Cancer Therapy & Research Center
7979 Wurzbach Rd., San Antonio, TX 78229 (210) 450-1000
Toll free: 1-800-340-CTRC (2872)
Toll free: 1-800-340-CTRC (2872)
Curative Surgery removes the cancerous tumor or growth from the body. Surgeons use curative surgery when the cancerous tumor is localized to a specific area of the body. This type of treatment is often considered the primary treatment. However, other types of cancer treatments, such as radiation, may be used before or after the surgery.
Preventive Surgery is used to remove tissue that does not contain cancerous cells, but may develop into a malignant tumor. For example, polyps in the colon may be considered precancerous tissue and preventative surgery may be performed to remove them.
Diagnostic Surgery helps to determine whether cells are cancerous. Diagnostic surgery is used to remove a tissue sample for testing and evaluation (in a laboratory by a pathologist). The tissue samples help to confirm a diagnosis, identify the type of cancer, or determine the stage of the cancer.
Staging Surgery works to uncover the extent of cancer, or the extent of the disease in the body. Laparoscopy (a viewing tube with a lens or camera is inserted through a small incision to examine the inside of the body and to remove tissue samples) is an example of a surgical staging procedure.
Debulking Surgery removes a portion, though not all, of a cancerous tumor. It is used in certain situations when removing an entire tumor may cause damage to an organ or the body. Other types of cancer treatment, such as chemotherapy and radiation, may be used after debulking surgery is performed.
Palliative Surgery is used to treat cancer at advanced stages. It does not work to cure cancer, but to relieve discomfort or to correct other problems cancer or cancer treatment may have created.
Supportive Surgery is similar to palliative surgery because it does not work to cure cancer. Instead, it helps other cancer treatments work effectively. An example of supportive surgery is the insertion of a catheter to help with chemotherapy.
Restorative Surgery is sometimes used as a follow-up to curative or other surgeries to change or restore a person's appearance or the function of a body part. For example, women with breast cancer sometimes need breast reconstruction surgery to restore the physical shape of the affected breast(s). Curative surgery for oral cancer can cause a change in the shape and appearance of a person's mouth. Restorative surgery may be performed to address these effects.
Cryosurgery technique uses extremely cold temperatures to kill cancer cells. Cryosurgery is used most often with skin cancer and cervical cancer. Depending on whether the tumor is inside or outside the body, liquid nitrogen is placed on the skin or in an instrument called a cryoprobe (which is inserted into the body so that it touches the tumor). Cryosurgery is being evaluated as a surgical treatment for several types of cancers.
Laser Surgery uses beams of light energy instead of instruments to remove very small cancers (without damaging surrounding tissue), to shrink or destroy tumors, or to activate drugs to kill cancer cells. Laser surgery is a very precise procedure that can be used to treat areas of the body that are difficult to reach including the skin, cervix, rectum, and larynx.
Electrosurgery
Skin cancer and oral cancer are sometimes treated with electrosurgery. This technique uses electrical current to kill cancer cells.
Microscopically Controlled Surgery
This surgery is useful when cancer affects delicate parts of the body, such as the eye. Layers of skin are removed and examined microscopically until cancerous cells cannot be detected.
The term LASER stands for "Light Amplification by the Stimulated Emission of Radiation." Laser light is concentrated so that it makes a very powerful and precise tool. Laser therapy uses light to treat cancer cells. Consider the following additional information regarding laser therapy:
Carbon Dioxide (CO2) Lasers can remove a very thin layer of tissue from the surface of the skin without removing deeper layers. The CO2 laser may be used to remove skin cancers and some precancerous cells.
Neodymium:yttrium-Aluminum-garnet (Nd:YAG) Lasers can penetrate deeper into tissue and can cause blood to clot quickly. The laser light can be carried through optical fibers to reach less accessible internal parts of the body. For example, the Nd:YAG laser can be used to treat throat cancer.
Laser-Induced Interstitial Thermotherapy (LITT) uses lasers to heat certain areas of the body. The lasers are directed to areas between organs (interstitial areas) that are near a tumor. The heat from the laser increases the temperature of the tumor, thereby shrinking, damaging, or destroying the cancer cells.
Argon Lasers pass only through superficial layers of tissue such as skin. Photodynamic therapy (PDT) uses argon laser light to activate chemicals in the cancer cells.
