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TREATMENTS
•Surgical Oncology
•Chemotherapy
•Radiation Therapy
•Bone Marrow Transplant
•Complementary Medicine
•Psychotherapy
Surgical Oncology
(Surgery)
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____________ form of tx for cancer.
First step in tx b/c used to dx & tx.
Alone cures cancer.
Used in conjunction w/ other txs.
Types of Surgery
• Staging Surgery
– Determines the extent of the disease
– Most accurate assessment of how far the cancer has
spread
• ____________ Surgery
– The removal of a tumor when it appears to be confined to
one area
– Done when there is hope of taking out all the cancer
– Primary treatment of cancer
– Used alone or in combination w/ other treatments
Types of Surgery
• Debulking Therapy
– Removal of as much of the cancer as possible
– Usually done when removing cancer entirely would cause
too much damage to organs or surrounding tissue.
• Diagnostic Surgery
– A tissue sample obtained to determine if cancerous or to
determine the type of cancer
– Confirmed by looking at cells under a microscope
• Preventative (Prophylactic) Surgery
– Removes tissue that is _______________________ but likely
to become.
Risks & Side Effects
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Pain (most common)
Infection at the site of the wound
Bleeding internally or externally
Damage to internal organs and blood vessels
Reactions to anesthesia
Problems with other organs
Blood clots
Slow recovery of other body fxns
Chemotherapy
• Defined as the use of medications or
chemicals with cancer fighting abilities
– Anticancer agents
– Interfere w/ the cancer cells’ ability to grow or
multiply
– Identification of disease important because
some work best for certain diseases
How is Chemotherapy given?
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IV (intravenous)
Oral
Intramuscular
Intrathecal (IT)
Intraperitoneal (IP)
Implanted Intravenous Port
Side Effects of Chemotherapy
• Damage to normal cells as well as cancer cells
– Hair follicles
– Cells in gastrointestinal tract
– Bone Marrow
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Can cause graft rejection
Hair loss (alopecia)
Mouth sores
Difficulty in swallowing, nausea, diarrhea,
infection, anemia
• Increase risk of bleeding
Radiation Therapy
• X-ray Therapy
• High energy that comes from special
machines or radioactive sources
• Destroys cells or keep them from growing
or dividing
• Effective way to treat many kinds of
cancer in almost any part of the body
• ½ of all patients treated with radiation
• Combined with other treatments
X-ray Therapy is given
• __________________
– Swallowed or injected into the body
– Admitted to the hospital 3-7 days
• Externally
– Doses of radiation given to carefully defined area
– Directs the x-ray particles at the cancer and the
normal tissue
– Given in small doses
– Once a day over a period of 3 to 7 wks
– Tx during outpatient visit.
Radiation Side Effects
• Can hurt _________________
• Generally limited the region of the body
being treated
• Skin reaction, reddening irritated, dry or
sensitive
• Hair loss
• Nutritional problems
• Fatigue
Bone Marrow Transplant
• Bone Marrow
– Spongy substance inside our _______ bones
– Made up of hematopoietic stem cells
– These cells are given (transplanted) from
donor to patient
2 Types of Transplant
• Autologous Transplant
– Structures of cells derived from you and your body
• Allogeneic Transplant
– Transplanted cells are coming from donor
– _____________ means cells come from identical twin
The cells must be “matched” to the patient which is
done by Human Leukocyte Antigen (HLA)
Transplant Side Effects
• Destruction of the bone marrow leading to
low blood counts
– Include bleeding due to low platelet cts
– Infections due to low blood cell cts
– __________ due to low red blood cell cts
Graft vs. Host Disease
• Donor’s cells attack the _______________
• Can affect the skin (rash, intestinal tract
(diarrhea), and liver
• Can occur anytime after transplant
• Treated with immunosuppressing
medications including steroids and
antithymocyte globulin (Atgam)
Graft vs. Tumor Effect
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Good
Donor’s cells attack any remaining cancer cells
Producing new blood cells
Carefully manage this balance
Graft failure occurs when the donors cells fail to
start working. If engraftment has not occurred by
42 days after transplant, graft has failed.
Transplant Side Effects (cont..)
• Pulmonary complications
– Generally caused by _______________
Psychotherapy
• Psychological interventions
• Can effectively reduce ______________
in patients undergoing treatment
• Includes counseling to alleviate stress
• Improve patient well-being
• Does increase or extend the life of cancer
patients.
Costs of Cancer Treatments
Table 1: National Cancer Treatment Expenditures in Billions
of Dollars – 1963-1995.
Year
Cancer
Treatment
Spending
Total Health
Care
Spending
Percent of Cancer Treatment
Spending to Total
1963
$1.3 billion
$29.4 billion
4.40%
1972
$3.9 billion
$78 billion
5.00%
1980
$13.1 billion
$217 billion
6.00%
1985
$18.1 billion
$376.4 billion
4.80%
1990
$27.5 billion
$614.7 billion
4.50%
1995
$41.2 billion
$879.3 billion
4.70%
Data source: Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annual Review of Public
Health 2001;22:91-113.
Table 2: Estimates of National Expenditures for Medical Treatment for the 13 Most Common Cancers – Based on Cancer Prevalence in 1996 and
Cancer-Specific Costs for 1995-1998, Expressed in 1996 Dollars.
Percent of all new
cancers (1998)
Expenditures (in
1996
dollars)
Percent of all cancer
treatment expenditures
Average Medicare payments per individual in first
year following diagnosis
Breast
18.2%
$5.4 billion
13.10%
$9,230
Colorectal
11.7%
$5.4 billion
13.10%
$21,608
Lung
12.5%
$4.9 billion
12.10%
$20,340
Prostate
13.6%
$4.6 billion
11.30%
$8,869
Lymphoma
4.2%
$2.6 billion
6.30%
$17,217
Bladder
4.0%
$1.7 billion
4.20%
$10,770
Cervix
2.3%
$1.7 billion
4.10%
$13,083
Head/Neck
3.3%
$1.6 billion
4.00%
$14,788
Leukemia
2.1%
$1.2 billion
2.80%
$11,882
Ovary
1.7%
$1.5 billion
3.70%
$32,340
Melanoma
5.2%
$0.7 billion
1.70%
$3,177
Which one is most effective?
• Really can’t say
• Treatments are used in combination with
each other to get best results.