According to the World Health Organisation the main goals of a cancer diagnosis and treatment are to cure or considerably prolong the life of patients and to ensure the best possible quality of life to cancer survivors.
The modern approach to cancer treatment and care of patients with cancer follows a multi-disciplinary clinical team approach. Therefore, the surgeon, the medical and radiation oncologists and your Family Practitioner and other health professionals, all play significant roles in the trajectory of care of a patient with regards to treatment for cancer.
Goals of Treatment
The important decision to be made once the diagnosis of cancer has been made is what treatment will be given and in which order. This decision is determined by the type of cancer, the aggressiveness of the growth of the cancer, the stage of the cancer at diagnosis of the disease and the overall clinical condition of the patient. The goal of the treatment is called the Treatment Intent. The treatment intent can broadly be divided into two categories:
- Curative intent: this is treatment for cancer which is deemed to be curable – the goal is to cure. The treatment can be any of the treatment modalities either as a single modality for example surgery or radiation therapy or chemotherapy but it could also be a combination of those.
- Palliative intent: if the cancer is not curable, the goals of treatment are to improve the quality of the patient’s life and to prolong life or to create comfort and to control symptoms like pain or shortness of breath. All treatment modalities can be used in palliative care but are aimed at the goals of improving symptoms and quality of life.
The treatment intent provides the input to the treating team for a careful selection of one or more of the major treatment modalities. Oncologists and surgeons use evidence of the best existing treatment, given the resources available – often affordability, to make their decisions. Treatment can be just a single modality like Surgery, Radiation therapy or Chemotherapy or a combination of treatment modalities.
A brief summary of the different treatment modalities follows.
Surgery: Surgery remains the most important treatment modality for solid tumors like cancers of the breast, ovaries, lung, and uterus as examples. The purpose is to remove all the tumor mass or if that is not possible, most of it. Surgery may in some instances be curative without any further treatment.
Radiation Therapy: This is the specialised field of the Radiation or Clinical oncologist and Nuclear Medicine Physician. It can now take on many forms.
- External Radiation therapy uses modern sophisticated machines with computer software and advanced technology to deliver X-rays to precisely shaped target areas to kill cancer cells. Sessions for radiation therapy are short and delivered over weeks.
New advances include the CyberKnife® which is an alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas, and kidney. The treatment delivers high doses of radiation to tumors with extreme accuracy. It is used in patients who have inoperable or surgically complex tumors.
- Internal radiation therapy refers to radiation delivered from radioactive materials placed inside or on the body. An example is the radioactive implants into the tumor of the prostate – a procedure called brachytherapy.
- Peptide Receptor Radionuclide Therapy (PRRT) is a form of molecular targeted therapy which is performed by using a small peptide linked with a radiation emitting molecule. “Targeted” means that the radio-active molecules bind to cancer cells of certain cancers and very specifically in treatment of cancers that is already widely disseminated. These newer treatments offer hope to many where options were previously limited.
Chemotherapy uses chemical agents that is taken by mouth or via an intravenous drip to kill the fast-dividing cancer cells. Treatment generally used a combination of the chemical drugs to treat specific cancers. The treatment is usually administered on a scheduled bases called cycles. This allows time for normal tissue to recover from the effects of the cancer destroying drugs used in the regimen. The response of tumors to chemotherapy varies between individuals and types of cancer.
Hormone Therapy: A few cancers are hormone dependent. Examples of hormone dependent tumors are breast, prostate, and uterus cancers. Hormone therapy targets the specific hormones that slows down the cancer growth.
Biologics or Targeted Therapy
Advances in the field of molecular oncology have resulted in the development of so-called biologic therapies for the treatment of cancer. These substances are also referred to as immunotherapy, biotherapy and biological response modifiers or targeted therapies. There have already been great successes, but the cost of these new developments may be prohibitive.
Deferred Treatment is mainly used in the management of prostate cancer. Many men outlive their prostate cancer, and as an alternative to active treatment the specialist may advise a waiting approach with regular follow ups to defer or even avoid treatment.
Clinical Trials in Cancer
The innovation and advances in treatment of cancer generate clinical trials to test the efficacy and safety of these new developments. Patients with specific cancers and criteria are recruited to participate in these clinical trials and may thus have access to advanced and successful technologies before those drugs are marketed. You may want to discuss with your oncologist whether such trials are recruiting if you, your family or friends are diagnosed.
* Compiled by Dr. Martin de Villiers, Medical Director of Medwell SA – The Home Health Care Specialists.
For more information visit www.medwell.co.za