Photodynamic Therapy
Because cancer cells can be selectively destroyed while most healthy cells are spared, photodynamic therapy (PDT) is useful for the treatment of certain cancer tumors. Photodynamic therapy (also called photoradiation therapy or photochemotherapy) is a treatment that uses a combination of a light source and a photosensitizing agent (a medication that is activated by light). The photosensitizing agent collects more in cancer cells than in normal cells. When the laser's light is focused directly on the tumor, the cancer cells absorb the light, and a chemical reaction occurs which destroys the cancer cells.
Chemotherapy is the use of anticancer drugs to treat cancerous cells. Chemotherapy has been used for many years and is one of the most common treatments for cancer. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. Chemotherapy may be used alone for some types of cancer or in combination with other treatments such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
There are over 50 chemotherapy drugs that are commonly used. The following table gives examples of some chemotherapy drugs and their various names. It lists some of the cancer types but not necessarily all of the cancers for which they are used, and describes various side effects. Side effects may occur just after treatment (days or weeks) or they may occur later (months or years) after the chemotherapy has been given. The side effects listed below do not comprise an all-inclusive list. Other side effects are possible.
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.
| Chemotherapy Drug | Possible Side Effects (Not all side effects are listed. Some of those listed may be short-term side effects; others are long-term side effects.) |
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Carboplatin
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Cisplatin
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Cyclophosphamide
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Docetaxel
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Doxorubicin
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Erlotinib
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Etoposide
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Fluorouracil
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Gemcitabine
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Imatinib mesylate
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Iirinotecan
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Methotrexate
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Paclitaxel
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Sorafinib
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Sunitinib
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Topotecan
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Vincristine
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Vinblastine
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Side Effects
The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience for the person receiving chemotherapy.
Hormones are chemicals produced by glands, such as the ovaries and testicles. Hormones help some types of cancer cells to grow, such as breast cancer and prostate cancer. In other cases, hormones can kill cancer cells, make cancer cells grow more slowly, or stop them from growing. Hormone therapy as a cancer treatment may involve taking medications that interfere with the activity of the hormone or stop the production of the hormones. Hormone therapy may involve surgically removing a gland that is producing the hormones.
How does hormone therapy work
Your physician may recommend a hormone receptor test to help determine treatment options and to help learn more about the tumor. This test can help to predict whether the cancer cells are sensitive to hormones.
The hormone receptor test measures the amount of certain proteins (called hormone receptors) in cancer tissue. Hormones (such as estrogen and progesterone that naturally occur in the body) can attach to these proteins. If the test is positive, it is indicating that the hormone is probably helping the cancer cells to grow. In this case, hormone therapy may be given to block the way the hormone works and help keep the hormone away from the cancer cells (hormone receptors). If the test is negative, the hormone does not affect the growth of the cancer cells, and other effective cancer treatments may be given. Always discuss the results of the hormone receptor test with your physician.
If the test indicates that the hormones are affecting your cancer, the cancer may be treated in one of following ways:
The type of hormone therapy a person receives depends upon many factors, such as the type and size of the tumor, the age of the person, the presence of hormone receptors on the tumor, and other factors.
When is hormone therapy given
Your physician may prescribe hormone therapies before some cancer treatments or after other cancer treatments. If hormone therapy is given before the primary treatment, it is called neoadjuvant treatment. Neoadjuvant treatments help to kill cancer cells and contribute to the effectiveness of the primary therapy. If hormone therapy is given after the primary cancer treatment, it is called adjuvant treatment. Adjuvant therapy is given to improve the chance of a cure.
With some cancers, patients may be given hormone therapy as soon as cancer is diagnosed, and before any other treatment. It may shrink a tumor or it may halt the advance of the disease. And in some cancer, such as prostate cancer, it is helpful in alleviating the painful and distressing symptoms of advanced disease. The National Cancer Institute (NCI) states that although hormone therapy cannot cure prostate cancer, it will usually shrink or halt the advance of disease, often for years.
What medications are used for hormone therapy
Hormone therapy may be used to prevent the growth, spread, and recurrence of breast cancer. The female hormone estrogen can increase the growth of breast cancer cells in some women. An example of this type of medication is tamoxifen (Nolvadex®), which works by blocking the effects of estrogen on the growth of malignant cells in breast tissue. However, tamoxifen does not stop the production of estrogen. Men who have breast cancer may also be treated with tamoxifen.
Tamoxifen is currently being studied as a hormone therapy for treatment of other types of cancer. There are several other hormonal agents for breast cancer that work like tamoxifen, including raloxifene (Evista®), toremifene (Fareston®), and fulvestrant (Faslodex®).
