The four most common cancers are:
Breast Cancer
Colon Cancer
Lung Cancer
Prostate Cancer
--------------------------------------------------------------------------------
Cancers of Blood and Lymphatic Systems:
Hodgkin's Disease
Leukemias
Lymphomas
Multiple Myeloma
Waldenström's Disease
--------------------------------------------------------------------------------
Skin cancers:
Malignant Melanoma
Skin Cancer
--------------------------------------------------------------------------------
Cancers of Digestive Systems:
Head and Neck Cancers
Esophageal Cancer
Stomach Cancer
Cancer of Pancreas
Liver Cancer
Colon and Rectal Cancer
Anal cancer
--------------------------------------------------------------------------------
Cancers of Urinary system:
Kidney Cancer
Bladder Cancer
Testis Cancer
Prostate Cancer
--------------------------------------------------------------------------------
Cancers in women:
Breast Cancer
Ovarian Cancer
Gynecological Cancers
Choriocarcinoma
--------------------------------------------------------------------------------
Miscellaneous cancers:
Brain Tumors
Bone Tumors
Carcinoid Tumor
Nasopharyngeal Cancer
Retroperitoneal sarcomas
Soft Tissue Tumors
Thyroid Cancer
Cancers of Unknown Primary Site
Monday, July 13, 2009
What is palliative treatment and when should it be used?
Palliative treatment means treatment that is designed to relieve symptoms, and improve your quality of life, rather than cure an illness. It can be used at any stage of an illness if there are troubling symptoms, such as pain or sickness. In advanced cancer, palliative treatment may help someone to live longer and to live comfortably, even if they cannot be cured. Palliative treatment can also mean using medicines to reduce or control the side effects of cancer treatments.
Palliative treatment does not just mean painkillers and anti-sickness drugs. Chemotherapy, radiotherapy, hormone therapy, biological therapy and surgery can all be used as palliative treatments. For example, surgery may be used to relieve a blocked bowel. The surgeon will remove as much of the cancer as necessary to relieve the blockage, even if the cancer has spread to another body organ, such as the liver. The operation can relieve severe nausea and vomiting, and may give the person with cancer more time feeling well. Chemotherapy, hormone therapy, biological therapy or radiotherapy can all be used to shrink tumours and relieve symptoms.
Palliative treatment does not just mean painkillers and anti-sickness drugs. Chemotherapy, radiotherapy, hormone therapy, biological therapy and surgery can all be used as palliative treatments. For example, surgery may be used to relieve a blocked bowel. The surgeon will remove as much of the cancer as necessary to relieve the blockage, even if the cancer has spread to another body organ, such as the liver. The operation can relieve severe nausea and vomiting, and may give the person with cancer more time feeling well. Chemotherapy, hormone therapy, biological therapy or radiotherapy can all be used to shrink tumours and relieve symptoms.
Palliative Radiotherapy
- Indications
- Bone pain that does not respond to pain medication (including opioids): at least partial palliation is achieved in about two thirds of patients and total relief on pain in about half. The onset of pain relief varies from a few days to four weeks, and palliation lasts on average 3 to 6 months; most patients benefit from repeated treatment.
- Prevention of fractures of the weight-bearing bones. If the risk of fracture is already present (more than half of the cortex is destroyed or there is a larger than 2 to 3 cm lytic metastasis in the diaphysis), consult a surgeon first.
- Treatment of spinal cord compression; Note: if the patient is developing paraparesis, tetraparesis, or the cauda equina syndrome (i.e., he/she has progressive neurological symptoms), radiotherapy (or surgical therapy) should be given as an emergency treatment. The neurological status of the patient at the time the therapy is started determines the outcome. Start the patient on steroids: see instructions below.
- Managing pressure symptoms (e.g., brain metastases, brain tumour, nerve compression)
- Haemorrhage: haemoptysis, haematuria
- Treatment of skin metastases
- Reducing obstructions (bronchus, vena cava superior, ureter)
- If pressure symptoms occur in the beginning of the treatment, or if they are to be expected during therapy, start the patient on a steroid (e.g., dexamethasone 3 to 10 mg x 1 to 3 p.o. or parenterally [some centres use doses up to 100 mg per day in medulla compression]) (Loblaw & Laperriere, 1998) [A].
- The aim of palliative radiotherapy is to relieve symptoms quickly with as few adverse effects as possible.
- On the average, palliative radiotherapy is administered in 1 to 10 fractions; at times, longer courses of radiotherapy are needed.
newer drugs: Doxil DaunoXome Agralbin Antisense based strategies Anti Angiogenesis
Doxil
Doxil is a rather new form of the old Doxorubicin, however combined with lipid (fat) molecules, also known as Liposomal Doxorubicin. Doxil seems to be effective in a variety of tumors, however it has been approved by FDA for treatment of AIDS related Kaposi’s Sarcoma. This drug is still under investigation to determine its efficacy against other cancers. It seems that Doxil should be effective against most of same cancers that are sensitive to Doxorubicin.
The type and extent of a cancer will determine the method and schedule of administration of this drug. This decision is made by the medical oncologist.
Side effects:
The degree and severity of the side effects depend on the amount and schedule of the administration of Doxil. Doxil does not cause nausea or vomiting. It can cause skin reactions. The important issue to prove is whether Doxil has less Cardiac Toxicity (Heart problems) as compared to Doxorubicin.
It is imperative that patients communicate any side effects or problems to his/her medical oncologist.
Antisense Strategies
The concept of Antisense medicated Gene Therapy is not a new one and was introduced in 1978. This is based on certain genes that are crucial in cell division and growth of cancer cells. Synthetic fragments of genetic substance DNA can achieve this goal. These strategies have been used, with some success in treatment of cancers as well as other illnesses. The following gene have been targeted in many studies:
-
Basic Fibroblast Growth Factor
-
Protein Kinase C
-
Insulin Like Growth Factor
-
Vascular Endothelial Growth Factor
-
Transforming Growth Factor Beta ( TGF-B)
-
Platelet Derived growth Factor
-
Proto-Oncogenes; c-erb, c-sis, c-myc, c-myb
-
Urokinase, CD 34,
-
Tumor Necrosis Factor. etc
Making of Antisense molecules is rather cumbersome, yet easier than some other gene therapy approaches. Such molecules bind to the targeted gene molecules in DNA of tumor cells, thereby inhibiting the translation of the genes and resulting in dysfunctional growth of these cells.
Anti Sense molecules have been administered by a variety of methods. The life span of these molecules in blood is rather short. In case of brain tumors, these molecules may be administered inside the spinal fluid or directly injected into the tumor itself.
Clinical trial incorporating these strategies are underway. This method of treatment of cancer is highly experimental and the jury is still out there to see the outcome of the studies.
Angiogenesis
Growth and development of tissues, including cancers, is dependant on blood supply. For tumors to grow and spread, they need a growing blood supply as well. This is achieved by growth and development of vessels within the cancer tissues, a phenomenon known as angiogenesis.
Blockage and inhibition of angiogenesis may control the growth of cancers. This has been a hypothesis that needs to be proven with clinical trials and show whether this theory has much practical value.
Certain drugs have such an inhibitory effect of growth of blood vessels. This effect may be directed at different stages of this biological phenomenon: Most of the following substances have shown significant tumor control in animal models, yet this does not mean that they would work in Human cancers. Although very exciting, these agents are still extremely experimental and jury is out and has to wait for up to a decade to have the verdict:
-
Antibodies against the Vascular Endothelial Growth Factor. There are many substances that act at this level such as: Avastin, BB-94, Batimastat
-
AGM-1470, is a substance from a fungus, Aspergillus Fumigates. Although quiet effective in laboratory models, clinical trials with this agent have been very disappointing.
-
Thalidomide, the well known drug, that was taken off the market due to sever damage to embryos. This drug seems to have some anti-angiogenesis efficacy, and this function was probably the cause of defects in children born to the mothers who took it during their pregnancy. Thalidomide is now approved by FDA as an accepted and effective drug for treatment of multiple myeloma.
-
Salfingol, was shown to inhibit Stomach cancer cells in animal models, human clinical trials are underway.
-
Tamoxifen also has some anti angiogenesis effect.
-
Tyrphostins, with clinical trials to begin.
Experimental cancer treatment
Experimental cancer treatments are medical therapies intended or claimed to treat cancer (see also tumor) by improving on, supplementing or replacing conventional methods (surgery, chemotherapy, radiation, and immunotherapy).
The entries listed below vary between theoretical therapies to unproven controversial therapies. Many of these treatments are alleged to only help against specific forms of cancer. It is not a list of treatments widely available at hospitals.
