The surgeon relies on computer imaging to guide the probes to the correct position and monitor the progress of the treatment.
Ablative therapy has several advantages. It causes minimal pain and has a shorter recovery time than surgery or radiation therapy. In fact, it usually does not require an overnight hospital stay. It can also be used in conjunction with other cancer treatments.
Cryoablation is also known as cryotherapy or cryosurgery. A special probe is inserted into the tumor and then cooled to temperatures well below freezing. A ball of ice forms at the tip of the probe, freezing and destroying cancerous tissue. Cryotherapy is not as invasive as surgery and can sometimes be performed as an outpatient procedure. Cryotherapy is currently used to treat prostate and kidney cancers.
The biggest disadvantage with using cryotherapy to treat prostate cancer is that most men (about 80%) will lose the ability to have an erection. However, for men who already have erectile dysfunction, cryotherapy is a convenient and effective prostate cancer treatment.
A needle-thin probe delivers radiofrequency waves directly to the tumor, heating the tissue until it is destroyed. Radiofrequency ablation is best for smaller, localized tumors. RFA can be used to treat a variety of cancers:
Also known as HIFU, this procedure is used to treat prostate cancer. A special probe uses high-frequency ultrasound to produce heat that kills cancerous tumors. The probe is inserted into the rectum and guided to the proper position using computer imaging. HIFU can either treat the entire prostate ("full" HIFU) or just certain portions ("focused" HIFU) and the procedure takes from 1-4 hours.
Some cancerous tumors are very efficient at creating new blood vessels, which increases blood supply to the tumor and allows it to grow rapidly.
Cancer cells begin the angiogenesis process by sending signals to nearby tissue and activating growth factors that allow the tumor to form new blood vessels. One such molecule is called vascular endothelial growth factor, or VEGF.
Researchers developed drugs called angiogenesis inhibitors, or anti-angiogenic therapy, to disrupt the growth process. These drugs search out and bind themselves to VEGF molecules, which prohibits them from activating receptors on endothelial cells inside blood vessels. Bevacizumab (Avastin®) works in this manner. It is used to treat glioblastoma and cancers of the lung, kidney, breast, colon and rectum.
Other angiogenesis inhibitor drugs work on a different part of the process, by stopping VEGF receptors from sending signals to blood vessel cells. These drugs are known as tyrosine kinase inhibitors (TKI). Sunitinib (Sutent®) is an example of a tyrosine kinase inhibitor.
While angiogenesis inhibitors work to cut off the tumor’s blood supply, they do not destroy the tumor itself. For this reason, these drugs are typically used in combination with chemotherapy or other treatments.
Angiogenesis inhibitors are particularly effective for treating liver cancer, kidney cancer and neuroendocrine tumors.
This is known as external beam radiation.Brachytherapy is different. It delivers radiation therapy with small pieces of radioactive material (usually about the size of a grain of rice) that are placed inside the patient’s body as close to the tumor as possible. This allows doctors to deliver very high doses of radiation directly to the patient’s tumor while limiting radiation exposure to healthy tissue.Brachytherapy is used to treat several different diseases, including breast cancer, gynecologic cancers and prostate cancer.
This is done using a breast implant, or tissue from another part of the body. The goal of reconstruction is to make breasts look natural and balanced when the patient is wearing clothing.
Candidates for breast reconstruction include women who have been:
With improved treatments, breast reconstruction techniques and new medical devices, there are many options. Surgeons can recreate a breast at the time of mastectomy or after you have had a mastectomy. They can also correct misshapen breasts that may result after breast conservation surgery.
Deciding which reconstruction method is best for you will be discussed during your consultation with the plastic surgeon, who will consider your personal preferences, as well as body shape, prior surgeries, current medical condition and cancer treatment needs. All reconstructive options have both risks and benefits, and each option usually requires multiple procedures to reach a final result
They help the immune system respond to a disease and directly kill diseased cells.
Unfortunately, naturally occurring T cells are not good at recognizing and fighting cancer cells.
Chimeric Antigen Receptor (CAR) T-cell therapy is a type of immunotherapy that changes a patient’s own T cells so they are able to recognize and attack cancer.
CAR T-cell therapy has been extremely effective in many patients. In some cases, the treatment has eliminated all signs of cancer.
