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Treatment Options

Advances in cancer treatment are happening every day. Learn more about the cancer treatment options available to you, including surgery, radiation therapy, chemotherapy, stem cell transplantation and other advanced therapies.


ABLATION THERAPY

Ablation therapy uses heat or cold to destroy, or ablate, cancer tumors without the need for more invasive surgery. Special probes are used to deliver ablative treatments directly to the tumor.

The surgeon relies on computer imaging to guide the probes to the correct position and monitor the progress of the treatment.

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Advantages of Ablative Therapy

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.

Types of Ablative Therapy

Cryoablation

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.

Radiofrequency Ablation (RFA)

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:

  • Bone cancer: RFA is mostly used to alleviate pain from cancer that has spread to the bone, usually from the colon.
  • Liver cancer: Radiofrequency ablation can be combined with local chemotherapy to treat liver cancers.
  • Lung cancer
  • Kidney cancer
  • High Intensity Focused Ultrasound for Prostate Cancer

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.


ANGIOGENESIS INHIBITORS

Angiogenesis is the process of creating new blood vessels.

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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.


BRACHYTHERAPY

Radiation therapy typically is delivered as high-energy beams that are aimed directly at a patient’s tumor.

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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.


BREAST RECONSTRUCTION

In breast reconstruction surgery, a plastic surgeon recreates all or part of a breast that has been surgically removed.

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.

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Candidates for breast reconstruction include women who have been:

  • Diagnosed with breast cancer and had or will have a mastectomy (surgical removal of a breast)
  • Diagnosed with breast cancer and had or will have breast conservation surgery, such as partial mastectomy or lumpectomy (surgical removal of the tumor and surrounding breast tissue)
  • Found to have a genetic mutation and will have prophylactic mastectomy (removal of non-cancerous breast to prevent cancer)

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


CAR T-CELL THERAPY

T cells are immune system cells that play several key roles in the body’s fight against disease.

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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.

How does CAR T-cell therapy work?

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

Chemotherapy uses powerful drugs to kill cancer cells, control their growth or relieve pain symptoms.

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.

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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).

Chemotherapy is administered in several ways:

  • Intravenous (IV) is the most common method. A needle is inserted into a vein and attached with tubing to a plastic bag holding the drug. For patients who undergo several chemotherapy sessions, a catheter is inserted into one of the large veins and left in place during the entire course of treatment. Some patients have a metal or plastic port implanted under the skin as an IV connection device.
  • Oral chemotherapy drugs are taken by mouth, either in pill or liquid form.
  • Injections are administered into the muscle, under the skin or directly into a cancer lesion, depending on the type or location of the cancer.
  • Isolated limb perfusion is a method of administering chemotherapy drugs directly to tumors in the arm or leg. The blood supply of the affected limb is isolated from the rest of the body. Then, heated chemotherapy drugs are pumped into the treatment area through tubes inserted into tiny incisions. Isolated limb perfusion is used to treat advanced or metastatic melanoma and some sarcomas.
  • Hepatic arterial infusion is used to treat liver cancer. A tiny pump is surgically inserted under the skin and connected to the hepatic artery, which supplies blood to the liver. Drugs are administered through the pump over a period of about two weeks.

HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a cancer treatment that involves filling the abdominal cavity with chemotherapy drugs that have been heated.

Also known as “hot chemotherapy,” HIPEC is performed after the surgeon removes tumors or lesions from the abdominal area.

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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.

HIPEC has several advantages over standard chemotherapy:

  • It is a single treatment done in the operating room, instead of multiple treatments over several weeks
  • 90% of the drug stays within the abdominal cavity, decreasing toxic effects on the rest of the body
  • It allows for a more intense dose of chemotherapy

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.


IMMUNOTHERAPY

The immune system finds and defends the body from infection and disease.

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.

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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.

Types of immunotherapies

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:

  • Chimeric Antigen Receptor (CAR) T-cell therapy gives patients large amounts of T cells that are all genetically engineered to find and fight the cancer.
  • Tumor infiltrating lymphocyte (TIL) therapy uses a patient’s T cells that are collected from a piece of surgically-removed tumor. While these cells may recognize the cancer, there are too few of them to succeed. The number of these cells is increased substantially in the lab and then given back to the patient.
  • Endogenous T-cell (ETC) therapy uses T cells from a patient’s blood. From this diverse pool of T cells, doctors select only those that may recognize signatures specific to the cancer. The number of these specific T cells is increased substantially and then given back to the patient.

Cancer vaccines help the body recognize cancer cells and stimulate the immune system to destroy them. Cancer vaccines usually contain one of the following:

  • cancer cells taken from the patient’s tumor
  • proteins designed to attach themselves to cancer cells
  • proteins specific to a patient’s tumor

Monoclonal antibodies attach to specific proteins on the surface of cancer cells or immune cells. They either:

  • mark the cancer as a target for the immune system, or
  • boost the ability of immune cells to fight the cancer

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.