For More Information click hear
The entries listed below vary between theoretical therapies to unproven controversial therapies. Many of these treatments are alleged to only help against specific forms of cancer. It is not a list of treatments widely available at hospitals.
For More Information click hear
Bone Marrow Transplantation (BMT)
Bone Marrow Transplantation (BMT)
Bone marrow transplantation is a procedure by which certain illnesses and cancers may be cured. Bone marrow itself is the organ in charge of producing blood. This method was initially used in treatment of patients with severe bone marrow dysfunction. The goal was to replace the diseased marrow with healthy bone marrow. Initially, bone marrow transplants were performed in identical twins because the genetic makeup of twins is the same.
In certain conditions and cancers, the purpose of transplant is to actually produce a healthy bone marrow in patients. These conditions are:
-
Acute Myeloid Leukemia
-
Acute Lymphoid Leukemia
-
Chronic Myeloid Leukemia
-
Chronic Lymphoid Leukemia
-
Lymphomas that also involve the bone marrow
-
Donor refers to the healthy person who donates the bone marrow.
-
Recipient refers to the ill person receiving the bone marrow.
-
Bone marrow cells are given intravenously, like giving a blood transfusion.
There are different types of transplantation. The type of transplantation depends solely on the donor and method of obtaining the bone marrow cells.
-
Autologous, using patient's own bone marrow
-
Allogeneic, using bone marrow from a sibling (brother, sister)
-
Syngeneic, using bone marrow from an identical twin
-
Unrelated, using marrow from a stranger with similar genetic makeup
Allogeneic Bone Marrow Transplantation: Allogeneic BMTs are used most frequently to treat patients with leukemia, aplastic anemia and immune deficiency diseases, where the bone marrow itself is sick and needs to be replaced. Patients are treated with very high doses of chemotherapy (with or without radiation). This treatment destroys the sick bone marrow, after which the normal marrow is obtained from the donor and given to the patient.
Autologous Bone Marrow Transplantation: Autologous BMT is commonly used in treatment of certain patients with breast cancer, leukemias, lymphomas, etc. The goal of this treatment is to destroy the cancer cells. The bone marrow cells are obtained and frozen, and patients are then treated with very high doses of chemotherapy. The frozen bone marrow is then thawed and returned to the patient.
Unrelated Bone Marrow Transplantation: Two-thirds of patients requiring an Allogeneic BMT do not have a matching bone marrow donor. This is due to genetic differences between siblings. Although a sibling is the preferred bone marrow donor, not every patient has a brother or sister with "matching" bone marrow. For this reason, transplants using unrelated donors are performed. There is a National Marrow Donor Program (NMDP) in the United States and in many other countries which is attempting to expand the international registry of volunteers who donate their marrow to those in need of such treatment.
-
Indications for Bone Marrow Transplantation
-
Process of Transplantation
Cancer Bone marrow transplants
When you might have a bone marrow transplant
Bone marrow transplants are used to treat people with several types of cancer, including leukaemia. Bone marrow transplants can be used when
Your cancer, lymphoma or leukaemia is in remission but is likely to come back
other treatments have not cured your cancer, leukaemia or lymphoma
What a bone marrow transplant is
Bone marrow transplant is a way of giving very high dose chemotherapy, sometimes with radiotherapy, to try to cure some types of cancer. Because you can have higher doses of treatment, there may be more chance of curing the cancer.
The bone marrow is the spongy substance inside your bones which makes all your blood cells. High doses of chemotherapy drugs kill off your bone marrow. This means you cannot make any blood cells. So doctors can take out some of your bone marrow before you have the chemotherapy and freeze it. This is called a bone marrow harvest.
After you have had the chemotherapy, you have your healthy bone marrow back through a drip (intravenous transfusion). The bone marrow cells find their own way back to your bone marrow. Then you can make the blood cells you need again. This is called an autologous transplant. You may hear this treatment called a bone marrow rescue. This is because your own bone marrow is given back to you to 'rescue' you from the effects of your cancer treatment.
Sometimes you cannot have your own bone marrow harvested because there is too great a risk that your cancer will come back. Then bone marrow from a brother or sister might be used. Occasionally, if you do not have a brother or sister (a sibling donor) who is a match, you can have marrow from a matched donor who is not related to you. The donor must have similar bone marrow to you. A transplant of bone marrow from another person is called an allogeneic transplant.
Having a bone marrow harvest
Before your bone marrow is taken you will have a general anaesthetic. To remove the marrow, the doctor puts a needle through the skin into the hip bone (pelvis). The bone marrow is sucked out through the needle into a syringe. To get enough marrow, the doctor usually has to put the needle into several different parts of the pelvis. Occasionally, the doctor uses the chest bone (sternum) as well. You will have about two pints (one litre) of bone marrow removed. This is then frozen until it is needed.
When you wake up, you will have up to about 6 puncture sites covered with plasters. You will probably feel a bit sore and bruised. This can last for up to a week. Your doctor will give you some painkillers to take.
You usually have to stay in hospital one to two nights for a bone marrow harvest. This is to make sure you have recovered from the anaesthetic. You may also need a blood transfusion.
More information about bone marrow and stem cell transplants
If you would like more information about anything to do with bone marrow and stem cell transplants, contact one of the cancer information organisations in our help and support section. They will be happy to help. They often have free factsheets and booklets which they can send to you.
Bone marrow transplants are used to treat people with several types of cancer, including leukaemia. Bone marrow transplants can be used when
Your cancer, lymphoma or leukaemia is in remission but is likely to come back
other treatments have not cured your cancer, leukaemia or lymphoma
What a bone marrow transplant is
Bone marrow transplant is a way of giving very high dose chemotherapy, sometimes with radiotherapy, to try to cure some types of cancer. Because you can have higher doses of treatment, there may be more chance of curing the cancer.
The bone marrow is the spongy substance inside your bones which makes all your blood cells. High doses of chemotherapy drugs kill off your bone marrow. This means you cannot make any blood cells. So doctors can take out some of your bone marrow before you have the chemotherapy and freeze it. This is called a bone marrow harvest.
After you have had the chemotherapy, you have your healthy bone marrow back through a drip (intravenous transfusion). The bone marrow cells find their own way back to your bone marrow. Then you can make the blood cells you need again. This is called an autologous transplant. You may hear this treatment called a bone marrow rescue. This is because your own bone marrow is given back to you to 'rescue' you from the effects of your cancer treatment.
Sometimes you cannot have your own bone marrow harvested because there is too great a risk that your cancer will come back. Then bone marrow from a brother or sister might be used. Occasionally, if you do not have a brother or sister (a sibling donor) who is a match, you can have marrow from a matched donor who is not related to you. The donor must have similar bone marrow to you. A transplant of bone marrow from another person is called an allogeneic transplant.
Having a bone marrow harvest
Before your bone marrow is taken you will have a general anaesthetic. To remove the marrow, the doctor puts a needle through the skin into the hip bone (pelvis). The bone marrow is sucked out through the needle into a syringe. To get enough marrow, the doctor usually has to put the needle into several different parts of the pelvis. Occasionally, the doctor uses the chest bone (sternum) as well. You will have about two pints (one litre) of bone marrow removed. This is then frozen until it is needed.
When you wake up, you will have up to about 6 puncture sites covered with plasters. You will probably feel a bit sore and bruised. This can last for up to a week. Your doctor will give you some painkillers to take.
You usually have to stay in hospital one to two nights for a bone marrow harvest. This is to make sure you have recovered from the anaesthetic. You may also need a blood transfusion.
More information about bone marrow and stem cell transplants
If you would like more information about anything to do with bone marrow and stem cell transplants, contact one of the cancer information organisations in our help and support section. They will be happy to help. They often have free factsheets and booklets which they can send to you.
CANCER TREATMENT :- Biological agents & immunotherapy
What are biological therapies?
These are man made proteins which alter the growth and replication of a cancer cell by interfering with its specific biological pathways. Biological agents aim to find chemical or genetic processes which are present in the cancer cell but not the normal cells. In this way they are more targeted than conventional chemotherapy which generally kills rapidly dividing cells. They can also have an anticancer effect by stopping the growth of new blood vessels into a tumour mass thus depriving it of oxygen and a means to grow and spread (angiogenesis).
Biological agents, once attached to a cancer cell can also make the cell more vulnerable to the bodies own immune system - that is why they have previously been known as immunotherapy. One of the 1st observations of an immunotherapy reaction was seen at the turn of the 20th century, when a patient's breast cancer shrunk following a severe skin infection. Her bodies defenses where so greatly stimulated to fight the infection they also attacked the tumour. There has been major strives to enhance this reaction by identifying specific tumour targets.
