Surgery plays a very important role in the treatment and diagnosis of cancer. There are mainly 2 types where the surgeon has to cut into the body called invasive surgery and a procedure that involves less cutting called less invasive surgery, removing the cancer while saving the normal surrounding tissues. In many types of cancer, surgery offers the greatest chance for cure if the cancer has not spread to other parts of the body.
Types of Cancer Surgery
- Preventive surgery: Used to remove free cancer lesions of the body.
- Diagnostic surgery: Taking a piece of the tumor for testing. This is often called a biopsy.
- Staging surgery: This is performed to know how far the cancer has spread. Common examples are laparoscopy or laparotomy.
- Curative surgery: This is performed to remove the cancer and usually is the main treatment . This can be performed alone or sometimes in combination with chemotherapy and/or radiation during the surgery.
- Debulking surgery: Removing some or most of the cancer that has caused damage to surrounding tissues. Then, the patient will undergo chemotherapy and/or radiation to treat the remaining tumor.
- Palliative surgery: This is used to debulk a cancer that causes a disability or discomfort. However, it does not treat or cure the cancer.
- Supportive surgery: This is performed for placement of a device such as a Port-A-Cath for vascular access.
- Reconstructive surgery: This is performed to restore part of the body or restore the function of a particular organ. An example includes breast reconstructive surgery.
Chemotherapy is very strong medications that are used to treat cancer. It is often used to cure the cancer, slow the growth of cancer, keep the cancer from spreading to other parts of the body, relieve symptoms such as obstruction or pain caused by the cancer and to kill cancer cells that have spread to other parts of the body.
Chemotherapy kills the cancers and also affects the normal cells. However, the majority of the normal cells can repair themselves after exposure to chemotherapy.
Chemotherapy is given through a pill, a shot, and most often administered through a catheter into the vein. There are different types of chemotherapy schedules: Once a day, once a week, or monthly. It is usually given in cycles. How long and how often chemotherapy is administered depends on the type of cancer. During administration of chemo, it usually does not cause any pain. If a patient experiences pain, burning sensation, or coolness when receiving the chemo, tell the nurse or your doctor immediately.
Other types of medication may affect your chemotherapy. It is important to tell your nurse or doctor of all the medications including over-the-counter medications that you take.
During chemotherapy, many patients can still perform their usual activities. However, other treatment requires chemotherapy to be done in the hospital setting. Fatigue is a common side effect of chemo and some patients may require changing their work schedules or hours.
Your physician or nurse will monitor your progress during treatment by performing exams and imaging tests to know if the chemo is working or not.
Radiation therapy uses waves or particles that destroy or damages cancer cells. Special equipment is used to send high doses of radiation to the cancer cells or the tumor. It may also affect nearby normal cells. Some cancers can be cured with radiation alone.
Radiation therapy treats only the tumor. It is not like chemotherapy that treats the whole body.
Targeted therapy is a new type of cancer treatment wherein medications are used to attack cancer cells precisely and causing little damage to neighboring cells. This medication does not work as chemotherapy. These medications have different side effects usually less severe than chemotherapy. Examples of targeted therapies are monoclonal antibodies that are man-made antibodies that attack specific target on cancer cells. Other types are often called small molecular targeted medications.
These medications are used to treat a specific type of cancer. These are often used for patients with chronic myelogenous leukemia, to target abnormal BCR-ABL gene.
A small portion of patients with lung cancer that have the abnormal ALK gene are candidates for targeted drugs called ALK inhibitors.
These medications are usually given orally through a pill or capsule, injections under the skin, or into the vein.
These medications are given daily, weekly, every few weeks, or less often. Some medications require treatment breaks to allow the body to recover.
It is important to tell your physician or nurse about your medications and supplements before starting targeted therapy medications.
Immunotherapy is using the patient’s immune system to fight the cancer by stimulating your own immune system to attack the cancer cells or giving your immune system components to attack the cancer cells.
The body’s immune system is composed of special cells, substances, or a group of organs that help protect the body from infection and other illnesses. It also protects the body from cancer in certain ways.
The main types of immunotherapy are monoclonal antibodies. These are man-made versions of the immune system proteins that are designed to attack a very specific part of the cancer cell.
Cancer vaccines are substances that are placed in the body to start an immune response.
Nonspecific immunotherapies are treatments that boost the immune system to help attack the cancer cells.
Stem Cell Transplant
Stem cells are the immature cells that mostly reside in the bone marrow. They develop into mature cells, leaving the bone marrow and enter the bloodstream that are called peripheral-blood stem cells and are mature.
Stem cell transplant is often used to restore the stem cell population when the bone marrow has been damaged by disease, radiation, or chemotherapy.
Stem cells are often taken from the bone marrow, peripheral blood, or the cord blood. Collectively, they are known as hematopoietic stem cells.
Stem cells are made up of the white blood cells, red blood cells, and the platelets. The red blood cells carry oxygen from the lungs to other parts of the body and bring the carbon dioxide back to the lungs. The white blood cells are part of the immune system that fights infections caused by viruses, bacteria, and fungi. The neutrophils are the most important type of white cells that fight bacterial infection. Patients with neutrophil count less than 1000/mm3 have high risk for serious infection. The platelets are pieces of cells that help the blood to clot and seal damaged blood vessels to prevent bleeding. Bleeding with no known injury often if a patient’s platelet count is just below 20,000.
Stem cell transplants are needed for certain types of cancers wherein the bone marrow has been destroyed by the cancer itself, by radiation, or chemotherapy. The damaged stem cells make very few healthy cells. The transplanted cells replace the body’s source of blood production. This is often performed in certain leukemias, certain lymphomas, multiple myeloma, aplastic anemia, and certain blood diseases. There are 3 basic types of stem cell transplants: 1) Autologous wherein the cells come from the patient themselves. 2) Allogeneic is where the cells come from a much related or unrelated donor. 3) Syngenic is where the cells come from your identical twin or triplet.
Blood Product Transfusion
In allogeneic transplant, the patient’s immune system recognizes new stem cells as foreign and are subject to destruction. This is called graft rejection and leads to graft failure. Human leukocyte antigen matching is performed and then lastly the transfusion. A transfusion is putting blood components or blood into the vein to replace a patient’s blood. It is usually sourced from another person called a donor. The donated blood is separated into components; these are the red cells, white cells, platelets, plasma, and clotting factors. Often patients with cancer develop anemia of chronic disease. This affects production and lifespan of the red cells. Some patients will have bleeding usually in the digestive tract that also leads to anemia. Possible side effects of transfusion include transfusion reactions, allergic reactions, febrile reactions, transfusion-related acute lung injury, acute or delayed hemolytic reaction, infections, bacteria contamination, hepatitis infection, HIV infection, and graft versus host disease.