What are the cancer treatments?

Surgery

Surgery is often the first treatment an oncologist uses to address cancer. It aims either to completely remove the tumor, a definitive and potentially curative surgery, or to remove as much of the tumor as possible. This second approach is called cytoreductive and is also used for palliative purposes, to reduce or eliminate symptoms. Surgery also allows samples of tissue affected by the tumor to be taken to refine the diagnosis.

When surgery is used with the aim of curing the disease, three options are available to patients:

• The tumor is completely removed without affecting the surrounding tissues;
• The tumor and a portion of the surrounding tissues are completely removed to minimize the risk that cancer cells that have invaded the tumor will lead to local recurrences and distant metastases;
• The tumor is completely removed with or without a portion of the surrounding tissues and affected lymph nodes. This approach is called radical surgery.

The choice of approach depends on the type of tumor, its local and distant spread, the amount and condition of the tissues surrounding it and on which surgery must be performed, as well as other factors.

In order to avoid functional or aesthetic problems after the operation, there are surgical procedures that minimize the amount of tissue to be removed, and this approach is called "conservative". This approach is only used if it does not limit the chances of success in terms of patient survival. For example, in the case of laryngeal cancer, a treatment protocol is followed that includes chemotherapy first, then radiotherapy, with the possibility of using surgery, called salvage surgery, as a fallback solution if the previous treatments fail. This approach is as effective as the initial surgical removal of the larynx (laryngectomy), followed by radiotherapy, except that delaying larynx surgery preserves the ability to speak for longer.

Like all treatments, surgery has side effects. These depend on the size and location of the tumor, the type of surgery performed, and the patient's general health. In general, the main side effect is pain, which can usually be controlled with medication. There may be several others, depending on the location of the cancer and the surgery performed. It is important that the advantages and disadvantages, and among these the possible side effects, of the proposed approach are clearly explained to the patient so that they are aware of these aspects.

Radiotherapy

Radiotherapy uses beams of ionizing radiation or beams of ionizing particles to damage the genetic material (DNA) of malignant cells. Radiotherapy works alone or in combination with other treatments such as chemotherapy, immunotherapy, or surgery. Through a specific machine that irradiates ionizing radiation or beams of ionizing particles, the genetic material of cancer cells is damaged. The damage caused prevents the tumor cells from reproducing and causes them to die.

The goal of radiotherapy is to slow and, ideally, stop the uncontrolled cell growth and spread that characterize malignant tumors.

The ionizing radiation used is high-energy X-rays and gamma rays. The former are produced by specific instruments called linear accelerators, while the latter are emitted by radioactive isotopes. Ionizing particle beams can consist of protons, neutrons, or positive ions.

When these radiations or particles hit the cell, they interfere with the genetic material, causing direct damage, and with the water inside the cell, causing indirect damage. The interaction of ionizing radiation with water generates free radicals capable of damaging the molecules that make up DNA.

While healthy cells have defense mechanisms capable of repairing any damage caused to their DNA, cancer cells have less efficient repair mechanisms, so that the damage caused to the DNA can be more easily lethal.  

In targeted radiotherapy, we try to target only the tumor cells, but unfortunately, parts of healthy cells may also be irradiated. Scanner-centered radiotherapy is a very important step. The centering of radiotherapy precisely delimits the area to be irradiated, thus protecting neighboring healthy organs from radiation.

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Drug Treatments and Hematopoietic Stem Cell Transplantation.

Antineoplastic drugs are used to treat tumors. This is why they are also called anticancer drugs. There are several types, which can be classified according to their mechanism of action and chemical structure.

Antineoplastic drugs can be taken orally (in the form of capsules or tablets), intravenously (via injections, drops, or infusion pumps), intramuscularly (in the thigh or buttock), subcutaneously, arterially, intrathecally (in the cerebrospinal fluid) or intracavitary (i.e., in a natural cavity of the body such as the bladder, chest, or abdomen). Contraindications to anticancer pharmacological therapies vary considerably from patient to patient and depending on the type of treatment. In general, their impact has decreased over the years due to advances in knowledge in the field and the development of methods to control them.

Hematopoietic stem cells, on the other hand, produce all the blood and immune cells in the body, which is why they are used in the curative treatment of patients with certain cancers such as leukemia or in pediatric oncology and general oncology. They are found in small quantities in the bone marrow (mainly in the ribs, sternum, and pelvis) and in peripheral blood. They have the particularity of reproducing at an extremely intense rate and differentiating into various cell lineages. Progenitor cells are rather rare but, in addition to their enormous reproductive activity, they are able to replicate so that their number remains unchanged throughout life, even if they are partially taken from donors. These cells represent less than 0.01% of the cells in the bone marrow and peripheral blood, and there is still no good way to separate them from other cells. This means that during the transplantation of bone marrow and peripheral blood cells, it receives a small number of therapeutic stem cells and many other cells that are not.

Cancer treatment is a therapeutic choice made with a multidisciplinary team. From the first visit with the oncologist, it is important to prepare a series of questions to ask the oncologist about cancer treatment.

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