Biological agents sometimes work in partnership chemotherapy. The chemotherapy kills the DNA and the biological agent stops the cells from repairing themselves.
In summary the modes of anti cancer action are:
They can bind to receptor proteins on the surface or inside cancer cells which block pathways which reduce the cells ability to grow, spread, invade other organs.
They interfere with new tumour blood vessel formation blocking its ability to grow
They can stimulate and recruit the bodies own immune system including natural killer (NK) cells to attack the cells.
They can carry poisons to a target more commonly found on tumour cells - targeted therapy
What are the main categories of biological agents? The two main categories of biological agents are:
Tyrosine kinase inhibitors. These are small molecules which can interfere with the intracellular or extra cellular section of a biological protein which is involved in triggering various essential biological functions of the cell.
Monoclonal antibodies (Mab). These are large natural proteins which are a normal part of the bodies defense against foreign organism. Although cancer cells come from our own bodies and hence not detected as foreign by our immune system there may be some supple difference which can be exploited in the immunity against them is enhanced. Antibodies are mass-produced in the lab by fusing a myeloma (a type of bone marrow cancer) cell from a mouse with a mouse B cell that makes a specific antibody. Because the antibodies are all identical clones produced from a single (mono) hybridoma cell, they are called monoclonal antibodies ( MAbs). In some cases, Mab can been congugated or joined to another substance which kills the tumour cells. This could be a chemotherapy drug, radioactive particle, or a toxin (a substance that poisons cells).
Commonly available biological agents and mode of action?
Monoclonal antibodies:
Rituximab (MabThera): Non-Hodgkin’s lymphoma. Targets the CD20 antigen found in excess on lymphoma cells. extensively used in both low and high grade lymphomas as long as they are shown to over express CD20 proteins.
Trastuzumab (Herceptin); Breast cancer. An intravenous agent, attacking the HER-2 receptor (activity is greatest in tumours also over expressing cMYC, PTEN or TOPO 11.
Cetuximab (Erbitux); Colorectal cancer head and neck cancers; An intravenous inhibitor of erbB1(EGFR) k-ras mutations should not be present.
Bevacizumab (Avastin); Breast and colorectal cancer plus others in development. An intravenous humanised Mab attaches to and inhibits vascular endothelial growth factor which then prevents new blood vessels forming in cancers (angiogenesis)
Panitumumab; Colorectal cancer. A humanised mab against EGFR under investigation.
Alemtuzumab (Campath): Chronic lymphocytic leukemia; Active against low grade lymphoma and CLL attacks the CD56 antigen.
Ibritumomab tiuxetan (Zevalin) Non-Hodgkin’s lymphoma; A Mab which has a radioactive molecule attached to it shown activity in patients with low grade NHL transforming into higher grade tumours
Tositumomab (Bexxar); Non-Hodgkin’s lymphoma; A Mab which has a radioactive molecule attached to it shown activity in low grade NHL.
Tyrosine Kinase inhibitors:
Gefitinib (Irissa); Lung & pancreas; Inhibits a mutated EGFR (p-Akt).
Erlotinib (Tarceva): Lung & pancreas; Inhibits a mutated EGFR
Imatinib (Gleevec); GIST & CML; An oral agent. Inhibits EGFR with the KIT mutation found in CML and gastrointestinal stromal tumours
Lapatinib (Tyverb); Breast; An oral, dual inhibitor of EGFR (erbB1) & HER2 (ErbB2)
Sunitinib (Sutent); Renal cell; An oral multi-targeted tyrosine kinase inhibitor with activity against vascular epidermal growth factor receptor (VEGFR), platelet derived growth factor receptor, KIT, RET and FLT3 having anti-tumour and anti-angiogenesis activity.
Sorafeneib (Nexxava); Renal cell; An oral agent with multiple targets against the tryosine kinase inhibitor.
Bortezomib (Velcade); Myeloma; Attacks a structure called the protosome.
Preparation for biological therapy. As these are specific treatments your doctor needs to find out if your tumour expresses the necessary target before even considering treatment. This is usually achieved by re-analysing a section of your original tumour (from the time of your original surgery or biopsy). Occasionally, your doctor will need a more recent tumour for analysis and recommend a further biopsy. In either case the tumour is usually send to a lab which specialises in specific testing for antigens (targets) called immunohistochemistry. A report will be issued by the pathologist on whether your tumour over expresses the target and to what degree. For example, Herceptin treatment for breast cancer requires the tumour to be HER-2+ve and on a scale of 1-3 it should be 3 to ensure a likely subsequent clinical response. More recently it has been discovered that certain mutations within the cancer cell can predict a likely response to biological agents. For example, the K-ras mutation found in 20% of cells from colorectal cancer, if present it means there will be little or no therapeutic response to Erbitux given to that patient.
How are Mab administered? Most tryrosine tynase inhibitors are oral drugs taken once or twice a day. Mab on the other hand cannot be taken orally as they would be destroyed by your stomach. They are therefore infused into a vein usually over a few hours. Occasionally, as with all protein based drugs it is possible to get an allergic reaction. The nurses will therefore be checking how you are feeling and measuring your breathing, pulse and blood pressure blood regularly. If all goes well the infusion can last 1-2 hours, sometimes, in response to mild reaction, it may have to be slowed down over several hours. Rarely if there allergic reaction is prominent it has to be stopped altogether and abandoned. To avoid a mild reaction often paracetamol and an antihistamine are given before the infusion. If you are are able to tolerate the first infusion it will be repeated thereafter, either at the same or a lower dose, on regular intervals. The specific regimen (ie weekly, 3 weekly) will be explain to you by the doctors and nurses and depends on the specific Mab used. Mab are often given in conjunction will chemotherapy the administration schedule and side effect also depend on these drugs.
Are there side effects to Mab therapy? Compared with side effects of standard chemotherapy, the side effects of naked MAbs are usually relatively mild. They can be broadly split into three categories:-
The early effects often related to an "allergic" reaction. If they do occur, it is often while the drug is being infused or . Potential side effects include:
Fever and sweating
Chills
Skin flushing - redness
Tightness in the chest or difficulty breathing
Discomfort in the throat
Agitation
Particularly if associated with a fast pulse and lower blood pressure these symptoms indicate an early allergic reaction. As mentioned above if these symptoms are prominent the infusion has to be slowed down or abandoned altogether. To avoid a mild reaction often paracetamol and an antihistamine are given before the infusion.
The ongoing effects may occurs over the entire period of time whilst you are receiving the Mab - usually weeks to months. these are usually worse a day or two after the infusion and could include:-
Weakness, lethargy or tiredness
Headache
Sore eyes
Joint pains
Nausea and rarely vomiting
Diarrhoea
Skin rashes
Shortness of breath on exertion
Very occasionally MAbs can also affect the bone marrow in a way similar to what most chemotherapy drugs can do. This can result in lower levels of blood cells, which can lead to an increased risk of bleeding and infection in some people.
Late side effects may occur occur after receiving Mab for some time - usually months. These include heart & lung damage - they are rare but this is the reason why patients receiving prolonged Mab therapy have special monitoring including Heart test.
These are man made proteins which alter the growth and replication of a cancer cell by interfering with its specific biological pathways. Biological agents aim to find chemical or genetic processes which are present in the cancer cell but not the normal cells. In this way they are more targeted than conventional chemotherapy which generally kills rapidly dividing cells. They can also have an anticancer effect by stopping the growth of new blood vessels into a tumour mass thus depriving it of oxygen and a means to grow and spread (angiogenesis).
Biological agents, once attached to a cancer cell can also make the cell more vulnerable to the bodies own immune system - that is why they have previously been known as immunotherapy. One of the 1st observations of an immunotherapy reaction was seen at the turn of the 20th century, when a patient's breast cancer shrunk following a severe skin infection. Her bodies defenses where so greatly stimulated to fight the infection they also attacked the tumour. There has been major strives to enhance this reaction by identifying specific tumour targets.
Biological agents sometimes work in partnership chemotherapy. The chemotherapy kills the DNA and the biological agent stops the cells from repairing themselves.
In summary the modes of anti cancer action are:
They can bind to receptor proteins on the surface or inside cancer cells which block pathways which reduce the cells ability to grow, spread, invade other organs.
They interfere with new tumour blood vessel formation blocking its ability to grow
They can stimulate and recruit the bodies own immune system including natural killer (NK) cells to attack the cells.
They can carry poisons to a target more commonly found on tumour cells - targeted therapy
What are the main categories of biological agents? The two main categories of biological agents are:
Tyrosine kinase inhibitors. These are small molecules which can interfere with the intracellular or extra cellular section of a biological protein which is involved in triggering various essential biological functions of the cell.
