></ul></ul><ul><ul><li>Different doses or ways of giving a standard treatment        </li></ul></ul><ul><ul><li>A new radiotherapy schedule with the standard one </li></ul></ul>
  12. 12. Example of Problems <ul><li>A new drug was developed for ovarian cancer </li></ul><ul><li>Phase 3 trial: </li></ul><ul><ul><li>multimillion dollar international trial </li></ul></ul><ul><ul><li>given after surgery compared with the then standard therapy showed it worked better than standard therapy </li></ul></ul>
  13. 13. Example of Problems 2 <ul><li>New studies about the same time showed that survival after ovarian cancer treatment was much better for patients who had been optimally debulked at surgery </li></ul>
  14. 14. Example of Problems 3 <ul><li>Questions were asked about the debulking success in the new chemotherapy trial </li></ul><ul><li>When looked at it was found that by chance alone most of the optimally debulked patients had ended up in the group that got the new drug </li></ul><ul><ul><li>Are we seeing the effect of the new drug or the optimal debulking? </li></ul></ul>
  15. 15. Example of Problems 4 <ul><li>Back to the drawing boards </li></ul><ul><li>A new multimillion dollar international trial to allow for the effects of the debulking </li></ul><ul><li>It turned out that in both optimally and non-optimally debulked groups the new chemotherapy did better </li></ul>
  16. 16. Complementary or Alternative Treatment <ul><li>Most medicos have little problem with complementary treatment </li></ul><ul><li>They recognise that many of our current drugs started as plant or animal extracts </li></ul><ul><li>We know what we are giving the naturopath does not. </li></ul>
  17. 17. St Anthony’s Fire <ul><li>Ergotism – a painful disease with seizures, spasms, diarrhoea, vomiting, paresthesia, headaches, burning in limbs sometimes leading to gangrene and death </li></ul><ul><li>Eating bread made from rye infected with a fungus claviceps purpurea </li></ul>
  18. 18. Ergot & Midwives <ul><li>Midwives knew that women having post partum haemorrhage could be stopped from bleeding by giving them some ergot infected bread </li></ul><ul><li>Problem: sometimes they killed women with ergotism </li></ul><ul><li>We have discovered that the active ingredient is ergometrine and now we give that or its synthetic cousin syntocinon. </li></ul>
  19. 19. Legislative requirements <ul><li>Only a licensed Vet can operate on an animal </li></ul><ul><li>Only a licensed gas fitter or plumber can install a gas stove or water heater </li></ul><ul><li>Only a qualified electrician can rewire your house </li></ul>
  20. 20. Legislative Enigma <ul><li>Anyone can hang up a piece of wood saying “Naturopath”, “Herbalist”, “Iridologist” or “Rake Healer” etc and provide treatment in isolation to people with cancer </li></ul><ul><li>These people have never provided a single phase 3 study to backup their treatment(s) </li></ul>

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