Cancer Treatment

Cancer is the uncontrolled growth and spread of cells. It can affect almost any part of the body. The growths often invade surrounding tissue and can metastasize to distant sites. Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke. In addition, a significant proportion of cancers can be cured, by surgery, radiotherapy or chemotherapy, especially if they are detected early.

Lung Cancer

What is the treatment for Lung Cancer?

Treatments for lung cancer may include surgery, external radiotherapy, chemotherapy and other supportive measures for palliation such as laser, internal radiation therapy, and medicines. These treatments may be used alone, or together, depending upon the patient’s general health status.

  • Surgery

This treatment method offers the best chance of cure for patients who have early-stage lung cancer that has not spread beyond the lung and the curative rate stands at more than 60% among patients in the earliest stage of disease. How much of the lung should be removed depends upon the status of the malignant tumour. The operation may involve the removal of a tumour together with some surrounding tissue, while some may involve removal of a whole lobe or even one whole lung.

  • External radiotherapy

This may be given as curative therapy of early-stage lung cancer for patients who are not suitable for surgery because of old age or other diseases. Where there is local spread of tumour, or there are surgically irremovable cancer cells left after operation, or there are symptoms of cancer spread (such as bone pain and brain metastases), radiotherapy will be useful for destroying cancer cells in patients.

  • Chemotherapy

For patients with metastatic lung cancer, chemotherapeutic drugs (anticancer drugs) will be used to help stop cancer cells from dividing and multiplying. A combination of 2 or 3 classes of anticancer drugs will be injected into the patient’s body by way of intravenous infusion. The patient will need to take 3-4 weeks for rest before receiving another infusion, while usually 4-6 infusions are given during the whole course.

  • Targeted therapy

This targets at specific molecules involved in tumour growth and progression. It causes fewer side effects than traditional chemotherapy with less impact on hematopoietic stem cells or the immune system. It is often applied to patients with metastatic lung cancer.

Bowel Cancer

What is the treatment for Bowel Cancer?

Once diagnosed, doctors generally recommend to patients the following treatment:

Surgery

Surgical removal of tumor is the primary treatment for bowel cancer. It is also used as symptom relief for advance-staged patients. The recent advent of minimally invasive surgery not only speeds up rehabilitation, but also greatly reduces risk of complications.

  • Rectal cancer: Total mesorectal surgery is a new surgical technique is recently advocated to improve treatment result in rectal cancer. Radiation therapy and chemotherapy may still be needed in selected cases after such surgery. Doctors may recommend stoma surgery in accordance with the physical conditions and psychological state of patients
  • Colon cancer: Surgical removal of tumor is the primary treatment for colon cancer
  • Metastatic bowel cancer: Patients with liver or lung metastases may be treated by surgical resection

Adjuvant Therapy

Adjuvant therapy assists rehabilitation of patients with colorectal cancer and is the key to reduce the relapse rate. Adjuvant treatment includes radiation therapy and chemotherapy. Radiation therapy is the use of high-energy radiation to destroy cancer cells, and chemotherapy is the use of anti-cancer drugs to kill cancer cells.

  • Stage II patients : Adjuvant therapy may be considered for Stage II colon cancer patients with high-risk features
  • Stage III patients : Doctors may recommend post-operative adjuvant therapy to stage III patients
  • Stage IV patients : This group consists of patients with metastasis to distant organs like the lungs and liver. Various treatment modalities are available, including radiotherapy, chemotherapy, surgical resection and radiofrequency ablation
  • Doctors may recommend palliative chemotherapy to patients with metastases involving various organs

Doctors may recommend post-operative adjuvant therapy for stage II and III patients to increase survival rate or improve local control.

Breast Cancer

What is the treatment for Breast Cancer?

Once the diagnosis has been confirmed, one or more of the following treatments will be recommended to patients:

  • Surgery

There are two main types of surgery:

1) Breast conservation therapy

The surgeon removes only the breast tumour and its surrounding tissues; patients should require radiotherapy afterwards to reduce the risk of recurrence. This approach is most suitable for smaller lumps located away from the nipple and there is less undesirable effect on the cosmesis.

2) Mastectomy (removal of whole breast)

When the breast tumours are too large or found in different parts of breasts, the whole breast has to be removed surgically.

In either procedures, the lymph nodes in the armpit of the affected side has to be sampled or removed for further microscopic examination.

For patients undergoing mastectomy, the patient may choose to have breast prosthesis or breast reconstructive surgery. The reconstructive surgery generally uses the fat from the belly or specially made saline implant to restore the contour and shape of breasts. It is recommended to seek further advice from experienced surgeons and nurse specialists before and after breast surgery.

  • Radiotherapy

For more aggressive tumours or potential residual tumour cells around the surgical wound (e.g. in breast conservation therapy), radiotherapy (treatment using high energy X-ray beams) may also be needed as an adjuvant treatment to reduce the risk of recurrence. A whole course of radiotherapy usually takes 5 to 6 weeks.

  • Chemotherapy

Adjuvant chemotherapy is often given after surgery for patients with intermediate to high risk of recurrence. Anti-cancer cytotoxic drugs will be used to kill the residual cancer cells, thus helping to reduce the risk of recurrence. A complete course of chemotherapy usually takes 4-6 months during which for patients with advanced breast cancer, chemotherapy can also be used in the palliative setting.

  • Hormonal treatment

Ostrogen will stimulate the growth of breast cancer cells. Therefore doctors may prescribe drugs to block the effect of female hormones to stop the growth of breast cancer cells. However, this approach can only be used in tumours with positive hormonal receptors. The treatment usually consists of oral tablets being taken for 5 years.

