Cancer treatments: Better. Safer. On target.
New technologies, advanced techniques, and scientific breakthroughs are revolutionizing treatments and making the fight against cancer more winnable than ever.
Year after year, from one decade to the next, cancer has been a constant presence among the most serious global health threats. The disease consistently ranks at or near the top as a cause of death in Thailand and throughout most of the world. The good news is, cancer treatments have improved dramatically in recent years. A new generation of treatments is responsible for better outcomes, higher survival rates, fewer side effects, and better quality of life for cancer patients during and after treatment.
For an in-depth look at recent trends in cancer treatment, Better Health turned to Dr. Narongsak Kiatikajornthada, a US board certified hematologist and oncologist who is co-director of the Horizon Regional Cancer Center at Bumrungrad International Hospital.
Being diagnosed with cancer is one experience most people fear. And until a few years ago, cancer treatments inspired plenty of fear as well. “Years ago, our treatment options were limited, and the main goal was to eliminate the cancer by any means necessary,” Dr. Narongsak recalls. “Many patients had quite severe side effects.”
“The entire treatment process has changed dramatically,” Dr. Narongsak continues. “To begin with, the treatment planning process is very thorough. A typical plan will include both primary and secondary treatments, plus a palliative care plan for managing pain and possible side effects. The primary treatment goal is eliminating most of the cancer, and the secondary treatment destroys any remaining cancer and helps prevent it from returning or spreading to neighboring organs.”
During treatment planning, doctors consider many factors including the location of the cancer, its stage of progression, and the current state of the patient’s overall health. “Cancer specialists have three main tools to fight cancer – surgery, radiation therapy and chemotherapy,” explains Dr. Narongsak. “Each can be used as a primary or secondary treatment. But there can be quite a lot of variation from one treatment plan to the next.”
Cancer’s two types
Each type of cancer falls into one of two categories – hematologic malignancy or solid tumor. Hematologic malignancies include cancers of the blood, bone marrow and lymph nodes; leukemia and lymphoma are two major cancers in the category. Hematological cancers move throughout the body, whereas solid tumors remain in a particular area attached to a specific organ or structure.
“Surgery is not an option for treating hematologic malignancies because the cancer cells are present throughout the body,” Dr. Narongsak explains. “The most common treatment is a combination of chemotherapy plus radiation therapy. For solid tumor treatments such as breast cancer or cervical cancer, doctors will usually recommend surgery as the primary treatment, typically followed by either radiation therapy or chemotherapy. Occasionally, a tumor will be too large to be safely removed by surgery. We usually solve this problem by using chemotherapy or radiation therapy as the primary treatment to shrink the tumor sufficiently so it can be removed surgically as the secondary treatment.”
Many cancer patients receive radiation therapy as part of their treatment program. High-speed ionizing radiation attacks and destroys most of the cancerous cells while keeping healthy cell damage to a minimum. Radiation therapy is given to some patients outside the body, while for others it is implanted in radioactive seed form next to the tumor. Radiation and surgery are categorized as local treatments because they are used in one particular area – breast, prostate, lung, etc. – and usually target the tumor directly. Chemotherapy is different from surgery or radiation because it’s almost always used as a so-called systemic treatment. Chemotherapy describes treatments that use one or more drugs to target rapidly-growing cancer cells.
Breakthroughs in understanding how cancer develops, and advances in technology and medical techniques have had a significant impact on cancer detection and cancer treatment. Doctors are able to detect cancers earlier than ever, when treatments are most successful. And treatment advances are producing better outcomes with less trauma than ever.
“The advances have led to better treatments and more options for treating different cancer types,” notes Dr. Narongsak. “For patients who previously would have undergone traumatic surgery for colorectal, lung or prostate cancer, laparoscopic surgery is now a minimally-invasive alternative. The surgeon uses hi-tech telescopic equipment inserted through tiny skin incisions to remove the tumor.”
Dr. Narongsak continues: “Tissue conservation surgery has been a life-changing advancement for many cancer patients; breast cancer patients can now avoid the disfiguring mastectomies which used to be standard protocol, and rectal cancer patients can look forward to resuming normal bowel function. This procedure removes only the cancerous tissue in the rectum, leaving the anal sphincter intact. That’s a giant step forward from previous surgical treatments that required permanent colostomies (waste removed through an abdominal opening connected to a colostomy bag) for rectal cancer patients.”
Beyond surgery, radiation therapy and chemotherapy treatments have seen considerable improvements. “Image Guided Radiation Therapy (IGRT) provides better accuracy and precision in delivering radiation to the cancerous tumor,” Dr. Narongsak says.“That’s especially helpful because tumors can move during treatment from the simple act of a patient breathing. And we now have IMRT, which means Intensity Modulated Radiation Therapy. This procedure uses computer-controlled linear accelerators to deliver a precise dose of radiation that conforms to the 3-Dimensional shape of the tumor by varying the intensity of the radiation beam.”
