Cancer Treatment

1. Cancer Treatment

2. Cancer Treatment
Cancer can be treated by:-
1) Surgery
2) Chemotherapy
3) Radiation therapy
4) Hormonal therapy
5) Targeted therapy (including immunotherapy such
as monoclonal antibody therapy)
6) Synthetic lethality
The choice of therapy depends upon the location and grade
of the tumor and the stage of the disease, as well as the
general state of the patient (performance status).

3.  1.Surgery:-
 In theory, non-hematological cancers can be cured if
entirely 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 impossible.
 In the Halstedian model of cancer progression, tumors
grow locally, then spread to the lymph nodes, then to
the rest of the body.
 This has given rise to the popularity of local-only
treatments such as surgery for small cancers.
 Even small localized tumors are increasingly recognized
as possessing metastatic potential.

4.  Examples:-
Examples of surgical procedures for cancer include for
non-small cell lung cancer:-
Such as-
o mastectomy for breast cancer,
o prostatectomy for prostate cancer,
o lung cancer surgery.
The goal of the surgery can be either the removal of only
the tumor, or the entire organ.
A single cancer cell is invisible to the naked eye but can
regrow into a new tumor, a process called recurrence.

5.  2.Chemotherapy:-
 It is one of the most common treatments for cancer.
 It uses certain drugs to kill cancer cells or to stop them from growing
and spreading to other parts of your body. Your doctor might prescribe
chemo by itself or with surgery or radiation therapy.
 Why You Need Chemotherapy ?
Even after surgery to remove a tumor, your body might still have cancer
cells. These cells can grow new tumors or spread the cancer to other parts
of your body
 Chemotherapy drugs help destroy, shrink, or control those cells. It
might also treat symptoms the cancer causes, like pain. You might also
get chemo to shrink a tumor before your doctor removes it in surgery.
 How It Works
 Chemotherapy drugs work in a few different ways. They can:
 Kill both cancerous and healthy cells
 Fight only cancer cells
 Keep tumors from growing blood vessels, which help them thrive
 Attack the cancer cells’ genes so the cells die and can’t grow into new
tumors

6.  Common Chemotherapy Drugs
o chemo drug interferes with the normal metabolism of cells,
which makes them stop growing.
o These drugs are called antimetabolites. Doctors often use
them to treat leukemia and cancer in the breasts, ovaries,
and intestines. Drugs in this group include 5-fluorouracil,6-
mercaptopurine, cytarabine, gemcitabine,
and methotrexate
 Anthracycline chemotherapy attacks the enzymes inside
cancer cells’ DNA that help them divide and grow. They
work for many types of cancer. Some of these drugs are
actinomycin-D, bleomycin, daunorubicin, and doxorubicin.

7. 3.Radiation therapy:-
 Radiation therapy (also called radiotherapy, X-ray therapy, or irradiation)
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.
 How Does It Work?
 Cells in your body are always dividing and making new copies. When you
have cancer, though, some cells start to divide way too fast.
 That's where radiation therapy can help. It uses high-energy particles to
make tiny breaks in the DNA of cancer cells to destroy or damage them,
so they can no longer make new copies.
 The aim is to treat your cancer by slowing or stopping tumor growth.
Your doctor may sometimes suggest you get radiation therapy to shrink a
tumor before you get surgery. Or he may recommend it after surgery to
keep a tumor from coming back.
 If cancer cells have spread to other parts of your body, radiation therapy
can kill them before they grow into new tumors.
 If you have a cancer that can't be cured, your doctor may still suggest
you use "palliative" radiation therapy. The goal is to shrink tumors and
ease symptoms of your disease.

8.  Types of Radiation Therapy:-
I. The kind of radiation therapy you get depends on things like:
II. Type of cancer you have
III. How big your tumors are
IV. Where your tumors are
V. How close your tumors are to other tissues
VI. Your general health
VII. Other treatments you're getting
 The two main types of radiation therapy for cancer
are:-
1. External beam radiation therapy
2. Internal radiation therapy
In another option, called brachytherapy-Brachytherapy usually
treats head, neck, breast, cervix, endometrial, prostate,
and eye cancers.