  • Targeted therapy

For HER2-positive breast cancers, targeted therapy drugs will further improve the effectiveness of adjuvant chemotherapy. The course will last for 1 year.

Liver Cancer

What are the treatments for Liver Cancer?

Upon diagnosis of liver cancer, the following treatments will generally be suggested:

  • Removal by surgery

How: This procedure removes the tumor and the surrounding affected tissues.

Who: Removal by radical surgery is suitable for 20% of liver cancer patients whose tumors affect only one of the liver lobes and their liver functions are normal. 62% of them can survive 3 years while 50% of them can survive 5 years.

  • Through transarterial chemoembolization

How: This is to block the blood vessels and stop them from providing the tumor with nutrition. This can stop the cancer tumor from growing, which can reduce its size. This can be achieved by injecting drugs into selected blood vessels to provide the tumor with nutrition through the aorta. By blocking the artery, which monitors the liver cancer, we can achieve treatment results that minimally affects normal liver tissues.

Who: This is suitable for a patient whose tumor has spread to both sides of the liver but has not yet metastasized to other organs, or a patient whose tumor is limited to one side of the liver, which causes poor liver functions rendering the patient to be unfit for surgery.

  • Injection of alcohol

How: With the help of ultrasound or computer scan, the location of the tumor is confirmed. Then alcohol with 95% concentration is injected directly into the tumor with a thin needle through the skin. The highly concentrated alcohol will dry up the cells and thus kill them.

Who: It is suitable for a patient whose tumor is smaller than 3cm or whose number of tumors is less than 3. As the injection can only make the central part of the tumor to wither, which means the neighboring tissues still survive and keep growing, the patient has to undergo numerous injections to ensure the liver cancer cells are killed.

  • Radiofrequency ablation

How: This uses a localised thermal treatment technique to destroy the tumor tissues with temperatures reaching 60∘C. Depending on the location and size of the tumor, the surgery can be performed through percutaneous or laparotomy. Simultaneously ultrasonography is used to guide the electrode and to monitor the ablation level of the tumor.

Who: This is for those who are infected with primary liver cancer and metastatic liver cancer.

  • Liver transplant

Who: This is for those not qualified for an operation for the removal of liver. They are patients whose livers are functioning badly, and patients who have undergone Transarterial Chemoembolization and injection of alcohol, provided that their tumors are no larger than 5cm. If the tumor has grown to a certain size, it is highly likely that the cancer cells have spread to other parts of the body. If liver transplant is carried out, the cancer cell will reproduce themselves rapidly in the new liver, which will result in the recurrence of liver cancer.

Prostate Cancer

What are the treatments for Prostate Cancer?

If a patient is diagnosed with localized prostate cancer, choices for treatments will depend on the estimated tumour growth rate, extent of disease, age and medical conditions of the patient:

  • Early stage of prostate cancer – small localized tumors without invading surrounding tissues

The prostate and surrounding lymph nodes will be removed in surgery (prostectomy). The resection can be done through conventional incisions or newer laparoscopic approach. After surgery, the patient may have some risk of urinary incontinence and impotence. External radiotherapy and internal radiotherapy (brachytherapy) are viable alternatives with similar treatment outcomes.

For elderly patients or those with chronic ill health, especially those with early slow-growing tumours with no significant discomfort, doctors may recommend only regular monitoring (i.e. “wait and see”) and no specific treatment. It is because some prostate cancer cells can grow very slowly and will not threaten the patient’s life in the near term.

  • Intermediate stage of prostate cancer – more extensive disease with invasion of surrounding tissues

The usual treatment is external radiotherapy, often used together with hormonal therapy to improve the treatment outcome.

  • Advanced stage of prostate cancer – cancer cells have spread to bones or other distant organs

The main treatment is hormonal therapy (androgen deprivation treatment) by either surgical removal of testicles or medication. The rationale is to control the growth of prostate cancer by suppressing the male hormone levels. This treatment may control the growth of cancer cells for a few years and relieve the discomfort and pain. For tumors no longer responding to hormonal therapy, palliative chemotherapy may also be considered.

Stomach Cancer

What are the treatments for Stomach Cancer?

If the patient is diagnosed of stomach cancer, doctor will suggest the following treatments to patient:

Stomach removal surgery

Stomach removal surgery is the most common treatment of stomach cancer. Doctor decides to remove a portion of or the entire stomach depending on the patient’s condition. During the surgery, doctor removes the tumor and the tissues and lymph nodes around the tumor. Surgery includes “Total Gastrectomy” and “Radical Subtotal Gastrectomy”.

In general, if the lesion is only limited to mucosa and submucosa, the cure rate of stomach removal surgery can be as high as 90%.

Radiotherapy

Radiotherapy uses high-powered radiation beams to destroy cancer cells. It may be used together with chemotherapy after surgery to prevent recurrence and enhance the survival rate after surgery.

Chemical anti-cancer drugs

Chemotherapy uses anti-cancer drugs to kill cancer cells and stop them from growing and dividing. There are drugs for oral administration and intravenous injection (injection of drugs into the bloodstream through a vein), mainly after surgery treatment, aiming at preventing recurrence and enhancing the survival rate after surgery. Chemotherapy can also be used as palliative treatment for relieving symptoms and prolonging life. There is also targeted therapy which is suitable for patients of gastrointestinal stromal tumor.