World Cancer Day 2021: Evolving Cancer Care
With a growing number of options for cancer treatment, patients today have improved chances of recovery and fewer side effects.
Nowadays, there are many types of treatment available for patients with cancer. As the range and effectiveness of treatments grow, patients are benefitting from improved overall results and reduced side effects. The treatment options, however, will depend on the type and stage of the cancer, whether the cancer has spread, and one’s general health and preferences.
Talking to a doctor to learn more about the types of cancer treatment, and weighing the benefits and risks of each treatment, can help a patient determine which treatment is best suited to him.
We discuss the different types of cancer treatment, who they are for, as well as the possible side effects and outcomes.
Chemotherapy refers to medicines which are either injected or taken orally to treat cancers. They work by interfering with the ability of cancer cells to grow and divide, and are frequently used as part of a cocktail of chemotherapy drugs.
Cancers harbour genetic mutations that allow them to grow unchecked. Targeted therapy involves the use of specific drugs to block these key genetic pathways, enabling the control of tumours. Because these drugs are specific to the cancer signalling pathways, they result in less collateral damage to normal healthy tissue.
Personalised medicine: The same type of tumour in different individuals can harbour different genetic mutations, resulting in differences in response and resistance to the same treatment. In personalised medicine, blood or tumour tissue from a patient is collected and genetically sequenced to look for specific cancer-causing genes. This enables doctors to understand the cancer and make treatment decisions individualised to each patient at each step of his or her cancer journey.
Immunotherapy: These are medications that harness the body’s own natural immune system to fight off cancer. As immunotherapy does not directly destroy cells, immunotherapy has less side effects compared to cytotoxic chemotherapy. Immunotherapy can be used alone or in combination with chemotherapy.
For whom: Anti-cancer medicines are a cornerstone of cancer treatment. They can be used to prevent cancer relapse following surgery or radiation therapy; downsize large tumours prior to surgery or radiation therapy; and in patients whose cancers have spread, to slow down cancer growth.
Possible side effects: Side effects of anti-cancer medicines are variable and depend on which class and which specific drugs within the class are being used. While each class of medicine may have similar general side effects, different members within each class may have differing side effects.
With cytotoxic chemotherapy, side effects may include nausea, hair loss, low blood count and fever.
With hormonal therapy, commonly used to treat breast cancer, side effects may include hot flushes, postmenopausal symptoms, deep vein thrombosis (commonly known as ‘economy class syndrome’) and osteoporosis.
With targeted therapy, many of which are oral tablets, side effects are more directed towards the skin and gastrointestinal tract (e.g. diarrhoea). For some targeted therapies designed to attack tumours of the blood vessels, high blood pressure, poor wound healing, and sometimes bleeding issues can be expected.
Recently, with the development of immunotherapy, patients experience significantly fewer side effects. The side effect profile is also completely different from what is seen with cytotoxic chemotherapy. As immunotherapy works by enhancing the patient’s immune system to attack the cancer, the side effects are associated with an overly strong immune system, resulting in collateral damage and inflammation to normal organs, including the skin, lungs, intestines, liver and hormonal organs.
Haematopoietic stem cell transplantation
Haematopoietic stem cell transplantation is a treatment that replaces a patient’s damaged or unhealthy bone marrow with blood (or bone marrow) stem cells from either himself or a donor. When blood stem cells are taken from oneself, it is called autologous transplantation. When it comes from a donor (foreign cells), it is called allogeneic transplantation.
Even though it is called bone marrow transplant, in more than 95 per cent of cases, the stem cells are derived from a procedure that removes blood from a vein rather than directly from the bone marrow.
In adults, the most common indicator for a bone marrow transplant is for the treatment of blood cancers like leukaemia, lymphoma, and myeloma. Other indicators include bone marrow failure and autoimmune disorders. Chemotherapy is usually given just before the transplant in order to kill off blood cancer cells and/or prepare the patient’s bone marrow for the incoming blood stem cells.
Risks of transplant: There are several risks associated with bone marrow transplant. Patients may develop bleeding and/or infections due to the transplant chemotherapy. There are also unique risks related to transplants using foreign cells because of the interaction between the donor cells and the patient’s (recipient’s) body. Donor cells can potentially attack the recipient in a process called graft versus host disease (GvHD). This is why patients need to be on regular medication to control donor cell activity after a transplant.
Does it cure blood cancer? Patients with blood cancers need to be carefully selected for transplantation based on a myriad of different factors including the exact diagnosis, stage of disease, and aggressiveness of the cancer. One of the most common blood cancers for which bone marrow transplant is performed is acute leukaemia, because it has the potential to cure.
Common questions to ask your doctor:
What are the ways to treat my cancer?
What are the benefits, risks and possible side effects of each of these treatments?
What do you recommend and why is it best for me?
When do I start treatment?
How long will each treatment session be?
How many treatment sessions will there be?
How will I know if the treatment is working?
What is my chance of recovery with the treatment?
Surgery remains one of the main treatments in many cancers and may even offer a chance of cure if the cancer is localised. Surgical methods include radical surgery (for advanced cancers), conservative surgery (where less of the surrounding normal tissue is sacrificed), and minimally invasive surgery (e.g. keyhole surgery). Cancer surgery is often accompanied by reconstructive surgery to restore body function and a more ‘normal’ appearance.
For whom: As it is a localised treatment, surgery works best for solid tumours that are contained in one area. It is not used for liquid tumours such as leukaemia or for cancers that have spread. Sometimes, surgery may be the only treatment option, but often, it is used as part of a multidisciplinary approach in combination with other treatments such as radiation therapy and/or chemotherapy.
Possible side effects: Side effects of surgery can be divided into immediate side effects and long-term side effects. Immediate side effects include pain, bleeding, swelling, wound infections and a small risk of general anaesthesia. Long-term side effects include the loss of, or reduced, function as a result of the removed organs/structures.
In radiation therapy, high-energy beams are used to kill cancer cells. Cutting-edge technologies (e.g. TrueBeam STx with Novalis, Versa HD with Novalis, Radixact Treatment Delivery System, Proteus One proton therapy, Gamma Knife) enable the delivery of precise doses to kill or shrink tumours while minimising radiation deposited on surrounding healthy tissue for improved overall outcomes.
For whom: Radiation therapy may be applied alone or in combination with chemotherapy or surgery.
Possible side effects: Side effects depend on which part of the body is treated. For instance, radiation to the head and neck may cause temporary dry mouth and loss of taste, or late effects like poorer dental health and a stiffness of jaw and neck muscles. Radiation to the pelvis area may cause temporary urinary urgency or diarrhoea, and future increased risk of hip fractures.
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.