Hormone therapy may be considered for women whose breast cancers test positive for estrogen and progesterone receptors.
Newer medications approved by the US Food and Drug Administration (FDA), called aromatase inhibitors, are used to treat advanced breast cancer or to prevent the recurrence of breast cancer in postmenopausal women. These drugs, such as anastrozole (Arimidex®), letrozole (Femara®), and exemestane (Aromasin®), prevent estrogen production.
Another new drug for recurrent breast cancer is fulvestrant (Faslodex®). Also approved by the FDA, this drug binds with the estrogen receptor and eliminates it, rather than than just blocking it, making it less effective in promoting growth of the cancer. Side effects for fulvestrant include hot flashes, mild nausea, and fatigue.
With prostate cancer, there may be a variety of medications used in hormone therapy. Male hormones, such as testosterone, stimulate prostate cancer to grow. Hormone therapy is given to help stop hormone production and to block the activity of the male hormones. Hormone therapy can cause a tumor to shrink and the prostate-specific antigen (PSA) levels to decrease.
What are the side effects of hormone therapy
The following are some potential side effects that may occur with hormone therapy. However, the side effects will vary depending upon the type of hormone therapy that is given. Every person's hormone treatment experience is different and not every person will experience the same side effects. Discuss the potential side effects of your hormone therapy with you physician.
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.
For prostate cancer, either the surgical removal of the testes or hormone drug therapy can improve the cancer. Both surgery and drugs may cause the following side effects:
For breast cancer, some women may experience side effects from tamoxifen that are similar to the symptoms some women experience in menopause. Other women do not experience any side effects when taking tamoxifen. The following are some of the side effects that may occur when taking tamoxifen:
Taking tamoxifen also increases the risk of endometrial cancer (involves the lining of the uterus) and uterine sarcoma (involves the muscular wall of the uterus), both cancers of the uterus. There is also a very small risk of blood clots and stroke, eye problems such as cataracts, and liver toxicities. Tamoxifen should be avoided during pregnancy.
Tamoxifen is used to treat men with breast cancer as well. As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.
Men may experience the following side effects:
Biological therapy (also called immunotherapy, biological response modifier therapy, or biotherapy) uses the body's immune system to fight cancer. The cells, antibodies, and organs of the immune system work to protect and defend the body against foreign invaders, such as bacteria or viruses. Physicians and researchers have found that the immune system might also be able to both determine the difference between healthy cells and cancer cells in the body, and to eliminate the cancer cells.
How does the immune system fight cancer
Biological therapies are designed to boost the immune system, either directly or indirectly, by assisting in the following:
The immune system includes different types of white blood cells - each with a different way to fight against foreign or diseased cells, including cancer:
These types of white blood cells - B cells, T cells, natural killer cells, and monocytes - are in the blood and thus circulate to every part of the body, providing protection from cancer and other diseases. Cells secrete two types of substances: antibodies and cytokines. Antibodies respond to (harmful) substances that they recognize, called antigens. Specific (helpful) antibodies match specific (foreign) antigens by locking together. Cytokines are proteins produced by some immune system cells and can directly attack cancer cells. Cytokines are "messengers" that "communicate" with other cells.
What are the different types of biological therapies?
There are many different types of biological therapies used in cancer treatment.
Biological response modifiers (BRMs) change the way the body's defenses interact with cancer cells. BRMs are produced in a laboratory and given to patients to:
BRMs include nonspecific immunomodulating agents, interferons, interleukins, colony-stimulating factors, monoclonal antibodies, cytokine therapy, and vaccines:
Nonspecific immunomodulating agents are biological therapy drugs that stimulate the immune system, causing it to produce more cytokines and antibodies to help fight cancer and infections in the body. Fighting infection is important for a person with cancer.
Interferons (IFN) are a type of biological response modifier that naturally occurs in the body. They are also produced in the laboratory and given to cancer patients in biological therapy. They have been shown to improve the way a cancer patient's immune system acts against cancer cells. Interferons may work directly on cancer cells to slow their growth, or they may cause cancer cells to change into cells with more normal behavior. Some interferons may also stimulate natural killer cells (NK) cells, T cells, and macrophages - types of white blood cells in the bloodstream that help to fight cancer cells.
