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How Cancer is Treated

There are many different ways to treat cancer and the CTRC offers a wide variety of all treatment types. Below are the different categories – from chemotherapy to surgery to radiation. If you click on the category, then the name of the different treatments you can read more about them. If you would like more information, please call to speak to a nurse or manager who can answer your questions.
Surgery is used in several ways to help cancer patients. According to the American Cancer Society (ACS), it is the oldest form of cancer treatment. It provides the best chance to stop many types of cancer, and it also plays a part in diagnosing, staging, and supporting cancer treatment.
Having surgery for cancer is different for every patient, depending on the type of surgery, the type of cancer, and the patient's health. For some people, surgery is a major medical procedure with life-changing side effects. For others, surgery is quick and has few side effects.

Surgery

Curative Surgery

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

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

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

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

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

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

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

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

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

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

Electrosurgery

Skin cancer and oral cancer are sometimes treated with electrosurgery. This technique uses electrical current to kill cancer cells.

Microscopically Controlled Surgery

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.

Laser Therapy

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:

  • Lasers can cut a very tiny area, less than the width of the finest thread, to remove very small cancers without damaging surrounding tissue.
  • Lasers are used to apply heat to tumors in order to shrink them.
  • Lasers are sometimes used with drugs that are activated by laser light to kill cancer cells.
  • Lasers can bend and go through tubes to access hard to reach places.
  • Lasers are used in microscopes to enable physicians to view the site being treated.

Carbon Dioxide (CO2) Lasers

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

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)

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

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

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

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.

Chemotherapy can be given

  • As a pill to swallow.
  • As an injection into the muscle or fat tissue.
  • Intravenously (directly to the bloodstream; also called IV).
  • Topically (applied to the skin)
  • Directly into a body cavity

chemotherapy drugs and potential side effects

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.)

Carboplatin
(Paraplatin)

  • usually given intravenously (IV)
  • used for cancers of the ovary, head and neck, and lung
  • decrease in blood cell counts
  • hair loss (reversible)
  • confusion
  • nausea, vomiting, and/or diarrhea (usually a short-term side effect occurring the first 24 to 72 hours following treatment)

Cisplatin
(Platinol, Platinol-AQ)

  • usually given intravenously (IV)
  • used for cancers of the bladder, ovary, and testicles
  • decrease in blood cell counts
  • allergic reaction, including a rash and/or labored breathing (rare)
  • nausea and vomiting that usually occurs for 24 hours or longer
  • ringing in ears and hearing loss
  • fluctuations in blood electrolytes
  • kidney damage

Cyclophosphamide
(Cytoxan) not common

  • can be given intravenously (IV) or orally
  • used for lymphoma, breast cancer, and ovarian carcinoma
  • decrease in blood cell counts
  • nausea, vomiting, abdominal pain
  • decreased appetite
  • hair loss (reversible)
  • bladder damage
  • fertility impairment
  • lung or heart damage (with high doses)
  • secondary malignancies (rare)

Docetaxel
(Taxotere)

  • given intravenously (IV)
  • used for breast cancer, lung, and prostate
  • decrease in blood cell counts
  • nausea, vomiting, abdominal pain
  • diarrhea
  • decreased appetite
  • hair thinning
  • rash
  • numbness and tingling in hands and feet

Doxorubicin
(Adriamycin)

  • given intravenously (IV)
  • used for breast cancer, lymphoma, and multiple myeloma
  • decrease in blood cell counts
  • mouth ulcers
  • hair loss (reversible)
  • nausea and vomiting
  • heart damage

Erlotinib
(Tarceva, OSI-774)

  • given orally
  • used for non small cell lung cancer
  • rash and other skin changes
  • diarrhea

Etoposide
(VePesid, VP-16)

  • can be given intravenously (IV) or orally
  • used for cancers of the lung, testicles, leukemia, and lymphoma
  • decrease in blood cell counts
  • hair loss (reversible)
  • nausea and vomiting
  • allergic reaction (rare)
  • mouth ulcers
  • low blood pressure (during administration) (rare)
  • decreased appetite
  • diarrhea and abdominal pain
  • bronchospasm (rare)
  • flu-like symptoms (rare)

Fluorouracil
(5-FU)

  • given intravenously (IV)
  • used for cancers of the colon, breast, stomach, and head and neck
  • decrease in blood cell counts
  • diarrhea
  • mouth ulcers
  • photosensitivity
  • dry skin, darkening of skin and nail beds

Gemcitabine
(Gemzar)

  • given intravenously (IV)
  • used for cancers of the pancreas, breast, ovary, and lung
  • decrease in blood cell counts
  • nausea and vomiting
  • fever and flu-like symptoms
  • rash

Imatinib mesylate
(Gleevec, STI 571)