Monoclonal antibodies (Mab). These are large natural proteins which are a normal part of the bodies defense against foreign organism. Although cancer cells come from our own bodies and hence not detected as foreign by our immune system there may be some supple difference which can be exploited in the immunity against them is enhanced. Antibodies are mass-produced in the lab by fusing a myeloma (a type of bone marrow cancer) cell from a mouse with a mouse B cell that makes a specific antibody. Because the antibodies are all identical clones produced from a single (mono) hybridoma cell, they are called monoclonal antibodies ( MAbs). In some cases, Mab can been congugated or joined to another substance which kills the tumour cells. This could be a chemotherapy drug, radioactive particle, or a toxin (a substance that poisons cells).
Commonly available biological agents and mode of action?
Monoclonal antibodies:
Rituximab (MabThera): Non-Hodgkin’s lymphoma. Targets the CD20 antigen found in excess on lymphoma cells. extensively used in both low and high grade lymphomas as long as they are shown to over express CD20 proteins.
Trastuzumab (Herceptin); Breast cancer. An intravenous agent, attacking the HER-2 receptor (activity is greatest in tumours also over expressing cMYC, PTEN or TOPO 11.
Cetuximab (Erbitux); Colorectal cancer head and neck cancers; An intravenous inhibitor of erbB1(EGFR) k-ras mutations should not be present.
Bevacizumab (Avastin); Breast and colorectal cancer plus others in development. An intravenous humanised Mab attaches to and inhibits vascular endothelial growth factor which then prevents new blood vessels forming in cancers (angiogenesis)
Panitumumab; Colorectal cancer. A humanised mab against EGFR under investigation.
Alemtuzumab (Campath): Chronic lymphocytic leukemia; Active against low grade lymphoma and CLL attacks the CD56 antigen.
Ibritumomab tiuxetan (Zevalin) Non-Hodgkin’s lymphoma; A Mab which has a radioactive molecule attached to it shown activity in patients with low grade NHL transforming into higher grade tumours
Tositumomab (Bexxar); Non-Hodgkin’s lymphoma; A Mab which has a radioactive molecule attached to it shown activity in low grade NHL.
Tyrosine Kinase inhibitors:
Gefitinib (Irissa); Lung & pancreas; Inhibits a mutated EGFR (p-Akt).
Erlotinib (Tarceva): Lung & pancreas; Inhibits a mutated EGFR
Imatinib (Gleevec); GIST & CML; An oral agent. Inhibits EGFR with the KIT mutation found in CML and gastrointestinal stromal tumours
Lapatinib (Tyverb); Breast; An oral, dual inhibitor of EGFR (erbB1) & HER2 (ErbB2)
Sunitinib (Sutent); Renal cell; An oral multi-targeted tyrosine kinase inhibitor with activity against vascular epidermal growth factor receptor (VEGFR), platelet derived growth factor receptor, KIT, RET and FLT3 having anti-tumour and anti-angiogenesis activity.
Sorafeneib (Nexxava); Renal cell; An oral agent with multiple targets against the tryosine kinase inhibitor.
Bortezomib (Velcade); Myeloma; Attacks a structure called the protosome.
Preparation for biological therapy. As these are specific treatments your doctor needs to find out if your tumour expresses the necessary target before even considering treatment. This is usually achieved by re-analysing a section of your original tumour (from the time of your original surgery or biopsy). Occasionally, your doctor will need a more recent tumour for analysis and recommend a further biopsy. In either case the tumour is usually send to a lab which specialises in specific testing for antigens (targets) called immunohistochemistry. A report will be issued by the pathologist on whether your tumour over expresses the target and to what degree. For example, Herceptin treatment for breast cancer requires the tumour to be HER-2+ve and on a scale of 1-3 it should be 3 to ensure a likely subsequent clinical response. More recently it has been discovered that certain mutations within the cancer cell can predict a likely response to biological agents. For example, the K-ras mutation found in 20% of cells from colorectal cancer, if present it means there will be little or no therapeutic response to Erbitux given to that patient.
How are Mab administered? Most tryrosine tynase inhibitors are oral drugs taken once or twice a day. Mab on the other hand cannot be taken orally as they would be destroyed by your stomach. They are therefore infused into a vein usually over a few hours. Occasionally, as with all protein based drugs it is possible to get an allergic reaction. The nurses will therefore be checking how you are feeling and measuring your breathing, pulse and blood pressure blood regularly. If all goes well the infusion can last 1-2 hours, sometimes, in response to mild reaction, it may have to be slowed down over several hours. Rarely if there allergic reaction is prominent it has to be stopped altogether and abandoned. To avoid a mild reaction often paracetamol and an antihistamine are given before the infusion. If you are are able to tolerate the first infusion it will be repeated thereafter, either at the same or a lower dose, on regular intervals. The specific regimen (ie weekly, 3 weekly) will be explain to you by the doctors and nurses and depends on the specific Mab used. Mab are often given in conjunction will chemotherapy the administration schedule and side effect also depend on these drugs.
Are there side effects to Mab therapy? Compared with side effects of standard chemotherapy, the side effects of naked MAbs are usually relatively mild. They can be broadly split into three categories:-
The early effects often related to an "allergic" reaction. If they do occur, it is often while the drug is being infused or . Potential side effects include:
Fever and sweating
Chills
Skin flushing - redness
Tightness in the chest or difficulty breathing
Discomfort in the throat
Agitation
Particularly if associated with a fast pulse and lower blood pressure these symptoms indicate an early allergic reaction. As mentioned above if these symptoms are prominent the infusion has to be slowed down or abandoned altogether. To avoid a mild reaction often paracetamol and an antihistamine are given before the infusion.
The ongoing effects may occurs over the entire period of time whilst you are receiving the Mab - usually weeks to months. these are usually worse a day or two after the infusion and could include:-
Weakness, lethargy or tiredness
Headache
Sore eyes
Joint pains
Nausea and rarely vomiting
Diarrhoea
Skin rashes
Shortness of breath on exertion
Very occasionally MAbs can also affect the bone marrow in a way similar to what most chemotherapy drugs can do. This can result in lower levels of blood cells, which can lead to an increased risk of bleeding and infection in some people.
Late side effects may occur occur after receiving Mab for some time - usually months. These include heart & lung damage - they are rare but this is the reason why patients receiving prolonged Mab therapy have special monitoring including Heart test.
Immunotherapy
In the 1850s, doctors in Germany noticed that patients' tumours would occasionally shrink if their tumour became infected. This observation led to the idea that the body's immune system could be harnessed and made to fight cancer.
Around the same time, doctors throughout Europe, encouraged by the success of Edward Jenner's smallpox vaccine, attempted to make a 'cancer vaccine' by injecting patients with crude extracts of tumours from other cancer patients. These treatments were largely ineffective, but the field of 'immunotherapy' was born.
Initial progress on immunotherapy was slow, and over a hundred years' work in the laboratory yielded little success in actual cancer treatment. This all changed when in 1975, Georges Köhler and César Milstein, working in Cambridge, discovered how to make synthetic antibodies.
Their discovery, coupled with an ever-increasing understanding of the immune system, has led to a variety of treatments and strategies that use the immune system to tackle cancer. Some, such as the antibody-based breast cancer drug Herceptin, are now used routinely to treat cancer patients.
Immunotherapy can be local or systemic.
Local immunotherapy delivers the treatment to the affected area. For example, the BCG vaccine can be injected into the bladder to treat bladder cancer, as it causes inflammation that can cause the tumour to shrink.
Systemic therapy treats the whole body and is useful for targeting cancer that may have spread. In the 1980s, scientists at the Cancer Research UK Medical Oncology Unit at the Christie Hospital in Manchester showed that the protein interferon alpha could cause tumours to shrink in patients with low-grade lymphoma. Interferon is now used to treat several different types of cancer.
Immunotherapy can also be non-specific or targeted.
Non-specific immunotherapy works by boosting the body's immune system in general, so that its natural cancer-killing activity is enhanced. Both of the examples of local and systemic therapies (above) are also examples of non-specific immunotherapy.
Targeted immunotherapy is designed to make the immune system specifically kill cancer cells. The following types of targeted immunotherapy are available or are in development:
Antibody-based therapies
Antibodies are proteins produced by the immune system. A type of white blood cell called a B-cell produces them in response to an infection. Normally, antibodies stick to foreign objects in the body and label them for destruction. Researchers have been trying to make antibodies that will attach themselves only to cancer cells. This can be useful in four ways.
It can stop the cancer from growing by stopping other essential 'growth factors' from sticking to it.
It can 'tag' the cancer for destruction by the immune system.