Interleukins (IL) stimulate the growth and activity of many immune cells. They are proteins (cytokines) that occur naturally in the body, but can also be made in the laboratory. Some interleukins stimulate the growth and activity of immune cells, such as lymphocytes, which work to destroy cancer cells.
Colony-stimulating factors (CSFs) are proteins given to patients to encourage stem cells within the bone marrow to produce more blood cells. The body constantly needs new white blood cells, red blood cells, and platelets, especially when cancer is present. CSFs are given, along with chemotherapy, to help boost the immune system. When cancer patients receive chemotherapy, the bone marrow's ability to produce new blood cells is suppressed, making patients more prone to developing infections. Parts of the immune system cannot function without blood cells, thus colony-stimulating factors encourage the bone marrow stem cells to produce white blood cells, platelets, and red blood cells. With proper cell production, other cancer treatments can continue enabling patients to safely receive higher doses of chemotherapy.
Monoclonal antibodies are agents, produced in the laboratory, that bind to cancer cells. When cancer-destroying agents are introduced into the body, they seek out the antibodies and kill the cancer cells. Monoclonal antibody agents do not destroy healthy cells.
Examples of monoclonal antibody therapy include trastuzumab (Herceptin®) for breast cancer and rituximab (Rituxan®) for lymphoma.
Cytokine therapy uses proteins (cytokines) to help your immune system recognize and destroy those cells that are cancerous. Cytokines are produced naturally in the body by the immune system, but can also be produced in the laboratory. This therapy is used with advanced melanoma and with adjuvant therapy (therapy given after or in addition to the primary cancer treatment). Cytokine therapy reaches all parts of the body to kill cancer cells and prevent tumors from growing.
Vaccine therapy is still an experimental biological therapy. The benefit of vaccine therapy has not yet been proven. With infectious diseases, vaccines are given before the disease develops. Cancer vaccines, however, are given after the disease develops, when the tumor is small. Scientists are testing the value of vaccines for melanoma and other cancers. Sometimes, vaccines are combined with other therapies such as cytokine therapy.
Are there side effects of biological therapies
As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.
Side effects of biological therapy, which often mimic flu-like symptoms, vary according to the type of therapy given and may include the following:
Specifically, cytokine therapy often causes fever, chills, aches, and fatigue. Other side effects include a rash or swelling at the injection site. Therapy can cause fatigue and bone pain and may affect blood pressure and the heart.
Bone marrow transplantation (BMT) is a special therapy for patients with cancer or other diseases which affect the bone marrow. A bone marrow transplant involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the patient or to another person. The goal of BMT is to transfuse healthy bone marrow cells into a person after their own unhealthy bone marrow has been eliminated.
Bone marrow transplantation has been used successfully to treat diseases such as leukemias, lymphomas, aplastic anemia, immune deficiency disorders, and some solid tumor cancers since 1968.
What is bone marrow
Bone marrow is the soft, spongy tissue found inside bones. It is the medium for development and storage of about 95 percent of the body's blood cells.
The blood cells that produce other blood cells are called stem cells. The most primitive of the stem cells is called the pluripotent stem cell, which is different than other blood cells with regards to the following properties:
It is the stem cells that are needed in bone marrow transplantation.
Why is a bone marrow transplant needed
The goal of a bone marrow transplant is to cure many diseases and types of cancer. When a person's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a marrow transplant may be needed.
A bone marrow transplant can be used to:
The risks and benefits must be weighed in a thorough discussion with your physician and physicians that specialize in bone marrow transplants prior to procedure.
What are some diseases that may benefit from bone marrow transplantation
The following diseases are the ones that most commonly benefit from bone marrow transplantation:
However, patients experience diseases differently, and bone marrow transplantation may not be appropriate for everyone who suffers from these diseases.
What are the different types of bone marrow transplants
There are different types of bone marrow transplants depending on who the donor is. The different types of bone marrow transplant include the following:
Matching involves typing human leukocyte antigen (HLA) tissue. The antigens on the surface of these special white blood cells determine the genetic make-up of a person's immune system. There are at least 100 HLA antigens, however, it is believed that there are a few major antigens that determine whether a donor and recipient match. The others are considered "minor" and their effect on a successful transplant is not as well defined.
Medical research is still investigating the role all antigens play in the process of a bone marrow transplant. The more antigens that match, the better the engraftment of donated marrow. Engraftment of the stem cells occurs when the donated cells make their way to the marrow and begin reproducing new blood cells.
