MODALITIES OF CANCER TREATMENT

MODALITIES OF CANCER TREATMENT

Today nearly half of all cancer patient are being cured because of early diagnosis and improved treatment methods. The oncologist plan the treatment according to the patient disseas. He also considers the medical history , age and general health. Today the treatment of cancer has been replaced by multimodality therapy which are surgery, chemotherapy, radiotherapy, hormonal therapy and immunotherapy. Since cancer metastasizes the treatment used are very powerful. Patient may have unpleasant side effects. Most side effect are temporary and end after the treatment.

1. CHEMOTHERAPY

antineoplastic drug causing cell destruction by interfering with the celular fungtion and reproduction. Chemotherapy may be administerd by oral, Intravenus, intramuscullar or subcutaneus. Intracavity and intrathecally.

2. RADIOTHERAPY

Also know as cobalt treatment, radiotherapy or irradiation. High energy rays are used to destroy cancer cells. It may be used before surgery to shrink the tumor or after surgery to destroy any cancer cell remaining locally that area.

a. External Radiotherapy

it is the use of high energy ionizing rays to treat cancer. It destroys the cells ability to grow and multiply. The patient are treated five days a week. They are not radioactive during or after treatment.

b. Internal radiotherapy

· Iodine Therapy : radioactive iodine is administered orraly in cases of cancer thyroid in medical ward.

· Brancy Therapy : it is intracavity application of radiation for cancer cervix, cancer uterus in the female medical ward.

Common side effects of radiation are unusual tiredness and skin reaction. It may also reduce the number of white blood cells. The type and degree of side effects depend on the area of the body being irradiated.

3. SURGERY

Surgery is a local treatment. It is removal of tumor and surrounding still a safety margin of normal tissue. In some lymph nodes and lymphatic chanels are also removed to examine for the present of malignat cells.

4. HORMONE THERAPY

Administration of hormone inhibits the growth of certain cancers for e.g. cancer of breast and cancer prostate etc.

5. IMMUNOTHERAPY

Drug that enhance the body natural immune system to fight against abnormal cells, for example : cetuximab, mabthera, avastin etc

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CANCER AND WOMEN’S HEALTH

Cancer is common cause of death in the industrialized world and is now of the most feared disease. Cancer is usually a progressive fatal disease if detected early, many cancers can be cured or the life expectancy can be prolonged with treatment. It is important that women should be aware of cancer which may lead to early diagnosis and treatment.

Secondary tumor arising in parts of the body distant from the primary tumor is metastasis. Malignant cell can travel via the blood, lymph or across body cavities. Most common site of metastasis is lungs, liver and bone ( especially in cancer breast ).

MALIGNANT	BENIGN
Invasive Uncontrolled, diffused, often rapid growing Undifferentiated (No resemblance to normal tissue) Tumors spreads to distant sites	Encapsulated Growth controlled or slow growing Well differentiated (mature cells, resemble normal tissue) Tumor are usually localized

EARLY DETECTION AND PREVENTION

Early detection of some cancer is possible in individuals who have no symptoms of disease.
MOUTH
Observe changes in color of gums, lips or cheeks as well as ulcer, sweeling, bleeding or thickening in any area of the mouth.
SKIN
You should check yourself for new growth or other changes in the skin, especially pigmented areas.
BREAST
Breast Self Examination ( BSE ) : women should perform BSE every month on the last day of menstrual period. Post menopausal women, on the same day monthly.
Women in the age group of 20 – 35 years should have a physical examination by the doctor yearly. 35 – 49 years should yearly examination and have a mammogram every 2 years. 50 years above should mammogram yearly.
CERVIX
Pap smear until 40 years every 3 years, and 40 years above every year.
Hight risk group : early age at first intercourse, multiple sex partners and multiple pregnancy.
ENDOMETRIUM
High risk group : infertility, obesity, failure of ovulation, abnormal uterine bleeding, oestrogen therapy.

PRE-DISPOSING FACTORS

About 80 % of cancer will be related to the things we eat, drink and smoke as well as our environment and work place. Other risk factors such as genetics are unavoidable.

1. TOBACCO AND BETEL NUT

It is a well know fact that smoking and chewing causes various cancers. Once you quit tobacco the risk decreases.

2. DIET

Diet also play an important role in develoving cancer. Diet rich in fat content can cause cancer colon, pancreas, endometrium, prostate and breast.

The national cancer institute believes that eating a well balanced diet can reduce the risk of getting cancer.

3. SUNLIGHT

Utraviolet radiation from the sun is the main cause of the skin cancer, especillay among light skinned persons.

4. ALCOHOL

Alcohol is associated with cancer of mouth, larynx, liver and esophagus.

5. IONIZING RADIATION

Large doses of radiation increase the risk of the cancer. Radiation given to the head and neck during childhood can result thyroid tumors and radiation carcinogenesis. Many children of the Hiroshima atom bomb explosion develoved leukemia and thyroid cancer later.

6. INDUSTRIAL AGENT

Avoid inhalation and ingestion and exposure to household solvent, cleaners, cleaning fluids, paint thinners and garden chemical. Follow instructions while using pesticides and fungicides. Such chemicals should not come in contact with toys and other household items.

7. HORMONE

a. Oestrogen associated with menopausal symptoms can cause uterine cancer.

b. Diethylstilbestrol ( DES )

Mother on DES administrations during pregnancy maybe at risk to breast cancer. Daughter born to these mothers are at risk to vaginal and cervical cancer. Women taking hormones should discuss the benefit and risk with their treating doctors.

CLINICAL MANIFESTASION

Although cancer may be present with many problems, the most common warning sign of cancer are :

a. Change in bowel or bladder habits

b. An ulcer that does not heal

c. Unusual bleeding or discharge

d. Thickening or lump in breast or elsewhere

e. Indigestion or difficulty in swallowing

f. Obvious change in wart or mole

g. Nagging cough or hoarseness

h. Headache mot relived by usual medications

CAUTION :
These sign and symptoms can be caused by cancer or number of other conditions. They are not sure sign of cancer. However it is to see a doctor if any problem last longer than two weeks. Do not wait the symptoms to be painful, pain in not an early sign of cancer.

DIAGNOSIS OF CANCER

Cancer is diagnosed by the following methods :

a. Patient medical history

b. Complete physical examinations

c. Laboratory investigations, CBC, differential count, platelets and oncology profile

d. Radiological examinations : X – Rays, mammogram ( breast ), radio active isotope scan, Ct scan, Ultrasonography

e. Endoscopy

f. Cytology

g. Bone marrow examinations ( in certain case )

h. Tumor marker studies ( in certain case )

i. Histopathology

STAGING OF CANCER

Staging is classification system based on the anatomic extent of the malignancy.

TNM Classification system
T – Primary tumor
T x – Tumor cannot be adequately assessed
T 0 – No evidence of primary tumor
TIS – Carcinoma in situ
T1, T2, T3, T4 – Progressive increase in tumor size and involment

N – Regional lymph nodes
Nx – Regional lymph nodes cannot assessed by clinically
N0 - Regional lymph nodes demonstrably normal
N1, N2, N3, N4 – increasing degrees of demonstrable abnormality of regional lymph nodes

M – Distant metastasis
Mx – Not assessed
M0 – No ( know ) distant metastasis
M1 – distant metastasis present, specify sites