If cancer drugs or radioactive particles are attached to the antibody, it can deliver them directly to the cancer cell without harming the rest of your body.
An enzyme (a type of protein that can promote chemical reactions) can be attached to an antibody, and then given to a patient along with a chemical that can be turned into a powerful drug by the enzyme. This directs the drug to the cancer, and minimise side effects. This process is known as Antibody-directed Enzyme/Pro-drug Therapy (ADEPT).
Several antibody-based therapies are available, including the breast cancer drug Herceptin.
Around the same time, doctors throughout Europe, encouraged by the success of Edward Jenner's smallpox vaccine, attempted to make a 'cancer vaccine' by injecting patients with crude extracts of tumours from other cancer patients. These treatments were largely ineffective, but the field of 'immunotherapy' was born.
Initial progress on immunotherapy was slow, and over a hundred years' work in the laboratory yielded little success in actual cancer treatment. This all changed when in 1975, Georges Köhler and César Milstein, working in Cambridge, discovered how to make synthetic antibodies.
Their discovery, coupled with an ever-increasing understanding of the immune system, has led to a variety of treatments and strategies that use the immune system to tackle cancer. Some, such as the antibody-based breast cancer drug Herceptin, are now used routinely to treat cancer patients.
Immunotherapy can be local or systemic.
Local immunotherapy delivers the treatment to the affected area. For example, the BCG vaccine can be injected into the bladder to treat bladder cancer, as it causes inflammation that can cause the tumour to shrink.
Systemic therapy treats the whole body and is useful for targeting cancer that may have spread. In the 1980s, scientists at the Cancer Research UK Medical Oncology Unit at the Christie Hospital in Manchester showed that the protein interferon alpha could cause tumours to shrink in patients with low-grade lymphoma. Interferon is now used to treat several different types of cancer.
Immunotherapy can also be non-specific or targeted.
Non-specific immunotherapy works by boosting the body's immune system in general, so that its natural cancer-killing activity is enhanced. Both of the examples of local and systemic therapies (above) are also examples of non-specific immunotherapy.
Targeted immunotherapy is designed to make the immune system specifically kill cancer cells. The following types of targeted immunotherapy are available or are in development:
Antibody-based therapies
Antibodies are proteins produced by the immune system. A type of white blood cell called a B-cell produces them in response to an infection. Normally, antibodies stick to foreign objects in the body and label them for destruction. Researchers have been trying to make antibodies that will attach themselves only to cancer cells. This can be useful in four ways.
It can stop the cancer from growing by stopping other essential 'growth factors' from sticking to it.
It can 'tag' the cancer for destruction by the immune system.
If cancer drugs or radioactive particles are attached to the antibody, it can deliver them directly to the cancer cell without harming the rest of your body.
An enzyme (a type of protein that can promote chemical reactions) can be attached to an antibody, and then given to a patient along with a chemical that can be turned into a powerful drug by the enzyme. This directs the drug to the cancer, and minimise side effects. This process is known as Antibody-directed Enzyme/Pro-drug Therapy (ADEPT).
Several antibody-based therapies are available, including the breast cancer drug Herceptin.
cancer and hormone therapy :- What hormone therapy is ?
What hormones are
Hormones are natural substances made by glands in our bodies. The network of glands that make hormones is called the endocrine system. Hormones are carried in our bloodstream and act as messengers between one part of our body and another. They control the growth and activity of certain cells and organs.
What hormone therapy is
Hormone treatments use the sex hormones produced by our bodies, or drugs that block them, to treat cancer. Not all cancers respond to hormone therapy. Doctors might use hormone therapy for people with cancers that are ‘hormone sensitive’ or ‘hormone dependent’. This means that the cancer needs the hormone to grow. Cancers that can be hormone sensitive are
How hormone therapy works
Cancers that are hormone sensitive or hormone dependent need hormones to grow. So stopping the hormone reaching the cancer cells may either slow down or stop the growth of the cancer. Hormone therapies can work by either
- Stopping hormones being made
- Preventing the hormone reaching the cancer cell
Types of hormone therapy
There are a number of different types of hormone therapy. Which one you have depends on a number of factors, including your type of cancer. There is information below on
What hormone therapy is
Hormone treatments use the sex hormones produced by our bodies, or drugs that block them, to treat cancer. Not all cancers respond to hormone therapy. Doctors might use hormone therapy for people with cancers that are ‘hormone sensitive’ or ‘hormone dependent’. This means that the cancer needs the hormone to grow. Cancers that can be hormone sensitive are
Breast cancer
Prostate cancer
Womb cancer (uterine)
How hormone therapy works
Cancers that are hormone sensitive or hormone dependent need hormones to grow. So stopping the hormone reaching the cancer cells may either slow down or stop the growth of the cancer. Hormone therapies can work by either
Stopping hormones being made
Preventing the hormone reaching the cancer cell
Types of hormone therapy
There are a number of different types of hormone therapy. Which one you have depends on a number of factors, including your type of cancer. There is information below on
Breast cancer hormone therapy
Prostate cancer hormone therapy
Womb cancer hormone therapy
Breast cancer hormone therapy
The female hormones oestrogen and progesterone affect some breast cancers. Doctors say these cancers are either oestrogen receptor positive or progesterone receptor positive, or both. Hormone treatment for breast cancer works by stopping these hormones getting to the breast cancer cells. There are different types of hormone therapies that doctors use to treat breast cancer
Tamoxifen
Aromatase inhibitors
Pituitary down regulators
Tamoxifen
Tamoxifen is one of the most common hormone therapies used for breast cancer. Both pre and postmenopausal women can take tamoxifen. It works by stopping the hormone oestrogen from reaching cancer cells.
Aromatase inhibitors
These are a relatively new type of hormone therapy. You can only take them if you have been through the menopause. After menopause, your ovaries stop producing oestrogen. But your body still makes a small amount by changing other hormones (called androgens) into oestrogen. You need an enzyme called aromatase to make this change happen. Aromatase inhibitors block this enzyme so it can’t convert androgen into oestrogen.
There are a few different types of aromatase inhibitor, including
Anastrozole (Arimidex®)
Exemestane (Aromasin®)
Letrozole (Femara®)
Pituitary down regulators
A gland in the brain, called the pituitary gland, controls the amount of sex hormones made by the ovaries. Pituitary down regulators are drugs that prevent the ovaries making oestrogen or progesterone. They do this by blocking the signal from the pituitary gland to the ovaries.
You will only have this treatment if you haven’t yet had your menopause. After menopause, your ovaries don’t produce hormones so this type of drug won’t help. Pituitary down regulators include goserelin for breast cancer (Zoladex) and leuprorelin.
Prostate cancer hormone therapy
Prostate cancer depends on the male hormone testosterone for its growth. Hormone therapy aims to reduce or stop the body making testosterone and slow down or stop the growth of the cancer. There are different types of hormone therapy
Pituitary down regulators
Anti-androgens
Pituitary down regulators
A gland in the brain, called the pituitary gland, controls the amount of testosterone made by the testicles. Pituitary down regulators are drugs that prevent the testicles making testosterone. They do this by blocking the signal from the pituitary gland to the testicles.
Pituitary down regulators include
Goserelin for prostate cancer (Zoladex)
Leuprorelin (Prostap)
Triptorelin (Decapetyl)
Anti-androgens
Prostate cancer cells have receptors on them that take up testosterone. Anti-androgen drugs work by attaching themselves to these receptors. This stops the testosterone reaching the prostate cancer cell. There are a few different types including
Bicalutamide (Casodex)
Cyproterone acetate (Cyprostat)
Flutamide (Drogenil)
Womb cancer hormone therapy
The female hormones oestrogen and progesterone affect the growth and activity of the cells that line the womb. Doctors give the hormone progesterone to help shrink larger womb cancers, or to treat womb cancers that have come back. There are different types of progesterone treatment, including medroxyprogesterone acetate (Provera) or megestrol (Megace).
Cancer Treatment :- Hormone therapy
Treatment Hormone therapy
Hormone treatments are treatments using natural body chemicals called hormones, or drugs that block hormones. Hormones are chemicals made in one part of the body, that travel in the bloodstream to make something happen in another part of the body. Some cancer cells need hormones to grow, or are encouraged to grow more quickly by hormones. These cancers are said to be 'hormone sensitive' or 'hormone dependent'. They include
Breast cancer
Prostate cancer
Uterine (womb) cancer
Ovarian cancer
Hormone treatments are also sometimes used for kidney cancer, thyroid cancer or melanoma.
