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Where Health Care Professionals
Go for Information
Cancer Treatment Options:
Medical Interventions
Contributed by Jason Machowsky, MS, RD, CDN, CSCS
Review Date 2/12
O-0535
Where Health Care Professionals
Go for Information
This presentation provides general
information about cancer treatment options.
Consult with your health care professional if
you have any questions or for additional
information because each case is unique.
Conventional
Treatment Options
• Surgery
• Chemotherapy
• Radiation therapy
Surgery
• Sometimes used to diagnose, treat, or
prevent (prophylactic) cancer
• Extent of surgery and potential for
anesthesia depends on condition
• Preoperative testing sometimes needed to
determine appropriateness and ability to
recover from surgery
Surgery (cont’d)
“The best chance of a cure from many types
of cancer is to remove all of the cancer as
soon as possible after diagnosis. If you have a
solid tumor, sometimes surgery alone will
cure the cancer, but you may need
chemotherapy, radiation therapy, or other
treatment, too. Your health care team will
discuss your best treatment options with
you.”
Source: American Cancer Society Web site
Surgery (cont’d)
• Minor surgeries and biopsies have lower
risk than major surgery/incisions
• Risks are generally low, but may include:
– During surgery: Bleeding, damage to internal
organs, and reactions to anesthesia or drugs
used
– After surgery: Pain, infection, bleeding, and
slow recovery of other body function
(ie, bowels)
Chemotherapy
• Use of medicines or drugs to treat
cancer/disease
• Unlike radiation or surgery that targets a
particular area, chemotherapy works
throughout the body and can kill cancer
cells that have spread to other parts of the
body, far from the original tumor
Chemotherapy (cont’d)
• Goals of chemotherapy: Cure, slow growth,
kill any spreading cancer cells, and relieve
cancer symptoms
• May receive chemotherapy orally, via the
skin, or injected into the body
Chemotherapy (cont’d)
• Potential side effects:
– Anemia
– Fatigue
– Hair loss
– Increased risk of bleeding, bruising, and
infection
– Nausea and vomiting
– Appetite changes and/or weight change
Chemotherapy (cont’d)
• Potential side effects (cont’d):
– Constipation and/or diarrhea
– Mouth, gum, and throat problems
– Nerve or muscle problems
– Skin and nail changes
– Bladder, kidney, or urine problems
Radiation Therapy
• Local exposure of the body to high energy
particles or waves (X-ray, gamma rays,
electron beams, etc) to destroy or damage
cancer cells
• Often performed multiple times for the
same cancer
Radiation Therapy
(cont’d)
• Many types of radiation therapy treatments
are available—selection depends upon the
cancer and severity
• Sometimes given orally or intravenously
(IV), but still usually has only local effects
• Given alone or in conjunction with other
treatment
Radiation Therapy
(cont’d)
• Potential side effects:
– Fatigue
– Skin problems
– Hair loss
– Blood count changes
– Eating problems
– Damage to healthy cells
– Small, but increased risk of another cancer
Taking Care of Yourself
During Radiation
• Get rest
• Eat a balanced and nutritious diet
• Take care of your skin at the treated area
• Tell your doctor about all medications
before treatment
Progressive Treatment
Options
• Targeted therapy
• Immunotherapy
• Hyperthermia
• Lasers
• Photodynamic therapy
• Bone marrow and stem cell transplants
• Molecular targeted therapy
Targeted Therapy
• Drugs that specifically target cancer cells
by identifying cancer-specific gene changes
• Can typically attack cancer cells with little
damage to normal cells, resulting in
different and usually less severe side
effects than traditional chemotherapy
Targeted Therapy
(cont’d)
• Used for many types of cancer to cure,
slow growth, kill metastases, or relieve
symptoms
• Types of targeted therapy:
– Enzyme inhibitors
– Apoptosis-inducing drugs
– Angiogenesis inhibitors
Targeted Therapy
(cont’d)
• Side effects and severity vary based on the
person and type of cancer treated
• Potential side effects:
– Skin problems (ie, rash, dry skin, and itching)
– Changes in hair growth or color
– Changes around the eyes
– High blood pressure
– Bleeding and clotting issues
Targeted Therapy
(cont’d)
• Potential side effects (cont’d):
– Nausea and vomiting
– Constipation
– Mouth sores
– Shortness of breath
– Cough
– Fatigue
– Headache
– Hand and foot swelling
Immunotherapy
• Uses your own immune system to fight
cancer by stimulating your own immune
system (active) or supplementing with
immune system components (passive)
• May treat some cancers on its own, but
typically used in conjunction with other
treatments
Immunotherapy
(cont’d)
• Examples include monoclonal antibodies,
vaccines, and immunomodulating agents
• Certain immunotherapy agents are
approved to treat certain cancers
• Side effects depend on type of
immunotherapy performed
Immunotherapy
(cont’d)
• Side effects may include:
– Fever
– Chills
– Weakness
– Headache
– Nausea and vomiting
– Diarrhea
– Low blood pressure
Immunotherapy
(cont’d)
• Side effects may include (cont’d):
– Rashes
– Bleeding
– Fatigue
– Joint pain
– Thinning hair
Hyperthermia
• Currently experimental and not widely