However, CAR T-cell therapy doesn’t work for every patient. Some have benefited for a short time before relapsing. Doctors are studying the reasons for these different responses.
CAR T-cell therapy begins with apheresis, a special kind of blood draw where certain blood components are removed and the remaining blood is pumped back into the patient. In this case, the patient’s T cells are removed and then shipped to a lab.
There, scientists genetically modify the T cells so they produce a protein (called a receptor) that recognizes another protein (called an antigen) on the surface of cancer cells. This recognition allows the modified T cells to identify and attack the cancer.
The modified T cells are multiplied by the hundreds of millions and then infused back into the patient to fight the disease.
Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and its rate of progression.
Chemotherapy can be used in combination with other treatments to either shrink tumors before surgery or radiation (neoadjuvant therapy), or to make sure all cancer cells have been eliminated after other treatments have been performed (adjuvant therapy).
Also known as “hot chemotherapy,” HIPEC is performed after the surgeon removes tumors or lesions from the abdominal area.
After all visible tumors are removed, cisplatin, a chemotherapy drug, is heated to 103 degrees Fahrenheit (42 degrees Celsius) and pumped through the abdominal cavity. The patient lies on a special cooling blanket to keep their body temperature at safe levels. Surgeons physically rock the patient back and forth on the operating table for about 2 hours to ensure that the drug reaches all areas of the abdomen, killing any cancer cells that remain after surgery and reducing the risk for cancer recurrence.
Heated chemotherapy is used on both adult and pediatric patients to treat soft tissue sarcomas, appendix cancer, Wilms' tumor, desmoplastic small round cell tumors(DSRCT) and other cancers in the abdominal cavity.
Cancer is a complex disease that can evade and outsmart the immune system. It’s often not recognized until it has already become too difficult to handle.
Cancer immunotherapy improves the immune system’s ability to eliminate cancer. There are several types of immunotherapies, and each helps the immune system in a different way.
Immune checkpoint therapy helps cancer-fighting immune cells, called T cells, mount a longer-lasting response against the cancer.
Adoptive cellular therapy increases the number and/or effectiveness of immune cells, usually T cells, which improves the power of the immune response against the cancer. There are three main types of adoptive cellular therapy:
Cancer vaccines help the body recognize cancer cells and stimulate the immune system to destroy them. Cancer vaccines usually contain one of the following:
Monoclonal antibodies attach to specific proteins on the surface of cancer cells or immune cells. They either:
Cytokine therapy relies on proteins called interferons and interleukins to trigger an immune response. Interleukin-2 (IL-2) is used to treat kidney cancers and melanomas that have spread to other regions of the body. Interferon alpha (IFN-alpha) is currently being used to treat melanoma, kidney cancer and certain leukemias and lymphomas. These cytokine treatments are also being combined with other types of immunotherapies to increase their effectiveness.
Moreover, certain immunotherapies are more effective for some types of cancer than others. A patient’s overall health and type of cancer determines which immunotherapies are available to them.
Sometimes two different types of immunotherapies are combined during treatment. Other times, a single immunotherapy is used with another type of therapy, such as chemotherapy. These combination approaches are used to improve treatment.
The immune system relies on T cells to fight cancer. These specialized cells are extremely powerful and have the potential to damage healthy cells. T cell activity is controlled through “immune checkpoints,” which can be positive or negative. Positive immune checkpoints help T cells to continue their work, while negative immune checkpoints shut T cells off.
Immune checkpoints were discovered in 1995 by Jim Allison, Ph.D. Allison found that T cells are controlled by a safety mechanism or “brake” – a negative immune checkpoint protein called CTLA-4. This checkpoint protein shuts a T cell off to prevent it from accidentally damaging healthy cells. By blocking CTLA-4, Allison allowed T cells to continue working and eliminate cancer in a laboratory setting.
Allison’s work led to the development and approval of the first immune checkpoint inhibitor, ipilimumab, which blocks the immune checkpoint protein CTLA-4. Blocking CTLA-4 allows T cells to continue to do their work. Ipilimumab has extended the survival of patients with advanced melanoma.