  • given orally
  • used for chronic myelogenous leukemia (CML) and gastrointestinal stromal tumor (GIST)
  • nausea and vomiting
  • fluid retention (swelling around ankles, eyes)
  • muscle cramps
  • diarrhea
  • gastrointestinal bleeding
  • rash

Iirinotecan
(Camptosar, CPT-11)

  • given intravenously (IV)
  • used for cancers of the colon and rectum
  • decrease in blood cell counts
  • diarrhea
  • fatigue

Methotrexate
(Folex, Mexate, Amethopterin)

  • may be given intravenously (IV), intrathecally (into the spinal column), or orally
  • used for cancers of the breast, lung, blood, bone, and lymph system
  • decrease in blood cell counts
  • nausea and vomiting
  • mouth ulcers
  • skin rashes and photosensitivity
  • dizziness, headache, or drowsiness
  • kidney damage (with a high-dose therapy)
  • liver damage (rare)
  • hair loss (reversible)

Paclitaxel
(Taxol, Abraxane)

  • given intravenously (IV)
  • used with cancers of the breast, ovary, and lung
  • decrease in blood cell counts
  • allergic reaction
  • nausea and vomiting
  • loss of appetite
  • change in taste
  • thin or brittle hair
  • joint pain (short term)
  • numbness or tingling in the fingers or toes

Sorafinib
(Nexavar)

  • given orally
  • used for advanced kidney cancer
  • high blood pressure (during first few weeks of treatment)
  • rash, other skin changes
  • diarrhea
  • fatigue
  • hair loss
  • nausea and vomiting

Sunitinib
(Sutent)

  • given orally
  • used for gastrointestinal stromal tumor (GIST) and kidney cancer
  • diarrhea
  • nausea and vomiting
  • mouth ulcers
  • upset stomach
  • skin changes, including skin discoloration and rash
  • fatigue
  • high blood pressure
  • bleeding
  • swelling
  • taste disturbance

Topotecan
(Hycamtin)

  • given intravenously (IV)
  • used for cancers of the ovary and lung
  • decrease in blood cell counts
  • diarrhea
  • hair loss (reversible)
  • nausea and vomiting

Vincristine
(Oncovin)

  • usually given intravenously (IV)
  • used for leukemia and lymphoma
  • numbness or tingling in the fingers or toes
  • weakness
  • loss of reflexes
  • jaw pain
  • hair loss (reversible)
  • constipation or abdominal cramping

Vinblastine
(Velban)

  • given intravenously (IV)
  • used for lymphoma and cancers of the testis and head and neck
  • decrease in blood cell counts
  • hair loss (reversible)
  • constipation or abdominal cramping
  • jaw pain
  • numbness or tingling in the fingers or toes

Side Effects

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.

  • Nausea / Vomiting
  • Hair Loss
  • Pain
  • Mucositis / Mouth Sores
  • Diarrhea
  • Constipation
  • Effects on Organs / Body Systems
  • Skin / Nails
  • Bone Marrow Suppression
  • Anemia
  • Infection
  • Blood Clots / Bruising
  • Appetite / Taste Changes

Hormone Therapy

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

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:

  • Treating cancer cells to keep them from receiving the hormones they need to grow
  • Treating the glands that produce hormones to keep them from making hormones
  • Surgery to remove glands that produce the hormones, such as the ovaries that produce estrogen, or the testicles that produce testosterone

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

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

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

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:

  • Hot flashes
  • Impotence
  • A loss of desire for sexual relations
  • Male breast enlargement

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:

  • Hot flashes
  • Nausea and/or vomiting
  • Vaginal spotting (a blood stained discharge from the vagina that is not part of the regular menstrual cycle)
  • Increased fertility in younger women
  • Irregular menstrual periods
  • Fatigue
  • Skin rash
  • Loss of appetite or weight gain
  • Headaches
  • Vaginal dryness or itching and/or irritation of the skin around the vagina

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:

  • Headaches
  • Nausea and/or vomiting
  • Skin rash
  • Impotence
  • Decrease in sexual interest

Biological Therapy

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

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:

  • Making cancer cells more recognizable by the immune system, and therefore more susceptible to destruction by the immune system
  • Boosting the killing power of immune system cells
  • Changing the way cancer cells grow, so that they act more like healthy cells
  • Stopping the process that changes a normal cell into a cancerous cell
  • Enhancing the body's ability to repair or replace normal cells damaged or destroyed by other forms of cancer treatment, such as chemotherapy or radiation
  • Preventing cancer cells from spreading to other parts of the body

The immune system includes different types of white blood cells - each with a different way to fight against foreign or diseased cells, including cancer:

  • Lymphocytes - white blood cells, including B cells, T cells, and NK cells.
    • B cells - produce antibodies that attack other cells.
    • T cells - directly attack cancer cells themselves and signal other immune system cells to defend the body.
    • Natural killer cells (NK cells) - produce chemicals that bind to and kill foreign invaders in the body.
  • Monocytes - white blood cells that swallow and digest foreign particles.
  • Dendritic cells - present the foreign cells to the immune system.