You can find more information about hormone therapy for particular types of cancer in the relevant treatment section. There is detailed information in our hormone therapy section including
Hormone treatments are treatments using natural body chemicals called hormones, or drugs that block hormones. Hormones are chemicals made in one part of the body, that travel in the bloodstream to make something happen in another part of the body. Some cancer cells need hormones to grow, or are encouraged to grow more quickly by hormones. These cancers are said to be 'hormone sensitive' or 'hormone dependent'. They include
Breast cancer
Prostate cancer
Uterine (womb) cancer
Ovarian cancer
Hormone treatments are also sometimes used for kidney cancer, thyroid cancer or melanoma.
You can find more information about hormone therapy for particular types of cancer in the relevant treatment section. There is detailed information in our hormone therapy section including
Cancer Treatment : - Radiation Therapy ( Selective internal radiation therapy for secondary bowel cancer )
What Selective Internal Radiation Therapy (SIRT) is
How SIRT works
Which cancers SIRT can treat
Research into SIRT
How you have SIRT
What Selective Internal Radiation Therapy (SIRT) is
SIRT stands for Selective Internal Radiation Therapy. It is a new way of using radiotherapy to treat liver cancers that can’t be removed with surgery. SIRT is internal radiotherapy, which is also called ‘brachytherapy’. It sends tiny beads called microspheres containing a radioactive substance directly to the tumours through a small tube called a catheter. The microspheres are also called ‘SIR-spheres’, and the radioactive substance is called ‘yttrium 90’.
The catheter goes into the hepatic artery. This is the main artery that supplies blood to the liver. The liver gets most of its blood supply from a blood vessel called the portal vein. But tumours in the liver get theirs from the hepatic artery. So by using the hepatic artery, SIRT is able to target the tumours without affecting the normal liver.
How SIRT works
The microspheres travel through the hepatic artery into the blood supply of the tumours. They then get trapped in the tumours’ small blood vessels where they release the radiation.
The radiation damages the tumours’ blood supply so the tumours can’t get the nutrients they need. This is why this is process is sometimes called ‘radioembolisation’. The radiation also damages the DNA of the cancer cells, which stops the cancer cells growing.
The liver can only cope with small doses of external radiotherapy. But because SIRT targets the tumours, not the liver, doctors can use it to give the tumours a larger dose of radiation.
The microspheres give off radiation to an area only 2 to 3mm around where they are trapped. This means they cause very little damage to the surrounding healthy tissue. The microspheres only stay radioactive for 10 to 14 days but stay in the liver permanently. They are harmless.
Which cancers SIRT can treat
Doctors only use SIRT if they cannot remove the tumours with an operation. They have looked at how well this treatment works for both primary and secondary tumours of the liver, including
Advanced bowel cancers that have spread to the liver
Cholangiocarcinomas
Hepatocellular cancers
Secondary neuroendocrine tumours that have spread to the liver
Research into SIRT
In 2004 NICE issued guidance stating that
SIRT was safe to use
Research showed SIRT could reduce the size of liver tumours
The NICE guidance says that doctors can use SIRT to treat people
Who can’t have surgery
Who have been told that SIRT is a new treatment
The guidance also said we needed more research to see if SIRT could help people live longer and reduce symptoms.
A phase 1 trial in 2007 used SIRT to treat people whose bowel cancer had spread to their liver. The researchers treated the people in the trial with SIRT along with FOLFOX chemotherapy.
As this was a phase 1 trial, the researchers were mainly trying to find out
How safe it was to combine these two treatments
What the doses should be
The results from this trial showed that the combination treatment was safe. They also suggest that the people who had the combination treatment were free of cancer for longer than people who had chemotherapy alone. However as this was a small, early trial, we need further research to confirm these results. The researchers are now planning a phase 3 trial to test SIRT in combination with chemotherapy.
How you have SIRT
You may have SIRT on its own or with chemotherapy.
Before you can have the SIRT, you have an angiogram. This is to look at the blood supply to the liver and to check your hepatic artery. This can vary between people. Occasionally people can't have treatment because their hepatic artery also supplies blood to their lungs or other sensitive tissue. This means that the SIRT microspheres could reach these areas and damage them.
Immediately before you have the treatment you will have
A sedative to relax you
Anti sickness medicine
Antibiotics
Then the doctor gives you an injection into your groin to numb the area. Once the area is numb they make a tiny cut in the groin and put a fine tube called a catheter into the artery in the groin (the femoral artery). Using scans the doctor passes the catheter up the femoral artery and into the hepatic artery. Once this is in place the doctor gives the treatment. The whole process takes about an hour.
After the treatment you will have a dressing put over the small wound. Most people need to stay in hospital overnight. Your doctor will give you painkillers and anti sickness medicine to take if you need it.
Generally the side effects are mild. They include raised temperature, chills, nausea, and stomach ache or a feeling of pressure in the abdomen. These side effects are usually gone in a few days. Tiredness may last for a couple of weeks.
Some research shows that people who had SIRT had a fall in the number of white cells in the blood. White cells help the body fight infection. As SIRT is often given with other treatments we need more research to find out exactly how and why this happens. More rarely, people have had inflammation of the liver.
How SIRT works
Which cancers SIRT can treat
Research into SIRT
How you have SIRT
What Selective Internal Radiation Therapy (SIRT) is
SIRT stands for Selective Internal Radiation Therapy. It is a new way of using radiotherapy to treat liver cancers that can’t be removed with surgery. SIRT is internal radiotherapy, which is also called ‘brachytherapy’. It sends tiny beads called microspheres containing a radioactive substance directly to the tumours through a small tube called a catheter. The microspheres are also called ‘SIR-spheres’, and the radioactive substance is called ‘yttrium 90’.
The catheter goes into the hepatic artery. This is the main artery that supplies blood to the liver. The liver gets most of its blood supply from a blood vessel called the portal vein. But tumours in the liver get theirs from the hepatic artery. So by using the hepatic artery, SIRT is able to target the tumours without affecting the normal liver.
How SIRT works
The microspheres travel through the hepatic artery into the blood supply of the tumours. They then get trapped in the tumours’ small blood vessels where they release the radiation.
The radiation damages the tumours’ blood supply so the tumours can’t get the nutrients they need. This is why this is process is sometimes called ‘radioembolisation’. The radiation also damages the DNA of the cancer cells, which stops the cancer cells growing.
The liver can only cope with small doses of external radiotherapy. But because SIRT targets the tumours, not the liver, doctors can use it to give the tumours a larger dose of radiation.
The microspheres give off radiation to an area only 2 to 3mm around where they are trapped. This means they cause very little damage to the surrounding healthy tissue. The microspheres only stay radioactive for 10 to 14 days but stay in the liver permanently. They are harmless.
Which cancers SIRT can treat
Doctors only use SIRT if they cannot remove the tumours with an operation. They have looked at how well this treatment works for both primary and secondary tumours of the liver, including
Advanced bowel cancers that have spread to the liver
Cholangiocarcinomas
Hepatocellular cancers
Secondary neuroendocrine tumours that have spread to the liver
Research into SIRT
In 2004 NICE issued guidance stating that
SIRT was safe to use
Research showed SIRT could reduce the size of liver tumours
The NICE guidance says that doctors can use SIRT to treat people
Who can’t have surgery
Who have been told that SIRT is a new treatment
The guidance also said we needed more research to see if SIRT could help people live longer and reduce symptoms.
A phase 1 trial in 2007 used SIRT to treat people whose bowel cancer had spread to their liver. The researchers treated the people in the trial with SIRT along with FOLFOX chemotherapy.
As this was a phase 1 trial, the researchers were mainly trying to find out
How safe it was to combine these two treatments
What the doses should be
The results from this trial showed that the combination treatment was safe. They also suggest that the people who had the combination treatment were free of cancer for longer than people who had chemotherapy alone. However as this was a small, early trial, we need further research to confirm these results. The researchers are now planning a phase 3 trial to test SIRT in combination with chemotherapy.
How you have SIRT
You may have SIRT on its own or with chemotherapy.
Before you can have the SIRT, you have an angiogram. This is to look at the blood supply to the liver and to check your hepatic artery. This can vary between people. Occasionally people can't have treatment because their hepatic artery also supplies blood to their lungs or other sensitive tissue. This means that the SIRT microspheres could reach these areas and damage them.
Immediately before you have the treatment you will have
A sedative to relax you
Anti sickness medicine
Antibiotics
Then the doctor gives you an injection into your groin to numb the area. Once the area is numb they make a tiny cut in the groin and put a fine tube called a catheter into the artery in the groin (the femoral artery). Using scans the doctor passes the catheter up the femoral artery and into the hepatic artery. Once this is in place the doctor gives the treatment. The whole process takes about an hour.