On progress in chemotherapy treatments, Dr. Narongsak notes, “Many new formulas and combinations have been introduced. Side effects – both immediate and delayed – are much easier to manage, and in many cases, they’ve been completely eliminated.”
Targeted therapy revolution
Chemotherapy remains the treatment-of-choice for a variety of cancer types. But some patients experience depression or other side effects to the point where they must discontinue chemotherapy treatment. These patients in particular are now benefitting first-hand from a whole new type of cancer treatment.
Dr. Narongsak shares the details of this exciting development: “This new generation cancer-fighting agent is called targeted therapy. It’s a type of medication that stops cancer from growing by targeting cancer cells. Targeted therapy has been approved for several cancer scenarios, including treating localized-and-advanced-stage breast cancers; in cases where colorectal cancer has spread to the liver; for lung cancer that is resistant to other chemotherapies; and for locally advanced-stage cancers of the head and neck, targeted therapy is considered for certain cases as an alternative to removing structures such as the larynx, sinuses or nasal cavities, for example.”
Dr. Narongsak continues: “Targeted therapies come in a number of variations. Though each has unique characteristics, they all work by targeting and destroying cancerous cells while keeping healthy cell damage to a minimum. Targeted therapy takes a three-pronged approach to destroy cancer cells: First, target the blood vessels that feed the tumors. Second, block the signaling receptors that promote cancer growth. Third, create antibody agents for the tumor as a way to prompt the patient’s immune system to initiate a response of sufficient power to defeat the cancerous cells.”
Targeted therapies are generally considered for use as second-line treatments that can improve survival rates when added to first-line treatments, i.e. surgery, radiation therapy and chemotherapy. Targeted therapies can be used either before or after first-line treatments, depending on the doctor’s recommendation for a patient’s specific situation.
“Targeted therapy outcomes have been encouraging so far,” notes Dr. Narongsak. “Since the therapy involves the targeting of a specific gene, not every patient is a good candidate for this particular type of treatment. A patient is given a specific genetic test that confirms whether the treatment is well-suited for the patient’s individual situation.”
Quality of life
The many treatment advances have provided a major boost in another area – patient quality of life. “It’s very satisfying to witness how far we’ve come in improving the quality of life for patients,” says Dr. Narongsak. “Cancer treatment has evolved so much; it’s gone from ‘defeat the cancer no matter what’ to ‘defeat the cancer but try to limit the harm’ to today’s treatments, where a patient can enjoy a good quality of life throughout the process. We’re taking a team approach to look after all aspects of a patient’s health. There are surgeons, radiologists, oncologists, hematologists, nutritionists, and psychologists to monitor and support the patient every step of the way.”
Need-to-know for the fight against cancer
Knowledge is a powerful tool in every facet – prevention, detection and treatment – of the fight against cancer. Here are some important points to boost your cancer knowledge:
- Genetic mutation is one of the primary causes of cancer. Stimulation from another source or factor hormones, viruses, chronic inflammation or exposure to carcinogens from outside the body – can cause a healthy gene to mutate into a cancerous gene;
- Patient quality of life is an important consideration in the process of devising a successful cancer treatment strategy;
- Surgery is an effective option beyond tumor removal. In certain cases, surgery helps in cancer diagnosis and prevention, and it is sometimes the best option for relieving side effects of cancer or cancer treatment;
- Radiation therapy can yield better results in some cases by first implanting radioactive seeds in the cancer area, followed by external radiation therapy;
- Cancer cells have these characteristics in common: They divide in a rapid and uncontrolled fashion; they are able to grow continuously through the release of growth factors; they lack the ability to self-repair;
- Some cancers can be removed using minimally-invasive laparoscopic surgery;
- Combining two or more treatments has proven effective in defeating cancer cells that have become resistant to a particular type of treatment;
- Side effects from chemotherapy can produce symptoms at different rates, ranging from immediate to several months’ after the start of treatment. Most side effects begin to subside once the treatment.
- Targeted therapy is one of the newest types of chemotherapy.
Intensity-Modulated Radiation Therapy (IMRT) is a highly advanced 3-Dimensional treatment that conforms to the shape of an individual tumor. During the procedure, the radiologist uses a computer-generated “virtual 3-D” image to pinpoint the precise location of the tumor.
Detailed images are examined thoroughly during the treatment planning process. The intensity of each radiation beam is individually controlled, while the shape of the beam can change hundreds of times during a single treatment. Radiation is precision-targeted right at individual tumors, with minimal exposure to surrounding healthy tissue.
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