Treatment Of Cancer


The treatment of cancer today is a multimodality treatment where more than one modality of treatment is used. Almost all cancers are treated with at least two modes of cancer therapy while a fairly large number of patients receive three or even more forms of treatment to fight cancer. Treatment of cancer needs a close consultation between the surgical, radiation and medical oncologists, who are the specialists of surgical oncology (cancer surgery), chemotherapy and radiotherapy respectively and the ontological pathologist. Hence all patients should be seen by a team of oncologists consisting of all these specialists to plan the treatment, before starting the therapy.

The various modality of treatment of cancer are as follows
•    Surgery
•    Chemotherapy
•    Radiotherapy
•    Hormonal therapy
•    miscellaneous therapies
•    Recent Advances

SURGERY

Surgery is the main mode of therapy in most of the cancers, especially those affecting the solid organs of the body. Surgery is the mainstay of treatment in the following organs
•    Head and neck tumors
•    Breast cancer
•    Brain tumors
•    Lung cancer
•    Cancers of intestines
•    Endocrine gland tumors
•    Cancers of muscles and bones
•    Genitourinary tract tumors

It can be used in the following settings
•    Curative -where the complete disease is removed with an intent to cure cancer
•    Debulking- here as much of the cancer is removed as possible, to reduce tumor burden
•    Biopsy –surgery may be performed for biopsy and to reach a diagnosis
•    Palliative-here surgery is done to combat the complications caused by cancer or the treatment, like in obstruction, severe infection or bleeding

Principles of Surgery
•    To remove the complete cancerous part
•    To remove a clear margin around it
•    To remove the local lymph nodes along with the organ or part of the organ being removed
•    To ensure minimum handling of the tumor
•    To reconstruct the organ or limb operated to maintain continuity or function
•    To ensure cosmesis with minimum functional disability without compromise in the extent of clearance of cancer

Contraindications for Surgery

Definitive major surgery should not be performed in the following circumstances
•    Distant spread of disease
•    Poor general condition of the patient
•    Extensive local spread
•    Disease which cannot be reconstructed after excision
•    Where there would be extensive functional or cosmetic defect
•    Where the survival of the patient is expected to be very short

Organ Preserving Surgery
With advancement of surgical skill and the use of chemotherapy and radiotherapy, extensive surgery is now a days being replaced by procedures where the organ is being preserved. This is especially being practiced in cancers of breast, voice box (larynx),limbs and the urinary bladder. Amputation as the treatment of cancers of muscles and bones has been replaced in most cases by limb preserving surgery where the affected part including the joint is excised and replaced by metallic prosthesis.

Minimal Access Surgery
Incision less or minimally invasive surgery is being practiced for cancer treatment also these days. Commonly called laproscopy, this is used in cancers of the intestine and other abdominal organs, lung and esophagus ( thoracoscopy and mediastenoscopy) .Here telescopes mounted with fibre-optic lights are used to enter the body cavity while surgery is performed under video monitoring. Here the incisions are very small so the postoperative recovery is faster.

Reconstructive (plastic )Surgery
Plastic surgery is often used in surgery of cancer. Common sites of its use are head and neck tumors, and in cancers of breast, larynx and muscles and bone. Common procedures performed are to provide skin cover, loss of inner lining, bone or muscles. Breast reconstruction is most commonly used besides transfer of muscles in limb saving surgery and head and neck cancers

 
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