Each type of immunotherapy has distinct side effects

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.


IMMUNE CHECKPOINT INHIBITORS

Immune checkpoint inhibitors stop the immune system from turning off before cancer is completely eliminated. They’re a type of immunotherapy.

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.

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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:

  • Melanoma
  • Non-small cell lung cancer
  • Kidney cancer
  • Bladder cancer
  • Head and neck cancers
  • Hodgkin’s lymphoma

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:

  • Bladder cancer
  • Non-small cell lung cancer
  • Merkel cell carcinoma

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.


LASER INTERSTITIAL THERMAL THERAPY (LITT)

Laser interstitial thermal therapy (LITT) is an emerging technique to treat primary and metastatic brain tumors that can be hard to reach with conventional surgery.

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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

An increasing number of cancer surgeries can now be performed with minimally invasive techniques that provide effective treatment with a much smaller impact on the patient.

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.

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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:

  • Less blood loss
  • Decreased need for blood transfusions
  • Shorter hospital stays
  • Decreased pain and need for pain medication
  • Quicker recovery and return to normal activities
  • Less scarring and improved cosmetic appearance

Robotic 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

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.


PALLIATIVE CARE

Palliative care is a holistic approach that helps ease the suffering of cancer patients and cancer survivors.

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.

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Palliative care can include:

  • Management of pain, fatigue, nausea, loss of appetite and other treatment-related symptoms
  • Treatment of depression and anxiety
  • End of life or hospice care

End of Life Care

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.


PROTON THERAPY

Proton therapy is similar to traditional radiation therapy, but it uses a different type of energy and is much more accurate at targeting tumors.

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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 and Intensity Modulated Proton Therapy

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

Radiation therapy uses focused, high-energy photon beams to destroy cancer cells. More than half of cancer patients will undergo some sort radiation therapy.

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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.


STEM CELL TRANSPLANTATION

A stem cell transplant is a procedure that replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer.

Stem cell transplants commonly are used to treat leukemia and lymphoma, cancers that affect the blood and lymphatic system. They also can help patients recover from or better tolerate cancer treatment.

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.

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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:

  • Red blood cells, which carry oxygen.
  • Platelets, which help the blood clot.
  • White blood cells, which help fight infection.

There are two types of stem cell transplantation:

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.

Finding stem cell donors

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.

Stem cell transplant side effects

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:

  • Graft versus host disease (GVHD): This condition occurs when the body’s immune cells attack cells from the donor, or when the donor cells attack your cells. GVHD can occur right after the transplant or more than a year later.
  • Increased risk of bleeding
  • Anemia: Some patients may require a blood transfusion to treat persistent low red blood cell counts.
  • Fatigue
  • Mouth sores

STEREOTACTIC BODY RADIATION THERAPY

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, administers very high doses of radiation, using several beams of various intensities aimed at different angles to precisely target the tumor.

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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.


STEREOTACTIC RADIOSURGERY

Stereotactic radiosurgery (SRS) is a non-invasive treatment that uses dozens of tiny radiation beams to accurately target brain tumors with a single high dose of radiation.

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.

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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:

  • Cancer that has metastasized (spread) to the brain, head or neck area
  • Tumors in the base of the skull
  • Malignant gliomas
  • Acoustic neuromas
  • Pituitary tumors
  • Meningiomas

SURGERY

About 60% of patients will undergo some type of surgery to treat their cancer. In some cases, surgery is the only treatment required. It may also be combined with chemotherapy or radiation as part of an overall treatment plan.

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There are several types of cancer surgery:

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.


TARGETED THERAPY

Traditional chemotherapy works by killing cells that multiply quickly, whether normal or cancerous. Targeted therapy, also called precision medicine, is different. It works by stopping or slowing the growth or spread of cancer.

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.

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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:

  • Small molecule drugs target molecules that are inside cancer cells themselves. Because of their small size, they can easily enter the cells and interfere with the molecules inside.
  • Monoclonal antibodies are larger and work outside of cancer cells. They target molecules on the surface of the cancer cells or nearby. These are made using cloned cells that produce antibodies that interfere with the targeted molecule. Monoclonal antibodies also can be used to deliver a toxic molecule directly into a cancer cell.

Side Effects of Targeted Therapies

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:

  • Skin problems, including hives and intense itching
  • Allergic-like reactions, including trouble breathing, tightness in the chest or throat, dizziness and swelling in the lips or tongue
  • Elevated liver enzymes
  • Diarrhea or constipation
  • Nausea and vomiting
  • Fatigue
  • Low blood cell counts
  • Poor blood clotting and wound healing
  • High blood pressure

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