9.  Radiation Therapy side effects:-
may include fatigue, temporary hair loss, sexual and fertilityproblems, blurry vision,
and skin changes.
4. Hormonal therapy:-
Hormone therapy is a cancer treatment that slows or stops the growth of cancer that
uses hormones to grow. Hormone therapy is also called hormonal therapy, hormone
treatment, or endocrine therapy .
Hormone therapy is used to:-
 Treat cancer. Hormone therapy can lessen the chance that cancer will return or
stop or slow its growth.
 Ease cancer symptoms. Hormone therapy may be used to reduce or prevent
symptoms in men with prostate cancer who are not able to
have surgery or radiation therapy.
How Hormone Therapy Is Given
 Hormone therapy may be given in many ways. Some common ways include:
I. Oral. Hormone therapy comes in pills that you swallow.
II. Injection. The hormone therapy is given by a shot in a muscle in your arm,
thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
III. Surgery. You may have surgery to remove organs that produce hormones. In
women, the ovaries are removed. In men, the testicles are removed.

10. 5. Targeted Therapy:-
Targeted cancer therapies block specific proteins or genes that
help cancers grow and spread. For some types of cancer, they
may work better than other treatments like chemotherapy.
The FDA has approved targeted therapies for many types of
cancer, including those of the breast, prostate, colon,
and lung.
Types of Targeted Therapies:_
 There are two main types of targeted therapies:
1) small molecule medicines
2) monoclonal antibodies.
 1.Small molecule medicines are small enough to slip inside
cancer cells and destroy them.
-You can often spot small molecule meds because their generic
name ends in "-ib." For example, imatinib (Gleevec)
treats chronic myelogenous leukemia(CML) and other cancers
by blocking signals that tell tumor cells to grow.

11. 2. Monoclonal antibodies:-
are too big to get into cells. Instead, they attack targets on
the outside of cells or right around them. Sometimes they're
used to launch chemo and radiation straight into tumors. You
usually get them through an IV in a vein in your arm at a
hospital or clinic. Sometimes they're given as a shot under
the skin.
A. Gene expression modulators. This type of targeted
therapy works to change the proteins that control the way
the instructions of genes in cancer cells get carried out, or
are expressed, because it's abnormal.
B. Immunotherapies use your own immune system to destroy
cancer cells. Some boost your immune system so it does a
better job of hunting down cancer. Others mark tumor cells
so it's easier for your immune system to find them.
Bortezomib (Velcade) is a drug that does this
to lymphoma and multiple myeloma, a blood cancer. Scientists
are also studying plant compounds like resveratrol (found in
red wine) to see if they, too, might trigger cancer cell death.

12. 6.Synthetic lethality
 Synthetic lethality arises when a combination of
deficiencies in the expression of two or more genes leads
to cell death, whereas a deficiency in only one of these
genes does not. The deficiencies can arise through
mutations, epigenetic alterations or inhibitors of one or
both of the genes.
 Cancer cells are frequently deficient in a DNA repair gene.
This DNA repair defect either may be due to mutation or,
often, epigenetic silencing. If this DNA repair defect is in
one of seven DNA repair pathways (see DNA repair
pathways), and a compensating DNA repair pathway is
inhibited, then the tumor cells may be killed by synthetic
lethality.
 Ovarian cancer:- Mutations in DNA repair
genes BRCA1 or BRCA2 (active in homologous
recombinational repair) are synthetically lethal with
inhibition of DNA repair gene PARP1 (active in the base
excision repair and in the microhomology-mediated end
joiningpathways of DNA repair)

13. Colon cancer:- In colon cancer, epigenetic defects in the WRN gene appear to
be synthetically lethal with inactivation of TOP1.
 In particular, irinotecan inactivation of TOP1 was synthetically lethal with
deficient expression of the DNA repair WRN gene in patients with colon cancer.
 There are five different stages of colon cancer, and these five stages all have
treatment.
 Stage 0, is where the patient is required to undergo surgery to remove the
polyp .
 Stage 1, depending on the location of the cancer in the colon and lymph nodes,
the patient undergoes surgery just like Stage 0
 Stage 2 patients undergoes removing nearby lymph nodes, but depending on
what the doctor says, the patent might have to undergo chemotherapy after
surgery
 Stage 3, is where the cancer has spread all throughout the lymph nodes but
not yet to other organs or body parts. When getting to this stage, Surgery is
conducted on the colon and lymph nodes, then the doctor orders Chemotherapy
to treat the colon cancer in the location needed.
 The last a patient can get is Stage 4.
 Stage 4 patients only undergo surgery if it is for the prevention of the cancer,
along with pain relief. If the pain continues with these two options, the doctor
might recommended radiation therapy. The main treatment strategy is
Chemotherapy due to how aggressive the cancer becomes in this stage not only
to the colon but to the lymph nodes.

14.  Pain medication, such as morphine and oxycodone,
and antiemetics, drugs to suppress nausea and vomiting,
are very commonly used in patients with cancer-related
symptoms. Improved antiemetics such
as ondansetron and analogues, as well
as aprepitant have made aggressive treatments much
more feasible in cancer patients.