A second negative immune checkpoint protein, PD-1, was identified in 2000. Pembrolizumab and nivolumab are immune checkpoint inhibitors that block PD-1. These drugs are used to treat several cancer types, including:
A third type of immune checkpoint inhibitor blocks PD-L1, which is a molecule that triggers the negative immune checkpoint PD-1. Atezolizumab, avelumab and durvalumab are immune checkpoint inhibitors that block PD-L1 and are used to treat several cancer types, including:
Each immune checkpoint inhibitor has distinct side effects. Moreover, not all types of cancer are currently treatable by this type of immunotherapy. A patient’s overall health and type of cancer determine which immune checkpoint inhibitors can be considered as treatment options.
LITT is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.
The catheter is implanted using advanced computer imaging techniques. The laser is guided through the catheter with real-time MRI, allowing neurosurgeons to limit thermal energy delivery only to the tumor. Most patients can go home the day after treatment and can quickly return to normal activities.
Laser interstitial thermal therapy is minimally invasive. It typically requires only a 2-millimeter incision in the scalp and takes only a few minutes to perform.
LITT can also help patients who do not respond to stereotactic radiosurgery or have radiation necrosis (tissue death caused by radiation treatment).
Minimally invasive surgery, also known as keyhole surgery or laparoscopic surgery, uses tiny surgical tools that can access tumors through incisions less than an inch in length.
A laparoscope is a long, thin tube with a microscopic lens that allows the surgeon to view the entire abdominal cavity on a large computer screen. The laparoscope is inserted through a tiny incision near the navel. Other incisions are made for specialized surgical instruments to perform the operation without having to make a large external incision.
Minimally invasive surgery has several advantages over conventional “open” surgery:
Robotic surgery systems consist of one or more robotic arms remotely controlled by surgeons. One robot arm has a laparoscope. Other arms hold tiny surgical instruments that can fit into an incision less than an inch long. The surgeon sits at a console with 3-dimensional views of the tumor. A joystick similar to that for a video game precisely controls each robotic arm.
Although the robot arms are doing the actual surgery, they still require direct input from the surgeon and cannot be operated without human intervention. Robotic surgery has the benefit of reducing surgeon fatigue and eliminating hand tremor during long, complicated procedures.
Robotic surgery can be used for removing the prostate or kidneys. It can also be used for removing tumors in the uterus, lung and colon.
Transoral laser microsurgery (TLM) is used to treat small tumors in the throat and larynx. A carbon dioxide (CO2) laser beam is used to cut through tissue with more precision than a scalpel.
For the transoral laser microsurgery procedure, an endoscope is inserted through the mouth to view the surgery site. A specially designed microscope is aligned with the endoscope, which helps surgeons guide the laser beam. The beam may be continuous or fired in short bursts, or pulses.
The CO2 laser beam generates minimal heat, limiting damage to structures that are crucial for speech and swallowing functions. It also seals off blood vessels and cauterizes the edges of the wound, resulting in much faster healing.
Despite popular belief, palliative care is not just for patients with untreatable or terminal cancer. The goal is to provide the best possible quality of life at every stage of treatment, starting at diagnosis. Palliative care is also known as supportive care or symptom control.
Palliative care can include:
If the cancer can no longer be treated, the focus shifts to providing end-of-life care. Palliative care specialists can help determine your needs and create a plan to address them.
End-of-life planning should include:
Patient comfort: Treat symptoms such as pain, fatigue, breathing difficulties and other problems.
Advance care planning: Decisions about wills, funeral arrangements and other details should be discussed with family members. Your palliative care team can help with advance care planning, including living wills and medical power of attorney.
Deciding where and how care will be provided. The palliative care team can help you decide whether to begin hospice care. Hospice care can be provided at home, in the hospital, in assisted-care communities or nursing homes. Some hospice organizations have facilities where patients can stay for a short time for treatment of uncontrolled symptoms.
Eligibility for hospice services requires a doctor’s certification that the patient’s life expectancy is six months or less.
Standard radiation therapy uses X-ray beams made up of photons, which are tiny particles that transmit light. Photons deposit energy as they travel to the tumor, into the tumor itself and beyond the tumor. This results in side effects from damage to nearby healthy tissues or organs. The dose delivered to the tumor must be limited to minimize these side effects.
Proton therapy uses protons, which are positively charged particles found in the nucleus of an atom. Proton beams enter the body with a low dose of radiation (“entrance dose”). The dose increases as it approaches the target area and deposits its maximum radiation directly to the tumor before stopping. There is no “exit dose” beyond the tumor. This means the tumor can be targeted more precisely, usually within one millimeter, and allows for the delivery of a more powerful dose of radiation.
