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About Cancer

Treatments of Cancer

1. Surgery
Surgery was the earliest-applied therapy in cancer treatment. It remains the most effective means against early-stage cancer. Great changes have taken place in the field of surgical treatment, from small-area tissue excision to large-area radical surgery. In recent years, small-area excision comes back to popularity. The trace of development in tumor surgery underlines the advancement in the understanding about the disease. Nonetheless, surgical treatment has not yet become an effective measure against cancer spread and expansion, despite advancement in operation techniques and enlarging surgical areas.

Surgical methods are categorized as radical surgery, palliative surgery and diagnostic surgery. Radical surgeries aim to eradicate primary focus as well as the neighboring areas where lymph may reach. Determination on the area depends on the nature of the tumor and the tissue in the area. For example, in the case of basal cell carcinoma, normally the tumor and the 2 cm adjacent area are removed. In the case of stomach however, much larger area needs to be excised, as the tumor is close to other organs.

The goal of palliative surgery is to ease the symptom and to improve patients' quality of life. Excising limbs that cause bleeding and pain, decompression in tumor-inflicted spine, are both typical palliative surgeries. Even though the purpose of palliative surgeries is nothing more than to relieve the symptoms, coupling chemotherapy with palliative surgeries generates satisfactory result in many cases.

Diagnostic surgery is an operation to collect tissue samples for biopsy. Probing through laparotomy is a typical diagnositic surgery to detect cancer spreading. Findings of diagnostic surgeries provide with evidence for decisions on further surgeries.

2. Radiotherapy
In contrast to surgery, radiotherapy has only a history of 80 years. Today, radiaotherapy has become an indispensable part of cancer treatment. Often used high-energy radiation sources in radiotherapy are x-ray, neutron negative meson and proton. In recent years, the advancement in combining radiation technology and computer brings forth x-ray or gamma ray devices, which focus precise amount of radiation accurately upon tumor locations in a three-dimensional perspective.

Approximately 60~70% of cancer patients receive radiotherapy. 37% to 53% of the cancer cases in areas such as oral cavity, pharynx, nasopharynx, radix linguae, cervix and tonsil are cured through radiotherapy. The cure rate for cancers in maxillary antrum and sinus is 38~40%. Through radiotherapy, early-stage tongue cancer, nasopharyngeal cancer and cervical cancer have a cure rate as high as 86%~94%. Early-stage esophageal cancer has a cure rate of 80% while late-stage has a cure rate of 8%~16%. Early-stage rectal and laryngeal cancers have a cure rate of 80~97%. Effects of radiotherapy have long been proven and highly recognized.

Yet the side effects from radiotherapy cannot be ignored. Cancer patients receiving radiotherapy demand special care and periodic recess from the therapy for recovery. Some side effects vanish after certain period of recess. For example, hair growth regained 3 to 5 months after radiotherapy ends. However, some other effects, such as necrosis of brain tissue, myelitis and paralysis of cerebral nerves, are mostly irretrievable.

3. Chemotherapy
Unlike radiotherapy, chemotherapy is more of a systemic treatment than local. The most commonly used chemotherapy drugs are antimetabolites, alkylating agents, antitumor antibiotics, phytopharmaceuticals, hormones and enzymes. Their anticancer effects are based on different mechanisms. The primary concerns in chemotherapy is the side effects and the generation of multi-drug resistance. A carefully designed treatment regime with multiple drugs needs to be developed for best result.

The widely adopted scale for rating symptoms after treatment on solid tumors is as follows:
CR (complete remission): the complete disappearance of tumor for over a month.
PR (partial remission): a reduction over 50% of the maximum diameter of the tumor, for over four weeks.
MR (moderate remission): a reduction over 25% of the product of both diameters of the tumor
SD (stabilized): the product of both diameters of the tumor grows or shrinks less than 25%, no other cancerous spot detected
PC (progressed condition): the product of both diameters of the tumor grows more than 25%, or new cancerous spot emerge

4. Immunotherapy
Immunotherapy has emerged as a more important treatment for cancer. The development of cell biology and molecular biology has brought about many breakthroughs in immunological treatments. There are three major groups of immunotherapies: non-specific immunotherapy and accessory treatments; active specific immunotherapy (cancer vaccine); and passive immunotherapy (monoclonal antibody). FDA has approved BCG, Interferon a, IL2, monoclonal antibody for lymphoma, and monoclonal antibody for late-stage and metastatic breast cancer.

Some other treatments are in clinical trials. A novel approach to enhancing specific immune functions is through cellular multiplication. For example, scientists are now using cell multiplication factors such as IL2 to cultivate and multiple in vitro T cells, which are a type of immune lymphocyte having limited sensitivity against cancer cells. The in vitro cultivated T cells are then injected back into the body. Results from preliminary experiments were satisfactory. Another approach is using monoclonal antibody, combined with anticancer drugs, toxins or isotopes, as a vehicle to attack cancer cells. This method has the unique advantage of coupling selectivity of antibodies with high toxicity of anticancer agents. Results show that treatment of liver cancer with this method is effective.

5. Integrated therapy
Integrated therapy refers to a therapeutic plan, which combines multiple therapeutic approaches according to patients' individual conditions. All the above-mentioned therapies are effective to the degree that they work better in some types of cancer than others. And the value of each therapy has to be counterbalanced with its side effects. A compounded therapeutic plan may generate better clinical effects by optimizing each method's strength. For instance, surgery is effective in excising visible tumors, yet totally unreliable when treating invisible tumors or infeasible when treating tumors within vital organs. Complemented with radiotherapy and chemotherapy against the metastasis or spread of cancer, surgery has more immediate and thorough results than using any therapy alone.

6. Psychological therapy and metal rehabilitation
The mental state of the patients greatly affects the occurrence, development and therapeutic result. Worries and fears are the common psychological states. Unbalanced mental state disturbs the immune system, lowers body's ability to defend against diseases and to recover. Medical professionals should pay much attention to patients' psychology and provide adequate care and treatment.

7. Alternative therapies
Conventional therapies all have limited effects for late-stage and metastatic cancers. Patients under these conditions start to seek help from alternative therapies. In fact, over 80% of cancer patients are receiving certain kind of alternative therapy simultaneous as they use conventional method.

Statistics confirms the fact that alternative medicine has become a trend. A survey in 1990 showed that visits to naturopathic doctors in the United States were numbered at 425,000,000, as opposed to 388,000,000 to medical doctors. In 1996, spending on alternative medicines was US$2 billion in the U.S. A 2001 statistics shows that 63% people take herbal medicines daily.

Chinese traditional medicine, oxygen therapy, heat therapy, among many others, have become integral parts of alternative medicine against cancer. Alternative therapy is oftentimes mistaken as a treatment to relief the symptoms while in reality many alternative therapies have effects in attacking the source of the disease. In addition, usually alternative therapy has less severe side effects.