used (under clinical trials)
• May use high temperatures in localized
areas to destroy small tumors
• Raises regional or total body temperature
to promote better effects of chemotherapy
or radiation therapy
Hyperthermia
(cont’d)
• Careful control of temperature, time, and
location is important, but not always easy
to do
Hyperthermia
(cont’d)
• Local side effects may include:
– Pain
– Infection
– Bleeding
– Blood clots
– Swelling
– Burns and blistering
– Local tissue damage
Hyperthermia
(cont’d)
• Regional/whole body side effects may
include:
– Nausea and vomiting
– Diarrhea
– Potential, but rare, problems with the heart,
blood vessels, and other major organs
Lasers
• For very careful surgical work, such as
cutting through body tissue or repairing the
retina
• Different types include CO2, argon, and
neodymium
• Shrinks or destroys a tumor with heat
• May activate a drug as part of
photodynamic therapy
Lasers (cont’d)
• Pros:
– More precise than scalpels
– The heat can help sterilize during cutting and
reduce infection risk
– Less bleeding, swelling, pain, or scarring
– May shorten operating time, even outpatient
– Often less invasive
– Healing time typically shorter
Lasers (cont’d)
• Drawbacks:
– Few doctors are trained to use lasers
– Lasers are expensive and large compared to
other surgical instruments
– Strict surgical safety precautions required
– May require multiple treatments to fully
eliminate a cancer
Photodynamic Therapy
• Uses specialized photosensitizing agent
drugs, typically injected into the
bloodstream, and light to kill cancer cells
• Drug is absorbed over time by the cancer
cells and light is applied to:
– Create a chemical that kills the cells
– Destroy cancer-feeding blood vessels
– Alert the immune system to attack cancer cells
Photodynamic Therapy
(cont’d)
• As effective as surgery and radiation in
certain cancers, but can only impact areas
reached by light (skin and linings of
organs)
• Drugs on market:
– Porfimer sodium
– Aminolevulinic acid (ALA)
– Methyl ester of ALA
Photodynamic Therapy
(cont’d)
• Pros:
– No long-term side effects when used properly
– Less invasive than surgery
– Usually quick, outpatient treatment
– Can have precise targeting
– Can repeat at the same site
– Little or no permanent scarring
– Costs less than many other treatments
Photodynamic Therapy
(cont’d)
• Drawbacks:
– Not always appropriate for deeper or
significantly spread cancers
– Not used for those with certain blood diseases
or who are allergic to porphyrins
– Skin and eyes may stay sensitive to light for
some time, from 30 days–3 months
– Swelling in the treated area
Photodynamic Therapy
(cont’d)
• Side effects depend on the drug and
treatment site, but may include:
– Nausea and vomiting
– Fever
– Dehydration
– Headache
– Hiccups
Photodynamic Therapy
(cont’d)
• Side effects depend on the drug and
treatment site, but may include (cont’d):
– Shortness of breath
– Coughing up blood
– Pneumonia
– Bronchitis
Bone Marrow and Stem
Cell Transplants
• Can help with certain leukemia, myeloma,
and lymphoma treatments
• May use to replace bone marrow destroyed
by disease, including blood-related
cancers, chemotherapy, or radiation
• Stem cells are grafted into the patient after
a high dose of radiation/chemotherapy
• May come from patient or matched donor
Bone Marrow and Stem
Cell Transplants (cont’d)
• Tests are required to determine
appropriateness for procedure
• Patients who do best are usually:
– Younger
– In early stage of disease
– Have not already had many treatments
Bone Marrow and Stem
Cell Transplants (cont’d)
• Insurance may not cover or cover well
• In-patient hospital stay necessary
• Significant demand placed on the body,
possibly including central venous line
placement
Bone Marrow and Stem
Cell Transplants (cont’d)
• Possible short-term side effects:
– Fever and chills
– Shortness of breath
– Hives
– Chest tightness
– Low blood pressure
Bone Marrow and Stem
Cell Transplants (cont’d)
• Possible short-term side effects (cont’d):
– Coughing
– Chest pain
– Low urine output
– Weakness
Bone Marrow and Stem
Cell Transplants (cont’d)
• Possible long-term side effects, including
1 year later:
– Graft-versus-host disease
– Infections
– Lung, kidney, liver, and heart problems
– Low thyroid levels
– Fatigue
– Memory loss
– Depression
Bone Marrow and Stem
Cell Transplants (cont’d)
• Possible long-term side effects, including
1 year later (cont’d):
– Cataracts
– Slowed growth (children)
– Reproductive problems
– Secondary cancers
– Changes in social relationships and feelings
Molecular Targeted
Therapy
• High specificity medications designed to
inhibit proteins, genes, and pathways
unique to cancerous cells
• Can help fight or delay progression of the
disease
• Still new to the market and clinical trials
• Availability depends on type of cancer
Molecular Targeted
Therapy (cont’d)
• Usually used in combination with
traditional therapies
• Fewer side effects than other options:
– Diarrhea
– Skin rash
– Fatigue
References and
Resources
American Cancer Society®. Treatment types. Available at:
http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTy
pes/index. Accessed February 23, 2012.
For more references and resources on cancer, visit the Oncology Center at
http://rd411.com/.