Basic cancer treatments: Surgery, Chemotherapy, Radiotherapy and Bone marrow transplants

Being diagnosed with the dreaded disease - cancer - can flood you with emotions that can be hard to deal with. Many questions run through your mind. What next? Am I going to die? Is there any treatmen

By: Dr Anitha Anchan | | Updated: June 10, 2014 6:26 pm

Being diagnosed with the dreaded disease – cancer – can flood you with emotions that can be hard to deal with. Many questions run through your mind. What next? Am I going to die? Is there any treatment? Can it be cured? Your doctor will talk you through a number of treatment options. You may hear words like surgery, chemotherapy, radiotherapy, hormone therapy, etc. So, what are these treatments? Which treatment would be best for you? Are there going to be side effects? Are you going to lose your hair? Will you ever be able to have children? This article tries to answer these questions and demystify the various treatment options, their uses, adverse effects, etc. Also Read - 33-year-old man with a rare cancer of the appendix and small intestine, gets second lease of life

SURGERY Also Read - Pancreatic cancer: Combination therapy may be able to suppress tumour growth significantly

Surgery remains the foundation of cancer treatment. For most of the cancers that are localised and not spread to other parts of the body, surgery is the best chance for a remission. It is also used for cancer diagnosis and staging (tells how far cancer has spread). Sometimes your doctor may advise you to undergo a surgery to remove a body tissue that is likely to become cancer even though there are no signs of cancer. This is called preventive surgery. Surgery may also be used to relieve some of the pain or disability (bowel obstruction, etc.) that your cancer causes. This is known as palliative surgery. Also Read - Bladder cancer: This drug can reduce death risk in patients with this condition

During the surgery for cancer treatment, your surgeon may either remove only the tumour with a clear margin (some normal tissue around the cancer) or the whole organ. Even a single cancer cell left behind can regrow into a new tumour and cause cancer recurrence. The lymph nodes nearest to the cancer may also be removed. Breast cancer (lumpectomy, mastectomy), prostate cancer (prostatectomy) and lung cancer (lobectomy, pneumonectomy) are some of the cancers where surgery may be advised.

CHEMOTHERAPY

Cancer treatment that uses drugs (anticancer drugs) to destroy cancer cells, stops them from spreading and slows their growth is called chemotherapy. Most of them are not specific to cancer cells and target all rapidly dividing cells like bone marrow cells, hair follicles, etc. Generally, normal cells can repair themselves. But many cancer cells are unable to do so and hence they die out. In combination chemotherapy two or more drugs are often given together because they work better together than alone. Sometimes chemotherapy is designed to shrink your tumour to minimise the destruction and increase effectiveness of surgery or radiotherapy. This is called preoperative or neoadjuvant chemotherapy. Whatever line of treatment is finally decided, it is very important that you are assessed to determine whether you are capable of undergoing the treatment. Your doctor may also adjust the dose of drugs accordingly.

One of the major side effects of chemotherapy is its effect on bone marrow. It may reduce the number of red cells and platelets in your body leading to anaemia and increased tendency to bleed. It also depresses your immune system making you susceptible to infections. Chemotherapy may also be physically exhausting to you and cause fatigue. You may also experience nausea, vomiting, diarrhoea or constipation. Chemotherapy may cause low sex drive and infertility. But these side effects are usually temporary.

Hair loss is the first thing that comes to mind when you hear chemotherapy. Chemotherapy can cause dramatic hair loss or may cause hair thinning. But this is often a temporary effect. Your hair will usually regrow a few weeks after the treatment. There is one technique, called scalp hypothermia, which may help prevent hair loss during chemotherapy. Ice packs are placed on the scalp a few minutes before and for about a half-hour after the treatment. This reduces blood flow to the hair follicles, making it harder for the chemotherapy drugs to get into the follicular cells. Cooling also makes the hair follicles less susceptible to damage from chemotherapy drugs. Though, there is a concern of cancer recurrence with this technique.

RADIOTHERAPY

Have you been suggested radiotherapy and wondering what to expect? Radiotherapy uses ionizing radiation to kill cancer cells and shrink tumours. Radiotherapy is administered either externally through a machine (external beam radiotherapy) or internally by placing radioactive material in the body near tumour cells (brachytherapy). Radioactive substances may also be injected into the blood in systemic radiotherapy. Radiotherapy targets specific areas and damages the genetic material of the cells. The cancer cells are damaged and die whereas the normal cells recover. Radiotherapy is given in fractions in order to help the normal cells recover between two courses.

In leukaemia, lymphoma, cancers of the brain, lung, skin, breast, cervix, prostate, pancreas, stomach, etc. radiotherapy may be used. Depending on the type and site of your cancer, radiation dose is adjusted. Radiotherapy may be used alone or along with surgery, chemotherapy, or both. You may experience various side effects depending on the area being irradiated. Some of the common side effects of radiotherapy are red and sore skin, fatigue, dry mouth, loss of appetite, etc. Radiotherapy to the abdomen area may cause diarrhoea. Similarly, radiotherapy of the head and neck may cause hair loss. Radiotherapy to pelvic area may cause low sex drive and infertility. However, these side effects are mostly temporary.

BONE MARROW TRANSPLANT

Immature stem cells in the bone marrow (soft, fatty tissue inside your bones) give rise to blood cells. These blood cells mature and enter the bloodstream. Bone marrow transplant is done to restore stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy. It is also used to treat certain cancers like multiple myeloma, leukaemia, lymphoma, neuroblastoma, etc. There are three different types of bone marrow transplants:

Autologous – your own bone marrow is used for transplant
Allogenic – bone marrow from a donor
Syngeneic – bone marrow from your identical twin sibling

The stem cells are harvested from a large bone of the donor usually under general anaesthesia. The pelvis bone is mostly entered with a large needle. The cells are then delivered into the recepient’s blood and reach the bone marrow.

An aggressive, high-dose chemotherapy and radiotherapy is given to destroy the cancerous cells in the body prior to the transplant. This can cause many side effects. You may lose your appetite just after your transplant due to sickness, diarrhoea and a sore mouth. There is a risk of graft versus host disease (GVHD), an immune reaction, if you have had a transplant from a donor. A low blood cell count can increase your risk of infection, anaemia and bleeding. Because of the high doses of chemotherapy involved, bone marrow transplants nearly always cause infertility. But you can opt for fertility preservation before starting your treatment, so that your chances of having a child do not end with cancer. In case of men, the procedure constitutes sperm cryopreservation – when the sperms are frozen for an indefinite period. In women, oocyte cryopreservation is done. Since the ovary has to be stimulated to produce eggs, the process can delay the treatment by four to six weeks.

Though cancer is a serious and life-threatening disease, don’t view it as an immediate death sentence. If treated early, the survivors can go on with life quite well. Acquire information about your cancer and the methods commonly used to treat it. Understanding the benefits and side effects of the treatment being offered can help you make the best possible decision.

Read more about causes, symptoms, diagnosis and treatment of cancer.