After the treatment you will have a dressing put over the small wound. Most people need to stay in hospital overnight. Your doctor will give you painkillers and anti sickness medicine to take if you need it.
Generally the side effects are mild. They include raised temperature, chills, nausea, and stomach ache or a feeling of pressure in the abdomen. These side effects are usually gone in a few days. Tiredness may last for a couple of weeks.
Some research shows that people who had SIRT had a fall in the number of white cells in the blood. White cells help the body fight infection. As SIRT is often given with other treatments we need more research to find out exactly how and why this happens. More rarely, people have had inflammation of the liver.
chemotherapy In cancer:- How chemotherapy works
How chemo kills cancer cells
Chemotherapy damages dividing cells. You can have chemotherapy either as an injection into the bloodstream or have it as tablets or capsules. The drugs circulate all round the body in the bloodstream and damage any cells that are dividing. Body tissues are made of billions of individual cells. Once we are fully grown, most of the body's cells don't divide much. They spend most of their time in a resting state and only divide if they need to repair damage. When cells divide they split into two, identical new cells.So, where there was 1 cell, there are now 2 and these then divide to make 4 and then 8 and so on. And cancer cells divide much more often than most normal cells. This is how tumours grow and form lumps. Cells in the process of dividing are more at risk of being damaged by chemotherapy. Chemotherapy damages part of the control centre inside each cell that makes cells divide. Or it interrupts the chemical processes involved in cell division. The damaged cells then die.
There is more detailed information about how normal cells grow and about how cancer cells differ from norm
al cells in the about cancer section of CancerHelp UK.How chemotherapy kills dividing cells
Chemotherapy damages cells as they divide. In the centre of each living cell is a dark blob, called the nucleus. The nucleus is the control centre of the cell. It contains chromosomes, which are made up of genes. These genes have to be copied exactly each time a cell divides into 2 to make new cells.
Chemotherapy damages the genes inside the nucleus of cells. Some drugs damage cells at the point of splitting. Some damage them while they are busy making copies of all their genes before they split. Cells that are at rest (most normal cells, for instance) are much less likely to be damaged by chemo. You may have a combination of different chemotherapy drugs. The combination will include chemo drugs that damage cells at different stages in the process of cell division. With more than one type of drug, there is more chance of killing more cells.
The fact that chemo drugs kill dividing cells helps to explain why chemotherapy causes side effects. It affects healthy body tissues where the cells are constantly growing and dividing. The skin, bone marrow, hair follicles and lining of the digestive system are examples of these. Your hair is always growing. Your bone marrow is constantly producing blood cells. The cells of your skin and the lining of your digestive system are constantly renewing themselves. These tissues have dividing cells and they can be damaged by chemotherapy.
But, normal cells can replace the healthy cells that are damaged by chemotherapy. So the damage to healthy cells doesn't usually last. Most side effects disappear once your treatment is over, and some only happen during the days while you are actually having the drugs (for example, sickness or diarrhoea). The section on chemotherapy side effects explains this in more detail.
How well chemotherapy works
The chance of the chemotherapy curing your cancer depends on the type of cancer you have
With some types of cancer, most people are cured by chemotherapy
With other types of cancer, fewer people are completely cured
Examples of cancers where chemotherapy works very well are testicular cancer and Hodgkin's lymphoma.
With some cancers, chemotherapy can't cure the cancer on its own. But it can help in combination with other types of treatment. Many people with breast or bowel cancer, for example, have chemotherapy after surgery to help lower the risk of the cancer coming back.
With some cancers, if a cure is unlikely, your doctor may still suggest chemotherapy to
Shrink the cancer
Relieve your symptoms
Give you a longer life by controlling the cancer or putting it into remission
What remission means
Remission is a word doctors often use when talking about cancer or leukaemia. It means there is no sign of the cancer. Doctors can be reluctant to say that a cancer is 'cured' because some cancers can come back years later. The more time that goes by, the less likely it is that a cancer will come back. But there is still that small chance. So doctors use the word 'remission'. You may hear your doctor talk about complete remission and partial remission.
Complete remission means that the cancer or leukaemia can't be detected on scans, X-rays, or blood tests etc.
Partial remission means the treatment has killed some of the cells, but not all. The cancer has shrunk, but can still be seen on scans and doesn't appear to be growing.. The treatment may have stopped the cancer from growing. Or made it smaller so that other treatments are more likely to help, such as surgery or radiotherapy.
Cancer Treatment :- Surgery for lung cancer
Surgery for lung cancer
Surgery is mostly used to treat non small cell lung cancer. But it may be better for you to have other cancer treatment such as radiotherapy, chemotherapy or possibly both if your cancer is very near any of the following structures
Heart
Windpipe
Gullet
Major blood vessels
Surgery is not normally used to treat small cell lung cancer, except very early ones. This is because small cell lung cancer has usually spread beyond the lung when it is diagnosed and so it is not then possible to remove it all with surgery. Chemotherapy and radiotherapy are more often used than surgery for small cell lung cancer.
The type of surgery you have will depend on the size of the cancer and its position within the lung.
Removing lobes of the lung
Lobectomy is the removal of one lobe of the lung. Your surgeon will recommend this type of operation if they think the cancer is just in one part of one lung. It is the most common type of operation for lung cancer. Bilobectomy is the removal of two lobes of the lung.
A small number of people with lung cancer have an operation called a sleeve resection. Your surgeon may do this to avoid removing your whole lung if the cancer is in the central area of the lung and is growing into one of your main airways (bronchi). In this situation a simple lobectomy can't be done. Sleeve resection involves removing the affected section of the bronchus, and any surrounding cancer in the lobe.
Removing the whole lung
Removing the whole lung is called pneumonectomy. Your specialist will recommend this operation if the tumour is in the central area of the lung and involves either the 2 lobes on the left or the 3 lobes on the right.
Many people worry that they won't be able to breathe properly with only one lung but you can breathe normally with only one lung. If you had breathing problems before the operation, you will probably still be breathless afterwards. Your doctor will arrange for you to have breathing tests before the surgery to help decide if this operation is right for you.
Removing a section of lung
Some operations remove particular areas of the lung. A wedge resection removes an area of the lung that includes part of one or more lobes. A segmentectomy removes areas of the lung along with their veins, arteries and airways. These types of operation are used when the specialist thinks the cancer has been diagnosed early and is only in one very small area. If the specialist thinks the cancer cells could be anywhere else in the lung they will not recommend this type of operation.
If your cancer has spread
If your cancer has spread to anywhere else in your body, then a major operation to remove your cancer is usually not the right treatment for you. If there are cancer cells anywhere else, the operation will not remove them and your doctor will probably suggest another type of cancer treatment such as chemotherapy and radiotherapy instead.
Your general health
If you have other health problems such as a severe heart condition or other lung disease, you may not be fit enough to have major lung surgery. Your surgeon will examine you thoroughly and do quite a few tests before you decide together whether an operation is right for you at all. Or whether you should have a smaller operation. Your doctor may recommend radiotherapy and you can find information about this in our section about radiotherapy for non small cell lung cancer.
Surgery is mostly used to treat non small cell lung cancer. But it may be better for you to have other cancer treatment such as radiotherapy, chemotherapy or possibly both if your cancer is very near any of the following structures
Heart
Windpipe
Gullet
Major blood vessels
Surgery is not normally used to treat small cell lung cancer, except very early ones. This is because small cell lung cancer has usually spread beyond the lung when it is diagnosed and so it is not then possible to remove it all with surgery. Chemotherapy and radiotherapy are more often used than surgery for small cell lung cancer.
The type of surgery you have will depend on the size of the cancer and its position within the lung.
Removing lobes of the lung
Lobectomy is the removal of one lobe of the lung. Your surgeon will recommend this type of operation if they think the cancer is just in one part of one lung. It is the most common type of operation for lung cancer. Bilobectomy is the removal of two lobes of the lung.
A small number of people with lung cancer have an operation called a sleeve resection. Your surgeon may do this to avoid removing your whole lung if the cancer is in the central area of the lung and is growing into one of your main airways (bronchi). In this situation a simple lobectomy can't be done. Sleeve resection involves removing the affected section of the bronchus, and any surrounding cancer in the lobe.
Removing the whole lung
Removing the whole lung is called pneumonectomy. Your specialist will recommend this operation if the tumour is in the central area of the lung and involves either the 2 lobes on the left or the 3 lobes on the right.
Many people worry that they won't be able to breathe properly with only one lung but you can breathe normally with only one lung. If you had breathing problems before the operation, you will probably still be breathless afterwards. Your doctor will arrange for you to have breathing tests before the surgery to help decide if this operation is right for you.
