Contents
Many of us are afraid of such a diagnosis. Fortunately, cancer is no longer always a death sentence. Doctors and scientists are finding ways to treat and stop the development of cancer. Says the oncologist.
Cancer is one of the major medical problems of the XNUMXst century. This is due to two factors: significant exposure to various kinds of carcinogens (it’s not only about environmental degradation, but also about what we drink, eat and what we use at home every day) and improved diagnostics, which allows us to detect more different diseases than ever before. either, and often in the early stages.
At the same time, the possibilities of cancer treatment are becoming wider. If earlier it was possible to cope with tumors only with the help of aggressive chemotherapy, now this is done, on the one hand, more carefully for the patient’s body, on the other hand, more targeted. Alexander Pavlovich Seryakov, head of the SM-Clinic Cancer Center, oncologist, hematologist, radiation therapist of the highest category, Doctor of Medical Sciences, professor, excellent health worker of the Russian Federation, talks about four modern methods of oncology treatment.
1. Personalized medicine
Not so much a specific method of treatment, but a global trend that I want to talk about at the very beginning. All patients with diagnosed oncological diseases have their own cancer: different types, with or without metastases, at different stages. Previously, people, despite these unique characteristics of tumor processes, received plus or minus the same treatment. But in recent years the situation has changed.
Individual selection of therapy
Doctors now know well that what worked well in one case may work poorly or not work at all in another. Therefore, they carefully study the patient’s history, conduct as many studies as possible in order to «get acquainted» with cancer from all sides. And only then prescribe therapy, based on the available data and capabilities. This is the so-called selection according to the sample of tumor tissue of the individual sensitivity of the tumor to chemotherapy, targeted and immunotherapy.
A personalized approach allows you to tailor the treatment method to a particular patient and his state of health (for example, if he has some other chronic diseases) and act on the body as gently as possible so that the effectiveness is not affected.
Biomarker tests
This requires diagnostic tests for biomarkers, on the basis of which treatment is selected. Biomarker testing is a way to look for genes, proteins, and other substances that provide more information about cancer.
We have already said above that each person’s cancer is unique. Just biomarkers allow the doctor to see the full picture of this uniqueness and correctly prescribe therapy. For example, cancer patients who have driver (major) mutations in the EGFR gene (primarily non-small cell lung cancer) can receive EGFR inhibitor drugs that target these mutations.
Testing for biomarkers in cancer patients is important to distinguish from genetic testing for mutations in healthy carriers that may increase cancer risk, although these may be the same markers. These include, for example, testing for mutations in the BRCA1 or BRCA2 genes that place a person at risk for breast, ovarian, prostate, and pancreatic cancers. Of course, the presence of a mutation does not mean that cancer will definitely come. This is just an excuse to be a little more attentive to your health, not to forget about screenings and visiting a doctor.
2. Targeted therapy
At one time, targeted therapy became a real breakthrough in cancer treatment, and it remains one of the innovative methods to this day. Unlike classical chemotherapy, which acts not only on diseased cells, but also on healthy cells, thereby having a serious impact on the patient’s health, the method is targeted. That is, in fact, targeted.
This type of cancer treatment targets proteins that are responsible for the growth, division, and spread of cancer cells within the body. Most often, either low molecular weight drugs or monoclonal antibodies are used in therapy. The former are small in size, easily penetrate the cells and hit the target. The second are proteins that are synthesized in the laboratory in such a way as to be able to recognize the “target” on cancer cells and attach to them.
Different monoclonal antibodies act differently. Some, as it were, mark cancer cells so that the immune system pays close attention to them and destroys them as soon as possible. Others can stop the growth of cancer cells themselves, which eventually leads to their self-destruction. And still others deliver toxins to cancer cells that destroy them.
The only problem with targeted therapy is that eventually tumor cells can become resistant to its effects. Therefore, it is often combined with other cancer treatments (chemotherapy, radiation therapy). And also here you need to constantly monitor how the drug works, so that if something goes wrong, prescribe a new one.
Unfortunately, not all tumors are amenable to targeted action, as it is sometimes difficult to determine the «target» or understand its structure. But the more genetic research is done around the world and the better we understand how different types of cancer work from the inside, the more perfect this method becomes. Personalized medicine (oncology) is based on the individual selection of the most sensitive targeted drugs in a particular case.
3. Immune therapy
Normally, our immune system itself detects any abnormal cells, after which it either inhibits their growth or destroys them. Immune cells (specifically, tumor-infiltrating lymphocytes, TILs) are often found in tumors. This suggests that the immune system still began to fight. And people whose cancers have these cells often have a better prognosis than those whose cancers don’t.
But cancer cells can trick the immune system: change genetically and become invisible, have proteins on the surface that “turn off” the immune system, or change normal cells around the tumor in such a way that the immune system does not suspect anything unusual. This is where immune therapy comes in, which helps a person’s own immune system fight cancer.
There are different methods of immunotherapy as a subtype of targeted therapy: immune response checkpoint inhibitors (prevent the immune response from being too strong), adaptive T-cell transfer (increases the natural ability of the main immune cells to fight cancer), monoclonal antibodies (laboratory-created proteins of the immune systems that bind to specific «targets» on cancer cells and either cause their death or highlight cancer cells so that the immune system notices them), as well as vaccines and modulators that enhance the body’s immune response.
How well immune therapy will work and how often it needs to be applied to get the desired result depends on the specific type of cancer and on each individual patient. But it is important to note that it also has many times fewer side effects than chemotherapy.
4. HIPEC
One of the problems that modern oncologists face is that it is not enough to destroy the tumor — you also need to deal with metastases. Particularly insidious tumors can spread very quickly and far enough that even if the tumor itself is destroyed, the cancer can return very quickly and begin to infect the body with renewed vigor.
In this sense, the method of combating metastases called hyperthermic intraperitoneal chemotherapy (HIPEC) has become unique. Studies show that it can be ten times more effective in treating cancer than the traditional method of injecting the drug into the bloodstream.
HIPEC can destroy not only small tumor nodes, but even individual malignant cells on the peritoneum, acting on the principle of a laser pointer. At the same time, it is in the abdominal cavity that it «likes» to metastasize cancer of the stomach, intestines, appendix and ovaries. So today HIPEC is the most effective method of dealing with multiple tumor metastasis to the peritoneum (peritoneal carcinomatosis).
Hyperthermic intraperitoneal chemotherapy is always carried out together with the main operation to remove the tumor. A drug solution is introduced into the abdominal cavity, which is preheated to the optimal temperature for exposure to 43-45°C, at the exit 41-42°C, and in the abdominal cavity itself — at least 41°C. Heating speeds up the delivery of the drug to the tumor cells, and the fact that the drug does not enter the patient’s bloodstream significantly reduces the risk of side effects.
And even if in the end it is not possible to achieve a complete recovery, here we can talk about an increase in the patient’s life expectancy up to 5-8 years. And this is comparable to a complete remission.
5. Photodynamic therapy
A relatively new treatment method, but gaining popularity in its segment of cancer treatment. Photodynamic therapy uses a light-activated drug called a photosensitizer or photosensitizing agent to kill cancer cells. The light can come from a laser or LEDs. Most often, this method is used locally, that is, on a specific part of the body.
This therapy is approved for the treatment of basal cell skin cancer, squamous cell skin cancer, cutaneous T-cell lymphoma, actinic keratosis. And also to relieve symptoms in laryngeal cancer and non-small cell lung cancer, when it interferes with normal breathing.
Photodynamic therapy works in the following way.
Cells first absorb the photosensitizers—depending on the type of cancer, the photosensitizer can be taken by mouth, applied to the skin, or given through a drip.
After 24-72 hours, most of it leaves normal cells, but remains in cancer cells.
Then the light work begins. Under the influence of light of a certain wavelength, oxygen radical is produced in the cells — a certain form of oxygen, which kills them. Also, using this method, you can damage the blood vessels in the tumor and deprive it of food.
Photodynamic therapy is good in that it limits damage to healthy cells, since most of them leave the photosensitizer even «before the operation begins.» If we talk about skin cancer, then its absolute advantage is that it does not provoke scarring.
Although, of course, it is not without drawbacks. Among them is that it can only be used to treat tumors that are on the skin, under the skin or on the cavities of internal organs, since light simply cannot penetrate far. Also, some types of photodynamic therapy make the skin and eyes sensitive to light for several weeks, and after treatment it is important to avoid not only direct sunlight, but also bright artificial light too.
There are a number of other techniques that deserve special attention and are gradually being introduced into the clinical practice of anticancer treatment, which are undergoing a series of clinical trials. But we will talk about them a little later.