Pencil beam scanning, also known as spot scanning, is a proton therapy technique used to treat complex tumors. Powerful magnets direct thousands of ultra-fine proton beams from multiple directions toward the tumor, creating a protective “U” shape around healthy tissue and avoiding sensitive areas. Proton Therapy typically uses pencil beam scanning to treat cancers of the prostate, brain, base of the skull and eye.
Intensity Modulated Proton Therapy is a treatment best used to deliver a potent and precise dose of protons to complex or concave-shaped tumors that may be next to the spinal cord or embedded in the head and neck or skull base, including nasal and sinus cavities; the oral cavity; salivary gland; tongue; tonsils; and larynx.
Radiation therapy can be used as a standalone treatment or in combination with other therapies, shrinking tumors before surgery or chemotherapy or destroying any cancer cells that might remain after other treatments.
Radiation is produced by a linear accelerator, or LINAC. It employs microwave energy to accelerate electrons to nearly the speed of light within a contained area. The electrons collide with a metal barrier, creating powerful X-rays called photons. The photons are shaped into beams and delivered to the patient through a gantry that moves 360 degrees around the treatment table.
A single dose of radiation is called a fraction. Most radiation treatments require several fractions. A typical radiation treatment plan has five fractions a week for four to six weeks.
Radiation therapy requires careful planning to ensure the tumor is targeted with the least amount of impact on surrounding tissues. CT scanners simulate treatments by testing various beam fields and immobilization devices used to keep the patient from moving during treatment. Data from the simulators help calculate the appropriate dose before treatment begins.
In addition, these stem cell transplants are used to treat hereditary blood disorders, such as sickle cell anemia, and autoimmune diseases, such as multiple sclerosis.
Stem cell transplants use hematopoietic stem cells. These immature cells begin life in the bone marrow and eventually develop into the various types of mature blood cells, including:
Autologous stem cell transplant
Cells are harvested from the patient's own bone marrow before chemotherapy and are replaced after cancer treatment. These are used most often to treat diseases like lymphoma and myeloma. They have little to no risk of rejection or graft versus host disease (GVHD) and are therefore safer than allogeneic transplants.
Allogeneic stem cell transplant
Stem cells come from a donor whose tissue most closely matches the patient. These cells can also come from umbilical cord blood extracted from the placenta after birth and saved in special cord blood banks for future use.
Allogeneic transplants are often used to treat diseases that involve bone marrow, such as leukemia. Unlike autologous transplants, they generate a new immune system response to fight cancer. Their downside is an increased risk of rejection or GVHD.
Stem cell transplant patients are matched with eligible donors by human leukocyte antigen (HLA) typing. HLA are proteins that exist on the surface of most cells in the body. HLA markers help the body distinguish normal cells from foreign cells, such as cancer cells.
HLA typing is done with a patient blood sample, which is then compared with samples from a family member or a donor registry. It can sometimes take several weeks or longer to find a suitable donor.
The closest possible match between the HLA markers of the donor and the patient reduces the risk of the body rejecting the new stem cells (graft versus host disease).
The best match is usually a first degree relative (children, siblings or parents). These can be full matches or half-match related transplants, also known as haploidentical transplants. However, about 75% of patients do not have a suitable donor in their family and require cells from matched unrelated donors (MUD), who are located through registries such as the National Marrow Donor Program.
Because the patient’s immune system is wiped out before a stem cell transplant, it takes about six months to a year for the immune system to recover and start producing healthy new blood cells. Transplant patients are at increased risk for infections during this time and must take precautions. Other side effects include:
SBRT begins with one or more sessions of treatment planning with CT, MRI or other advanced imaging techniques to precisely map the position of the tumor. The images are used to design a four-dimensional, customized treatment plan that determines beam intensity and positioning. The goal is to deliver the highest possible dose to kill the cancer while minimizing exposure to healthy organs.
Stereotactic body radiation treatments are usually given as a single dose or up to five doses once a day, although this can vary depending on the type and location of the tumor and the patient’s physical condition. The best candidates for this procedure are patients with small, well-defined tumors who cannot tolerate surgery. For some patients, SBRT may be able to replace surgery as a primary cancer treatment.