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

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:

  • Boost the body's ability to fight the disease.
  • Direct the immune system's disease fighting powers to disease cells.
  • Strengthen a weakened immune system.

BRMs include nonspecific immunomodulating agents, interferons, interleukins, colony-stimulating factors, monoclonal antibodies, cytokine therapy, and vaccines:

  • Nonspecific immunomodulating agents
  • 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)
  • 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)
  • 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)
  • 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
  • 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
  • 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
  • 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

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:

  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue

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

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

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:

  • Renewal - it is able to reproduce another cell identical to itself.
  • Differentiation - it is able to generate one or more subsets of more mature cells.

It is the stem cells that are needed in bone marrow transplantation.

Why is a bone marrow transplant needed

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:

  • Replace diseased, non-functioning bone marrow with healthy functioning bone marrow (for conditions such as leukemia, aplastic anemia, and sickle cell anemia).
  • Replace the bone marrow and restore its normal function after high doses of chemotherapy or radiation are given to treat a malignancy. This process is often called "rescue" (for diseases such as lymphoma and neuroblastoma).
  • Replace bone marrow with genetically healthy functioning bone marrow to prevent further damage from a genetic disease process (such as Hurler's syndrome and adrenoleukodystrophy).

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

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:

  • Leukemias
  • Severe Aplastic Anemia
  • Lymphomas
  • Multiple Myeloma
  • Immune Deficiency Disorders
  • Solid-tumor cancers, such as breast or ovarian

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

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:

  • Autologous bone marrow transplant
    The donor is the patient him/herself. Stem cells are taken from the patient either by bone marrow harvest or apheresis (a process of collecting peripheral blood stem cells) and then given back to the patient after intensive treatment. Often the term "rescue" is used instead of "transplant."
  • Allogeneic bone marrow transplant
    The donor shares the same genetic type as the patient. Stem cells are taken either by bone marrow harvest or apheresis from a genetically-matched donor, usually a brother or sister. Other donors for allogeneic bone marrow transplants include the following:
    • A parent - a haploid-identical match is when the donor is a parent and the genetic match is at least half identical to the recipient.
    • An identical twin - a syngeneic transplant is an allogeneic transplant from an identical twin. Identical twins are considered a complete genetic match for a marrow transplant.
    • Unrelated bone marrow transplants (UBMT or MUD for matched unrelated donor) - the genetically matched marrow or stem cells are from an unrelated donor. Unrelated donors are found through the national bone marrow registries.
  • Umbilical cord blood transplant
    Stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells reproduce into mature, functioning blood cells quicker and more effectively than do stem cells taken from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are ready to be transplanted.

How are a donor and recipient matched?

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 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:

  • Physicians - physicians who specialize in oncology, hematology, immunology, and bone marrow transplantation.
  • Bone Marrow Transplant Nurse Coordinator - a nurse who organizes all aspects of care provided before and after the transplant. The nurse coordinator will provide patient education, and coordinates the diagnostic testing and follow-up care.
  • Social Workers - professionals who will help your family deal with many issues that may arise, including lodging and transportation, finances, and legal issues.
  • Dietitians - professionals who will help you meet your nutritional needs before and after the transplant. They will work closely with you and your family.
  • Physical Therapists - professionals who will help you become strong and independent with movement and endurance after the transplantation.
  • Pastoral Care - chaplains who provide spiritual care and support.
  • Other team members - several other team members will evaluate you before transplantation and will provide follow-up care as needed. These include, but are not limited to, the following:
    • Pharmacists
    • Respiratory therapists
    • Lab technicians
    • Infectious disease specialists
    • Dermatologists
    • Gastroenterologists
    • Psychologists

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:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Availability of a donor
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Expectations for the course of the transplant
  • Your opinion or preference

WPreparation for the recipient

Preparation for the recipient

For a patient receiving the transplant, the following will occur in advance of the procedure:

  • Prior to the transplant, an extensive evaluation is completed by the bone marrow transplant team. All other treatment options are discussed and evaluated for risk versus benefit.
  • A complete medical history and physical examination are performed, including multiple tests to evaluate the patient's blood and organ functions (i.e., heart, kidney, liver, lungs).
  • A patient will often come into the transplant center up to 10 days prior to transplant for hydration, evaluation, placement of the central venous line, and other preparations. A catheter, also called a central venous line, is surgically placed in a vein in the chest area. Blood products and medications will be administered through the catheter.
  • A suitable (tissue typed and matched) donor must be available. Finding a matching donor can be a challenging and lengthy process. Voluntary marrow donors are registered in several national and international registries. A bone marrow search involves searching these registries for donors whose blood most closely resembles or matches the individual needing the transplant.

