CELIAC

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Where Health Care Professionals Go for Information
Cancer Treatment Options Medical Interventions
Review Date 2/12 O-0535
Contributed by Jason Machowsky, MS, RD, CDN, CSCS
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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.

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Conventional Treatment Options

• Surgery
• Chemotherapy
• Radiation therapy

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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

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Surgery (contd)

• 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

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Surgery (contd)

• 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)

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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

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Chemotherapy (contd)

• 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

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Chemotherapy (contd)

• Potential side effects
• Anemia
• Fatigue
• Hair loss
• Increased risk of bleeding, bruising, and
  infection
• Nausea and vomiting
• Appetite changes and/or weight change

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Chemotherapy (contd)

• Potential side effects (contd)
• Constipation and/or diarrhea
• Mouth, gum, and throat problems
• Nerve or muscle problems
• Skin and nail changes
• Bladder, kidney, or urine problems

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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

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Radiation Therapy (contd)

• Many types of radiation therapy treatments are
  availableselection 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

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Radiation Therapy (contd)

• Potential side effects
• Fatigue
• Skin problems
• Hair loss
• Blood count changes
• Eating problems
• Damage to healthy cells
• Small, but increased risk of another cancer

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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

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Progressive Treatment Options

• Targeted therapy
• Immunotherapy
• Hyperthermia
• Lasers
• Photodynamic therapy
• Bone marrow and stem cell transplants
• Molecular targeted therapy

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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

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Targeted Therapy (contd)

• 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

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Targeted Therapy (contd)

• 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

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Targeted Therapy (contd)

• Potential side effects (contd)
• Nausea and vomiting
• Constipation
• Mouth sores
• Shortness of breath
• Cough
• Fatigue
• Headache
• Hand and foot swelling

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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

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Immunotherapy (contd)

• 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

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Immunotherapy (contd)

• Side effects may include
• Fever
• Chills
• Weakness
• Headache
• Nausea and vomiting
• Diarrhea
• Low blood pressure

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Immunotherapy (contd)

• Side effects may include (contd)
• Rashes
• Bleeding
• Fatigue
• Joint pain
• Thinning hair

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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

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Hyperthermia (contd)

• Careful control of temperature, time, and
  location is important, but not always easy to do

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Hyperthermia (contd)

• Local side effects may include
• Pain
• Infection
• Bleeding
• Blood clots
• Swelling
• Burns and blistering
• Local tissue damage

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Hyperthermia (contd)

• Regional/whole body side effects may include
• Nausea and vomiting
• Diarrhea
• Potential, but rare, problems with the heart,
  blood vessels, and other major organs

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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

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Lasers (contd)

• 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

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Lasers (contd)

• 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

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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

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Photodynamic Therapy (contd)

• 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

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Photodynamic Therapy (contd)

• 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

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Photodynamic Therapy (contd)

• 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 days3 months
• Swelling in the treated area

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Photodynamic Therapy (contd)

• Side effects depend on the drug and treatment
  site, but may include
• Nausea and vomiting
• Fever
• Dehydration
• Headache
• Hiccups

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Photodynamic Therapy (contd)

• Side effects depend on the drug and treatment
  site, but may include (contd)
• Shortness of breath
• Coughing up blood
• Pneumonia
• Bronchitis

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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

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Bone Marrow and Stem Cell Transplants (contd)

• 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

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Bone Marrow and Stem Cell Transplants (contd)

• Insurance may not cover or cover well
• In-patient hospital stay necessary
• Significant demand placed on the body, possibly
  including central venous line placement

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Bone Marrow and Stem Cell Transplants (contd)

• Possible short-term side effects
• Fever and chills
• Shortness of breath
• Hives
• Chest tightness
• Low blood pressure

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Bone Marrow and Stem Cell Transplants (contd)

• Possible short-term side effects (contd)
• Coughing
• Chest pain
• Low urine output
• Weakness

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Bone Marrow and Stem Cell Transplants (contd)

• 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

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Bone Marrow and Stem Cell Transplants (contd)

• Possible long-term side effects, including 1
  year later (contd)
• Cataracts
• Slowed growth (children)
• Reproductive problems
• Secondary cancers
• Changes in social relationships and feelings

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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

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Molecular Targeted Therapy (contd)

• Usually used in combination with traditional
  therapies
• Fewer side effects than other options
• Diarrhea
• Skin rash
• Fatigue

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References and Resources

• American Cancer Society. Treatment types.
  Available at
• http//www.cancer.org/Treatment/TreatmentsandSideE
  ffects/TreatmentTypes/index. Accessed February
  23, 2012.
• For more references and resources on cancer,
  visit the Oncology Center at http//rd411.com/.