SBRT is typically used to treat small, early-stage non-small cell lung tumors.
Despite its name, SRS is not a surgical procedure and does not require an incision or anesthesia. However, the radiation beams are as small and precise as a scalpel.
A computer uses three-dimensional images from MRI and CT scans to determine the exact dimensions of the tumor. It then calculates the radiation dose to be administered by nearly 200 radiation beams. This allows radiosurgeons target the tumor without affecting delicate structures nearby. SRS can treat multiple lesions in a single procedure.
Because stereotactic radiosurgery is typically done in just one outpatient session, patients are spared from multiple radiation treatments and can return to a normal routine within a few days.
In some cases, additional SRS treatments may be ordered by your oncologist. The single dose of radiation is split into smaller doses, or fractions. This procedure is known as fractionated stereotactic radiosurgery.
Stereotactic radiosurgery is effective for treating tumors in small areas in the head and neck that cannot be reached by surgery. It also can be used on patients who cannot tolerate surgery or have had previous radiation therapy to the brain.
There are several types of SRS systems. Gamma Knife®, a photon-based radiosurgery system is used to treat:
Curative surgery simply involves removal of a cancerous tumor. It works best on localized cancers that haven't yet spread to other parts of the body and is often followed by radiation therapy or chemotherapy to make sure all cancerous cells have been removed.
Preventive surgery is used to keep cancer from occurring. Many colon cancers can be prevented by removing precancerous polyps before they become malignant. Women at high risk for breast cancer due to family history or genetic mutations may decide to have their breasts removed to prevent cancer from occurring. Preventive surgery is also known as prophylactic surgery.
Reconstructive surgery returns the body to normal or near-normal appearance or function following cancer treatment. The most common is breast reconstruction surgery after a mastectomy (breast removal). Facial reconstruction and testicular implants are other examples of reconstructive surgery.
Staging surgery determines the extent of cancer. Staging surgery can sometimes be done without an incision by using an endoscope to view the suspicious area and take a tissue sample. For abdominal tumors, a laparoscope is used to view the area, a procedure that involves a small incision in the abdominal cavity done under general anesthesia.Staging surgery determines the extent of cancer.
Staging surgery can sometimes be done without an incision by using an endoscope to view the suspicious area and take a tissue sample. For abdominal tumors, a laparoscope is used to view the area, a procedure that involves a small incision in the abdominal cavity done under general anesthesia.
Supportive surgery is used to help with other cancer treatments. For example, some chemotherapy devices require a port (connecting device) to be inserted under the skin.Supportive surgery is used to help with other cancer treatments. For example, some chemotherapy devices require a port (connecting device) to be inserted under the skin.
Palliative surgery is used to improve a patient’s quality of life by easing pain or other symptoms caused by advanced or untreatable cancer. Palliative surgery is not a cure or anti-cancer treatment.Palliative surgery is used to improve a patient’s quality of life by easing pain or other symptoms caused by advanced or untreatable cancer. Palliative surgery is not a cure or anti-cancer treatment.
Minimally invasive surgery employs advanced techniques to remove tumors through tiny incisions. Minimally invasive procedures can also be performed by robotic arms controlled by surgeons. Minimally invasive surgery employs advanced techniques to remove tumors through tiny incisions. Minimally invasive procedures can also be performed by robotic arms controlled by surgeons.
This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves.
Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. In some cases, the drug will attach to the molecule it targets, stopping it from doing its job. Other times, the drug will physically block the molecule from the place it normally goes. By stopping the normal work of these molecules, cancer’s growth can be slowed or even stopped.
Because targeted therapies are made to work on specific molecules, doctors usually perform blood or DNA tests to see if and how many of these molecules are present in the patient’s body. If there are not enough, the drug will not be given. Even if a patient has enough of the targeted molecule, in some cases the drug stops working after a period of time. This usually occurs when the cancer finds some other way to finish the job the targeted therapy is made to stop.
Targeted therapies can be given in pill form or through an infusion and are often given along with another treatment like chemotherapy or radiation. There are two main types of targeted therapies drugs:
While targeted therapies generally have fewer side effects than chemotherapy, they can still be serious. Side effects depend on the targeted therapy drug a patient is taking. Common side effects include: