This blog is the 5th in a series of 5 on the topic of cancer written by Dr Philip Borg MD FRCR FAAMFM.
Dr Borg is a Consultant Cancer Interventional Radiologist and a Longevity Medicine Specialist.
Cancer is the second leading cause of death globally, and the focus of researchers and medics around the world. By expanding our understanding on the origin and mechanisms by which cancers form and spread, so have the various treatment approaches. There are many types of cancer treatments depending on the type of cancer, its location, how advanced it is (stage), whether the cancer has spread (metastasised), as well as your general health. Some cancer patients will have one type of treatment but most have a combination of treatments.
Modern cancer care consists of 4 pillars of treatment:
1. Surgery
2. Chemotherapy
3. Radiation
4. Interventional Oncology (IO)
Surgical oncology, or surgery for cancer treatment, is the most invasive treatment option that can be used as a first line treatment option for primary tumour masses that have not spread. Surgery offers the best chance of cure in early stage cancer. Prior to this cancer specialists use specialised radiology investigations like MRI and PET-CT to quantify the degree of spread of the cancer. Sometimes surgery can be used as a treatment option to remove tumours that have spread to organs like the liver and lung.
Chemotherapy is a type of medical treatment and refers to a broad range of drugs which are used to kill cancer cells. This sort of treatment is typically used in combination with other treatments. For example, it may be used to reduce the size of tumours prior to removal by surgery. As chemotherapy targets fast growing cells it has the side effect of also killing or slowing down the growth of healthy cells which normally grow fast, e.g. hair follicles and skin cells.
Radiotherapy, or radiation oncology, is a range of therapies which employ the use of high doses of radiation to kill cancerous cells and shrink tumours. The type of radiation therapy used will depend on many factors including the cancer type, size, location, proximity to healthy tissue. It is also typically administered alongside other treatments. This type of treatment also affects surrounding healthy tissue.
Sometimes radiotherapy can be delivered internally through brachytherapy (implantation of beads for example prostate and cervical cancers), directly into liver tumours through catheters in the blood vessels (SIRT) or through injection of radioactive iodine for thyroid cancers.
Interventional Oncology (IO) uses imaging methods such as fluoroscopy (X-rays), ultrasound, CT for cancer diagnosis and treatment.
IO comprises three interventional areas:
Diagnosis (image-guided biopsies to sample tissue). Biopsies (taking a sample of the cancer) are an important first step in diagnosis and obtaining tissue for analysis of the tumour to determine what treatments are likely to be most effective.
Cancer therapy
Ablation - treating solid cancers with special probes which burn or freeze the cancer. These probes are inserted using CT or ultrasound as image guidance.
Embolisation - killing tumours by cutting off blood supply or and delivery of chemotherapy using catheters in blood vessels.
Cancer symptom palliation - for example nephrostomy, biliary drainage and oesophageal stent insertion for blockages caused by cancers.
Immunotherapy is a more recent development in medical oncology which has proved effective against certain cancers. Our immune system (white blood cells, lymph glands and spleen) work to protect the body against infection, illness and cancer detection. Normally our immune system destroys faulty cells in the body, stopping cancer from developing and spreading. Cancer cells can sometimes stop the immune cells from functioning against them by hiding. Immunotherapy are specialised medicines that help our immune system to fight cancer. There are different types of immunotherapy treatments and results using immunotherapy vary widely from patient to patient and between different cancer types. These work in different ways to help our immune system recognise and attack cancer cells.
Different types of immunotherapy include: monoclonal antibodies, checkpoint inhibitors, vaccines, cytokines and CAR-T cell therapy. CAR-T cell therapy is a very complex and specialist treatment. First the patient’s blood is collected and blood cells called T-cells (white blood cells) are separated and a small change is made to them. Before the change the cancer cells were able to ‘hide’ from the T-cells. The modified T-cells are then reintroduced into the patient’s body via a drip and are able to recognise and attack the cancer cells. There have been good results in CAR-T therapy in some childhood leukemias and some adult lymphomas. Clinical trials for other types of cancer are ongoing.
All cancers are different. In the past all patients with the same cancer received the same kind of treatment, however we know that a one size fits all approach doesn’t work for all patients. The future of cancer treatment is personalised medicine.
Personalised medicine - The future of cancer treatment
Cancers originating from the same organ have different genetic changes that mean they behave differently to each other and therefore respond differently to treatment like chemotherapy.
For example there are many different types of breast cancer depending on subtype and receptor status and genetic changes. A biopsy from the tumour will be able to determine which different drugs and treatments are most likely to work to control the cancer and minimise side effects from damage to normal tissue.
Cancer will soon become the leading cause of death in the western world. This is partly due to increasing life expectancy so we are living long enough to develop cancer, but also because of the incredible advances in reducing other causes of death like infectious diseases. Although we continue to develop amazing new cancer treatments, this will never be enough to beat cancer.
Prevention is better than cure. In the previous blogs we learnt about what you can do to reduce your risk of developing cancer through various cancer prevention strategies. We also learnt about the huge differences in chances of cure and survival of cancer depending on the stage at which the tumour is first detected. The only way to reduce the burden of cancer is through prevention and screening to catch cancers at an early stage when there is a better chance of cure.
If you are interested in a private cancer screening programme including access to a multi cancer screening blood test, please visit the Longevitydoctor cancer screening section.