The bone marrow transplant team
The group of specialists involved in the care of patients going through transplant is often referred to as the "transplant team." All individuals work together to provide the best chance for a successful transplant. The team consists of the following:
An extensive evaluation is completed by the bone marrow transplant team. The decision for you to undergo a bone marrow transplant will be based on many factors, including the following:
Preparation for the recipient
For a patient receiving the transplant, the following will occur in advance of the procedure:
The bone marrow transplant procedure
The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your tolerance for certain medications. Consider the following:
The days before transplant are counted as minus days. The day of transplant is considered day zero. Engraftment and recovery following the transplant are counted as plus days. For example, a patient may enter the hospital on day -8 for preparative regimen. The day of transplant is numbered zero. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the patient and family understand where they are in terms of risks and discharge planning.
During infusion of bone marrow, the patient may experience the following:
After infusion, the patient may:
After leaving the hospital, the recovery process continues for several months or longer, during which time the patient cannot return to work or many previously enjoyed activities. The patient must also make frequent follow-up visits to the hospital or physician's office.
Engraftment of the stem cells occurs when the donated cells make their way to the marrow and begin reproducing new blood cells. Depending on the type of transplant and the disease being treated, engraftment usually occurs around day +15 or +30. Blood counts will be performed frequently during the days following transplant to evaluate initiation and progress of engraftment. Platelets are generally the last blood cell to recover.
Engraftment can be delayed because of infection, medications, low donated stem cell count, or graft failure. Although the new bone marrow may begin making cells in the first 30 days following transplant, it may take months, even years, for the entire immune system to fully recover.
How are the stem cells collected?
A bone marrow transplant is done by transferring stem cells from one person to another. Stem cells can either be collected from the circulating cells in the blood (the peripheral system) or from the bone marrow.
Peripheral blood stem cells (PBSCs) are collected by apheresis, a process in which the donor is connected to a special cell separation machine via a needle inserted in the vein. Blood is taken from one vein and is circulated though the machine which removes the stem cells and returns the remaining blood and plasma back to the donor through another needle inserted into the opposite arm. Several sessions may be required to collect enough stem cells to ensure a chance of successful engraftment in the recipient.
A medication may be given to the donor for about one week prior to apheresis that will stimulate the bone marrow to increase production of new stem cells. These new stem cells will be released from the marrow and into the circulating or peripheral blood system.
Bone marrow harvesting involves collecting stem cells with a needle placed into the soft center of the bone, the marrow. Most sites used for bone marrow harvesting are located in the hip bones and the sternum. The procedure takes place in the operating room. The donor will be anesthetized during the harvest and will not feel the needle. In recovery, the donor may experience some pain in the areas where the needle was inserted.
If the donor is the person him/herself, it is called an autologous bone marrow transplant. If an autologous transplant is planned, previously collected stem cells, from either peripheral (apheresis) or harvest, are counted, screened, and ready to infuse
What complications and side effects may occur following BMT
Complications may vary, depending on the following:
The following are complications that may occur with a bone marrow transplantation. However, each individual may experience symptoms differently. These complications may also occur alone, or in combination:
Long-term outlook for a bone marrow transplantation
Prognosis greatly depends on the following:
As with any procedure, such as bone marrow transplant, prognosis, and long-term survival can vary greatly from person to person. The number of transplants occurring for an increased number of diseases and medical developments has greatly improved the outcome for bone marrow transplant in children and adults. Continuous follow-up care is essential for the patient following a bone marrow transplant. New methods to improve treatment and to decrease complications and side effects of a bone marrow transplant are continually being discovered.
Hyperthermia is heat therapy. Heat has been used for hundreds of years as therapy. According to the National Cancer Institute (NCI), scientists believe that heat may help shrink tumors by damaging cells or depriving them of the substances they need to live. There are research studies underway to determine the use and effectiveness of hyperthermia in cancer treatment.
Heat can be applied to a very small area or to an organ or limb. Hyperthermia is usually used with chemotherapy, radiation therapy, and other treatment therapies. The types of hyperthermia are described in the following chart:
| Type of Hyperthermia | Treatment Area | Method of Application |
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| local hyperthermia | Treatment area includes a tumor or other small area. |
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| regional hyperthermia | An organ or a limb is treated. |
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| whole body hyperthermia | The whole body is treated when cancer has spread. |
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Are there any side effects
There are no known complications of hyperthermia. Side effects may include skin discomfort or local pain. Hyperthermia can also cause blisters and occasionally burns but generally these heal quickly.
