TREATMENTS

•Surgical Oncology•Chemotherapy

•Radiation Therapy•Bone Marrow Transplant•Complementary Medicine

•Psychotherapy

Surgical Oncology(Surgery)

• ____________ 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

• 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?

• 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

• 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

• 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 TreatmentsTable 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.

Cancer Progress Report 2001 (http://progressreport.cancer.gov/)

National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

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

Pancreas 2.1% $0.6 billion 1.50% $23,504

Esophagus

0.9% $0.4 billion 0.90% $25,886

All Other 18.1% $8.7 billion 21.20% $17,201

Total 100.0% $41.0 billion 100%

Data source: Brown ML, Riley GF, Schussler N, Etzioni R. Estimating health care cost from SEER-Medicare data. Submitted to Medical Care.

Cancer Progress Report 2001 (http://progressreport.cancer.gov/)

National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

Which one is most effective?

• Really can’t say

• Treatments are used in combination with each other to get best results.