Removing a section of lung
Some operations remove particular areas of the lung. A wedge resection removes an area of the lung that includes part of one or more lobes. A segmentectomy removes areas of the lung along with their veins, arteries and airways. These types of operation are used when the specialist thinks the cancer has been diagnosed early and is only in one very small area. If the specialist thinks the cancer cells could be anywhere else in the lung they will not recommend this type of operation.
If your cancer has spread
If your cancer has spread to anywhere else in your body, then a major operation to remove your cancer is usually not the right treatment for you. If there are cancer cells anywhere else, the operation will not remove them and your doctor will probably suggest another type of cancer treatment such as chemotherapy and radiotherapy instead.
Your general health
If you have other health problems such as a severe heart condition or other lung disease, you may not be fit enough to have major lung surgery. Your surgeon will examine you thoroughly and do quite a few tests before you decide together whether an operation is right for you at all. Or whether you should have a smaller operation. Your doctor may recommend radiotherapy and you can find information about this in our section about radiotherapy for non small cell lung cancer.
About Cnacer : - Cancer Treatment
Cancer Treatment
Fighting cancer is similar to going to war with a country. One must use different fighting strategies, different weapons and powerful ammunition. Following is a list of weapons currently available for the war against cancer. Each one of the following is also referred to as a Modality or Discipline. At all times, we should use state-of-the-art technology and science and the best methods at our disposal to fight the enemy.
A multi-modality approach is the use of one or more of the above weapons to fight cancer. For example, a patient with breast cancer initially will undergo surgery to remove the tumor, followed by chemotherapy and radiation therapy.
To insure a successful outcome, one has to know the enemy very well, its weaknesses, strengths, its potential to damage us, its way of resisting our attacks. We must be prepared for counterattack with backup plans. We must understand our ammunition and its potential to destroy the enemy, as well as possible backfire and side effects to the patient. At the same time, we must be prepared to deal with the backfire by using medicines and remedies available to us.
Treatment of cancer may be moderate or very sophisticated and complex. It is best managed by a team of capable and qualified physicians. A breast cancer patient should preferably be seen by a surgeon, medical oncologist, radiation oncologist and a plastic surgeon prior to treatment. A treatment plan must then be initiated by each member of the team. Different strategies must be discussed and explained with input from the patient to direct the course of treatment.
This is very difficult for the patient. Imagine a woman just diagnosed with breast cancer. Her anxiety and depression levels are very high at the onset; therefore, this is a critical period for a group effort to treat her problem. In the best case scenario, the first physician who sees her will arrange for all the necessary care. However, this is not true for every patient. Some patients suffer from the inefficiencies of our healthcare system and receive less than adequate care.
- Surgery
Chemotherapy
Radiation Therapy
Hormonal Therapy
Immunotherapy
Bone Marrow Transplantation
Experimental Treatments
Pain Management
Palliative Treatments
Alternative Treatments
Hospice
Treating Cancer :- Treating Cancer Carefully
Treating Cancer Carefully
Cancer is treated with surgery, chemotherapy, or radiation — or sometimes a combination of these treatments. The choice of treatment depends on:
- the type of cancer someone has (the kind of abnormal cells causing the cancer)
- the stage of the tumor (meaning how much the cancer has spread within the body, if at all)
Surgery is the oldest form of treatment for cancer — 3 out of every 5 people with cancer will have an operation to remove it. During surgery, the doctor tries to take out as many cancer cells as possible. Some healthy cells or tissue may also be removed to make sure that all the cancer is gone.
Chemotherapy (say: kee-mo-ther-uh-pee) is the use of anti-cancer medicines (drugs) to treat cancer. These medicines are sometimes taken as a pill, but usually are given through a special intravenous (say: in-truh-vee-nus) line, also called an IV. An IV is a tiny plastic catheter (straw-like tube) that is put into a vein through someone's skin, usually on the arm. The catheter is attached to a bag that holds the medicine. The medicine flows from the bag into a vein, which puts the medicine into the blood, where it can travel throughout the body and attack cancer cells.
Chemotherapy is usually given over a number of weeks to months. Often, a permanent catheter is placed under the skin into a larger blood vessel of the upper chest. This way, a person can easily get several courses of chemotherapy and other medicines through this catheter without having a new IV needle put in. The catheter remains under the skin until all the cancer treatment is completed.
Radiation (say: ray-dee-ay-shun) therapy uses high-energy waves, such as X-rays (invisible waves that can pass through most parts of the body), to damage and destroy cancer cells. It can cause tumors to shrink and even go away completely. Radiation therapy is one of the most common treatments for cancer. Many people with cancer find it goes away after receiving radiation treatments.
With both chemotherapy and radiation, kids may experience side effects. A side effect is an extra problem that's caused by the treatment. Radiation and anti-cancer drugs are very good at destroying cancer cells but, unfortunately, they also destroy healthy cells. This can cause problems such as loss of appetite, tiredness, vomiting, or hair loss. With radiation, a person might have red or irritated skin in the area that's being treated. But all these problems go away and hair grows back after the treatment is over. During the treatment, certain medicines can help a kid feel better.
While treatment is still going on, a kid might not be able to attend school or be around crowds of people — the kid needs to rest and avoid getting infections, such as the flu, when he or she already isn't feeling well. The body may have more trouble fighting off infections because of the cancer or side effects of the treatment.
Getting Better
Remission (say: ree-mih-shun) is a great word for anyone who has cancer. It means all signs of cancer are gone from the body. After surgery or treatment with radiation or chemotherapy, a doctor will then do tests to see if the cancer is still there. If there are no signs of cancer, then the kid is in remission.
Remission is the goal when any kid with cancer goes to the hospital for treatment. Sometimes, this means additional chemotherapy might be needed for a while to keep cancer cells from coming back. And luckily, for many kids, continued remission is the very happy end of their cancer experience.
About Cancer :- What Is Cancer?
What Is Cancer?
Cancer is actually a group of many related diseases that all have to do with cells. Cells are the very small units that make up all living things, including the human body. There are billions of cells in each person's body.
Cancer happens when cells that are not normal grow and spread very fast. Normal body cells grow and divide and know to stop growing. Over time, they also die. Unlike these normal cells, cancer cells just continue to grow and divide out of control and don't die when they're supposed to.
Cancer cells usually group or clump together to form tumors (say: too-mers). A growing tumor becomes a lump of cancer cells that can destroy the normal cells around the tumor and damage the body's healthy tissues. This can make someone very sick.
Sometimes cancer cells break away from the original tumor and travel to other areas of the body, where they keep growing and can go on to form new tumors. This is how cancer spreads. The spread of a tumor to a new place in the body is called metastasis (say: meh-tas-tuh-sis).
Causes of Cancer
You probably know a kid who had chickenpox — maybe even you. But you probably don't know any kids who've had cancer. If you packed a large football stadium with kids, probably only one child in that stadium would have cancer.
Doctors aren't sure why some people get cancer and others don't. They do know that cancer is not contagious. You can't catch it from someone else who has it — cancer isn't caused by germs, like colds or the flu are. So don't be afraid of other kids — or anyone else — with cancer. You can talk to, play with, and hug someone with cancer.
Kids can't get cancer from anything they do either. Some kids think that a bump on the head causes brain cancer or that bad people get cancer. This isn't true! Kids don't do anything wrong to get cancer. But some unhealthy habits, especially cigarette smoking or drinking too much alcohol every day, can make you a lot more likely to get cancer when you become an adult.
Finding Out About Cancer
It can take a while for a doctor to figure out a kid has cancer. That's because the symptoms cancer can cause — weight loss, fevers, swollen glands, or feeling overly tired or sick for a while — usually are not caused by cancer. When a kid has these problems, it's often caused by something less serious, like an infection. With medical testing, the doctor can figure out what's causing the trouble.
If the doctor suspects cancer, he or she can do tests to figure out if that's the problem. A doctor might order X-rays and blood tests and recommend the person go to see an oncologist (say: on-kah-luh-jist). An oncologist is a doctor who takes care of and treats cancer patients. The oncologist will likely run other tests to find out if someone really has cancer. If so, tests can determine what kind of cancer it is and if it has spread to other parts of the body. Based on the results, the doctor will decide the best way to treat it.
One test that an oncologist (or a surgeon) may perform is a biopsy (say: by-op-see). During a biopsy, a piece of tissue is removed from a tumor or a place in the body where cancer is suspected, like the bone marrow. Don't worry — someone getting this test will get special medicine to keep him or her comfortable during the biopsy. The sample that's collected will be examined under a microscope for cancer cells.
The sooner cancer is found and treatment begins, the better someone's chances are for a full recovery and cure.
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