Preparation for the donor:

  • Donor sources available include: self, sibling, parent or relative, non-related person, or umbilical cord from a related or non-related person. There are national and international registries for non-related persons and cord blood. For family members, they may be typed because of the desire to help. These relatives may or may not elect to have their type registered for use with other recipients.
  • If the potential donor is notified that they may be a match for a patient needing a transplant, they will undergo additional tests. Tests related to their health, exposure to viruses, and complete genetic analysis will be done to determine the extent of the match. The donor will be given instructions on how a bone marrow donation will be made.
  • Once a match for a patient needing a bone marrow transplant is found, then stem cells will be collected either by a bone marrow harvest (collection of stem cells with a needle placed into the soft center of the bone marrow) or peripheral blood stem cell collection (stem cells are collected from the circulating cells in the blood). Cord blood has already been collected at the time of a birth and stored for later use.

The bone marrow transplant 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:

  • Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces all the blood cells in our body. Ablative therapy prevents this process of cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
  • After the chemotherapy and/or radiation is administered, the marrow transplant is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
  • Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, daily weigh-ins, and providing a protected and sterile environment.

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:

  • Pain
  • Chills
  • Fever
  • Hives
  • Chest pain

After infusion, the patient may:

  • Spend several weeks in the hospital.
  • Be very susceptible to infection.
  • Experience excessive bleeding.
  • Have blood transfusions.
  • Be confined to a sterile environment.
  • Take multiple antibiotics and other medications.
  • Be given medication to prevent graft-versus-host disease - if the transplantation was allogeneic. The transplanted new cells (the graft) tend to attack the patient's tissues (the host), even though the donor is a relative, such as a brother, sister, or parent.
  • Undergo continual laboratory testing.
  • experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness.
  • Experience temporary mental confusion and emotional or psychological distress.

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.

When does engraftment occur?

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)
  • 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 Harvest
  • 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

What complications and side effects may occur following BMT

Complications may vary, depending on the following:

  • Type of marrow transplant
  • Type of disease requiring transplant
  • Preparative regimen
  • Age and overall health of the recipient
  • Variance of tissue matching between donor and recipient
  • Presence of severe complications

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:

  • Infections
    Infections are likely in the patient with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, anti-fungal medications, and anti-viral medications are often given to prevent serious infection in the immunosuppressed patient.
  • Low platelets and low red blood cells
    Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a non-functioning bone marrow, can be dangerous and even life threatening. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI) tract, and brain.
  • Pain
    Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (inflammation of the mouth and GI tract).
  • Fluid overload
    Fluid overload is a complication that can lead to pneumonia, liver damage, and high blood pressure. The primary reason for fluid overload is because the kidneys cannot keep up with the large amount of fluid being given in the form of intravenous (IV) medications, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, or antibiotics.
  • Respiratory distress
    Respiratory status is an important function that may be compromised during transplant. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may occur in the lungs and pulmonary system.
  • Organ damage
    The liver and heart are important organs that may be damaged during the transplantation process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.
  • Graft failure
    Graft failure is a potential complication. Graft failure may occur as a result of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment.
  • Graft-versus-host disease
    Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the recipient's tissue. The new cells do not recognize the tissues and organs of the recipient's body. The most common sites for GVHD are GI tract, liver, skin, and lungs.

Long-term outlook for a bone marrow transplantation

Long-term outlook for a bone marrow transplantation

Prognosis greatly depends on the following:

  • Type of marrow transplant
  • Type and extent of the disease being treated
  • Disease response to treatment
  • Genetics
  • Your age and overall health
  • Your tolerance of specific medications, procedures, or therapies
  • Severity of complications

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

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.

How is it used

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
local hyperthermia Treatment area includes a tumor or other small area.
  • Heat is applied from the outside with high-frequency waves aimed at the tumor.
    or
  • Inside the body a small area may be heated with thin heated wire probes, hollow tubes filled with warm water, or implanted microwave antennae and radiofrequency electrodes.
regional hyperthermia An organ or a limb is treated.
  • Magnets and devices that produce high energy are placed over the region to be heated.

    or
  • Some of the patient's blood is removed, heated, and then pumped into the region to be heated. The process is called perfusion.
whole body hyperthermia The whole body is treated when cancer has spread.
  • warm water blankets
  • hot wax
  • inductive coils (similar to the coils in an electric blanket)
  • thermal room or chambers

Are there any side effects

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.