PRINCIPLES OF CANCER
TREATMENT
Rakesh KumarGroup :- 3rd Course :-5th
Goals of cancer treatment1- Primary goal Cure the patient Render him clinically and pathologically
free of disease and return their life expectancy to that of healthy individuals of the same age and sex.
Current therapies do not offer cures for all patients
Goals of cancer treatment2- The best alternative goal To prolong survival while maintaining
the patient's functional status and quality of life.
3- The 3rd goal Relive symptoms such as pain for
patients in whom the likehood of cure or prolonged survival is very low
Modalities of cancer treatmentThe Major Modalities Surgery Radiation Chemotherapy Biological therapy
Modalities of cancer treatmentThe most appropriate type of therapy for
each individual patient is determined by Type and extent of tumor involvement Treatment goals Performance status Age Concomitant disease Many patient receive 2 or 3 of these modalities
together
I-Surgery The oldest cancer treatment The most invasive method Requires patient be able to tolerate
physical challenges of surgery Was only method that could produce cures Still provides the best chance of cure for
most patients with solid tumors.
I-Surgery Uses
…Treat the primary cancer…To remove isolated metastatic masses…To make other methods of treatment
possible e.g. providing access for chemotherapy delivery (implanted infusion pumps)
I-SURGERY Diagnosis and Staging Reconstruct anatomical defects to
improve function, cosmetic appearance, and quality of life
Prevention… Permitting the removal of precancerous
lesions such as abnormal moles or colon polyps.
I-SURGERY Treat complication
… Hemorrhage… Perforation… Bowel obstruction… Spinal cord compression
I-SURGERY
Debulking …Reduce the size of the tumor even though the entire tumor cannot be resected
1ry to relive pain or other symptoms Increase effectiveness of radiation or
chemotherapy
I-SURGERY
Surgical removal of a source of hormone…A form of hormonal therapy…Used in to treat tumors whose growth depends on those hormones…Most common type: removal of testes in prostate cancer and removal of ovaries in breast cancer.
II- Radiation
It is the destruction of cancer cells by ionizing radiation
A component of treatment for ½-2/3 of all patients with cancer
Radiation is usually generated by machines outside the patient (external beam radiation)
II- Radiation
Less commonly radiation sources are placed close to the body surface or within the body cavity (brachy-therapy)
Sometimes radiation sources are implanted into or around cancerous tissue (interstitial brachytherapy)
II- Radiation
Usually administered in small doses over several weeks (fractionating)
fractionating permits the administration of levels of radiation sufficient to kill tumor cells while allowing normal surrounding tissue to recover from damage
II- RadiationSide Effects Radiation can never be directed only at tumor
and normal cells and tissue are also damaged The most sensitive tissues are those that
undergo continuous cell renewal such as the skin, hair , GI mucosa, bone marrow, reproductive tissue, and sweat glands
In slowly growing tissue such as lungs, effects of radiation is seen much later
II- RADIATIONSide effects: the ability to produce a cure with
radiation will depend on the capacity of normal tissues surrounding the tumor to withstand the toxic effects… if the normal tissue are very sensitive,
the range of radiation doses used may be limited
II- Radiation Radiocurability: ability to cure by
radiation Depends on
… The size and location of the tumor… Type of tumor… Tumor’s radiosensitivity
Curative radiation is limited to localized tumors like surgery
II- RadiationUses Curative for localized tumors Total body radiation to prepare for bone
marrow transplant , but highly toxic As supplement to surgery
To destroy micro metasitasis
II- RadiationUses Palliatively
… the most common used is to relive pain caused by skeletal bone metastases
… such as seizures associated with brain metastases
… spinal cord compression caused by growth of tumors on the spine
III-CHEMOTHERAPY
refers to the use of conventional cytotoxic drugs in addition to hormonal and endocrine therapy.
Originally started in 1941, when Goodman and Gilman first administered nitrogen mustard to patients with lymphoma
III-CHEMOTHERAPY
Now there are > 50 conventional cytotoxic agents and > 15 hormonal agents for cancer treatment
III-CHEMOTHERAPY
Cancer chemotherapy may be Primary Palliative Adjuvant neoadjuvant
Chemotherapy used alone with curative intent
Acute lymphocytic leukemia Acute myelogenous leukemia
Chemotherapy used as adjuvant therapy with curative intent
Breast cancer Colorectal cancer
Chemotherapy used as neoadjuvant therapy
Anal carcinoma Bladder cancer
Chemotherapy used to palliate symptoms in advanced disease
Bladder cancer Brain tumors
Chemotherapy has little or no effect on palliation
Hepatocellular cancer Renal cell carcinoma