Cancer treatments

What to expect and side effects



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New treatments and techniques are emerging from clinical trials every week. Fortunately the chance of being cured or living for a very long time with established disease is increasing significantly. For example, 20 years the average chance of surviving breast cancer was 54 % now it is 84%. The average time to survive prostate cancer which has spread to he bones was 2 years, now  it is over 10 years. The latest statistics of cancer incidence and survival can be found on the CRUK website. What's more many patient are living longer and longer with metastatic disease albeit with ongoing medical treatments.

Why have cancer outcomes improved? Most people with cancer are now managed by  multidisciplinary medical teams which consider the latest guidelines such as those produced by NICE to recommend an optimal care plan. Screening programmes for breast and bowel cancer mean that more patients are presenting at an earlier stage (smaller cancers which have not spread). The time it takes for a patient with suspected cancer to be seen has improved by the 2 week rule in the UK. Radiological and biopsy tools are improving and pathologists have more sophisticated techniques to determine the type of cancer they have and the proteins and genes it over or under expresses which is helping to individualize cancer treatments.  Surgical and particularly radiotherapy techniques have dramatically improved, increasing the chance to removing the primary cancer. The support of chemotherapy drugs has improved ensuring more rapid treatment of life threatening complications treatments but the biggest advance has been the discovery and development of new biological treatments which can target specific defects within cancer cells - attacking their Achilles heal. 

What determines cancer treatments?  The choice of cancer treatments given to each patients varies according to a wide range of factors ranging from their type of cancer, The grade (how aggressive it is), the stage (how advanced it is - whether it has spread), whether it is sensitive to hormone therapies, the age and general condition of the patient and more recently whether it expresses specific genetic markers such as Oestrogen receptor,  Her2 or Kras. Doctors often use computer programmes such  NHS breast cancer predict or the more expensive oncotypeDX. Although these test try to better select patients it still means that patients often have to undergo more intense treatments and have to take them for longer, often leaving them suffering acute and long term side effects. Although some of these often distressing symptoms can be managed with medical treatments most can be alleviated by sensible self help lifestyle strategies. 

Cancer treatments may involve surgery alone or combined with one or all of the individual therapies listed below. Surgery may recommended be to obtain a diagnosis or to completely excise the cancer. Surgery is usually performed first but is some cases it may be recommended after either chemotherapy or radiotherapy (neo-adjuvant therapy).

The use of high energy x-rays to treat patients with malignant disease. Radiotherapy beams can be directed very accurately to any area of the body using highly sophisticated machines. The most commonly used of these are called a linear accelerators, with other machines  called orthovoltage or superficial depending on the energy of the X-rays required. It is also possible to deliver radiotherapy to small volumes of the body using radioactive wires or seeds, which produce gamma rays.

The use of drugs or chemicals to treat cancer. These can be given orally or into a vein and essentially poison the cells in the body - If successful more cancer cells than normal cells or killed. Your cancer specialist has a choice of over fifty different drugs that can be used as single agents or in a variety of different combinations.

Hormone therapy
Many tumours particularly breast and prostate are stimulated by the bodies own hormones (usually the female hormone oestrogen or the male hormone testosterone). Hormone therapy uses strategies to stop or reduce the bodies hormones reaching the tumour cause the cancer cells and by doing so stop them growing.

Biological therapy
The use of biological agents which specifically target genetic sites within the tumour or supportive tissues. They can be broadly classified as small molecules - usually tyrosine kinase receptors (e.g. Sunitinib) or monoclonal antibodies (Mab) which are large molecules (e.g. Herceptin) which attack via the immune system either on the blood vessels (anti-angiogenesis) or the also the tyrosine kinase pathway. 

Other ablative therapies 
Sometimes it is possible to damage tumours by using sound waves - High frequency Ultrasound (HIFU) or freezing them - Cryotherapy

Complementary therapy
This refers to supportive methods that are used to complement, or add to, mainstream treatments. Examples might include meditation to reduce stress, peppermint tea for nausea, and acupuncture for chronic back pain. Some of the methods, such as massage therapy, yoga, and meditation, that are categorized as complementary have actually been referred to as supportive care in the past.

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