MultiCare > Cancer Treatments

Cancer Treatments

RADIATION THERAPY

Nearly one-half of all people diagnosed with cancer will receive radiation therapy, alone or combined with surgery and/or chemotherapy. Radiation treatments most often consist of high-energy X-rays aimed directly at tumors in an effort to shrink or destroy malignant growths. Radiation therapy targets cancer cells that are multiplying rapidly by killing the cell or injuring it so that it cannot divide. Although radiation causes severe damage to cancerous cells, it causes minimal permanent damage to the normal cells surrounding the area, and healthy tissue typically recovers with little permanent damage.

The most common type of radiation given during outpatient visits to a treatment center or hospital is external radiation. A machine directs high-energy rays at the tumor and at a small margin of tissue surrounding it. Internal radiation, or brachytherapy, is a method of implanting a source of radiation directly into a tumor, body cavity, or “tumor bed” after surgery to clean up cancer cells. Internal radiation may be given by injecting a radioactive solution into the bloodstream or a body cavity.

At the MultiCare Regional Cancer Center, radiation is delivered by highly skilled and compassionate physicians. Using a multidisciplinary approach to cancer care, MultiCare offers comprehensive radiology services in close coordination with your complete treatment plan. With our leading- edge equipment, advanced technology and skilled providers, patients can be assured that more radiation is delivered to the tumor, and less to the healthy tissue surrounding it. For more information on the different radiation options in more detail, please go to www.multicare.org/cancer.

Radiation services are offered at Tacoma General Hospital, Monday through Friday, 8am to 5:30 pm. Reserved, covered parking is available for oncology patients just outside the clinic’s entrance on 1L.
Enter the Fifth Street parking garage at the corner of 5th and J Streets.

CHEMOTHERAPY

In the last 35 years, the use of one or more of the anticancer chemotherapy drugs now available has become standard treatment for those diagnosed with cancer. The concept behind this treatment is quite basic: cancer cells divide and multiply rapidly, and anticancer drugs interfere with their growth and/or their reproduction.

Chemotherapy is administered to the body through the bloodstream, thus treating all tissues and organs. Frequently, some cells of a cancerous tumor will have broken off from the original site (metastasis) and spread throughout the body, traveling through the blood and lymph system. Because these cancer cells have yet to form a tumor large enough to be detected by tests, chemotherapy is often used as an additional treatment to eliminate hidden cancer cells. Combining two or more anticancer drugs increases the power of the treatments, decreases any single side effect, and lowers the chances that cancer cells become “immune” to the drugs given in high doses.

Depending on the type of cancer and how advanced it is; chemotherapy can achieve different goals:

Cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells.
Control the cancer by keeping it from spreading, slowing the cancer’s growth, and killing cancer cells that may have spread to other parts of the body from the original tumor.
Relieve symptoms to help patients live more comfortably.

Great advances have been made in the use of chemotherapy. New chemotherapy agents, anti-nausea drugs, methods and timing of administering these drugs have led to larger doses being given with fewer side effects. Many cancer patients share the fear that the cure is worse than the disease, but most would say that the treatment results are well worth the effort.

Talk to your oncologist and get a realistic view of what’s ahead. Find out why you will receive chemotherapy, how it will be administered, and what you can expect. It’s best to know what to anticipate and get organized to prepare for your chemotherapy treatments.

Here are some suggestions to help prepare for treatment:

Make arrangements to have your dentist clean your teeth and have all necessary dental work completed.
Get a short, stylish haircut.
Get your ﬂu and/or pneumonia shot.
If possible, schedule your therapy right before the weekend so that it interferes with work as little as possible. Take time to pamper yourself – it helps speed your recovery time.
Shop for food. Prepare and freeze meals ahead.
Arrange for rides to and from treatments.
Rent funny movies.
Arrange childcare.

Keep your eyes on the prize!

SURGERY

Surgery is the oldest form of cancer treatment. It plays an important role in the diagnosing and staging of cancer, and technological advances have allowed surgeons to successfully operate on a growing number of patients. Today, less-invasive procedures are often done to remove tumors while preserving as much
normal function as possible. Surgery offers the greatest chance for cure for many types of cancer, especially those that have not yet spread to other parts of the body. Most people with cancer will have some type of surgery.

• Diagnostic surgery is used to get a tissue sample to determine the existence and type of cancer. The diagnosis of cancer often can be conﬁrmed only by looking at the cells under a microscope. Several surgical techniques can be used to obtain a sample.

• Staging surgery helps determine the extent and amount of the disease. While the physical exam and results of lab and imaging tests can help determine the clinical stage of the cancer, surgical staging
is usually a more accurate assessment of how far the cancer has spread.

• Curative surgery is the removal of a tumor when it appears to be conﬁned to one area. This type of surgery is done when there is hope of taking out all of the cancer. Curative surgery is thought of as
primary treatment. It may be used alone or with chemotherapy or radiation therapy, which can be given before or after the operation. In some cases, radiation therapy is actually used during an operation
(interoperative radiation therapy).

Biological Therapies: Using your immune system to fight cancer. Chemotherapy and biological therapy are treatments that ﬁght cancer but they work in very different ways. Chemotherapy can’t always tell the difference between cancer cells and healthy cells, therefore two of the most frequent side effects of chemotherapy are anemia and immunosuppression (decreased ability to ﬁght infection).

Biotherapy adjusts your immune system and makes it easier for it to stop and slow the growth of cancer cells. The body’s ability to mount an attack against tumor cells might determine which patients survive cancer using conventional therapies like chemo, surgery and radiation.

Several methods of biotherapy are now available.

• Growth Factors are substances made by the body to regulate cell growth and survival. Some growth factors can be produced in the laboratory and used in biological therapy.

Pegﬁlgrastim. Chemotherapy can lower your white blood cell (WBC) count. If your white blood cells are too low, chemotherapy may be delayed or your dose may be reduced. Pegﬁlgrastim is a growth factor used to keep white blood cells at an adequate level to ward off infection during chemotherapy; it is administered by an injection underneath your skin.

Darbepoetin. Chemotherapy will also have an effect on your red blood cell (RBC) count. Hemoglobin is the portion of the RBCs that carries oxygen to your body. If your hemoglobin is too low, the fatigue you feel following chemo treatments can be more severe, your chemotherapy may be delayed or you may need a blood transfusion. Darbepoetin is the growth factor used to maintain your red blood cells at an adequate level; it is an injection underneath your skin.

Both of these growth factors, as well as others, are given at intervals prescribed by your doctor during your cancer treatment.

• Targeted therapies are used to block the growth and spread of cancer. By focusing on cancer at the cellular level, these targeted drugs may be less harmful to normal cells.

Targeted therapy may be used alone or in combination with other cancer treatments. These types of treatment will give doctors more latitude in tailoring cancer treatments to the individual patient.

Depending on the cancer being treated, the drugs can be administered by mouth— as a once-a-day dose or by intravenous (IV) infusion over several hours.

Some current biological therapies include: Rituxamab, Trastuzumab, Bortazomib, and Imatinib. Each of these drugs works in a different way and is indicated for different cancers, but all of them are targeted treatments. New biological agents are being tested and approved by the FDA at an increasing rate.

There are side effects associated with biological therapy, including low-grade fever, chills and irritation at the injection site. Your doctor and your pharmacist will see that you receive medications to prevent and minimize these discomforts.

Here are some websites you may ﬁnd helpful:

http://www.cancer.gov/drugdictionary/
http://www.cancer.gov/cancertopics/biologicaltherapy
http://www.medterms.com/script/main/art.asp?articlekey=2465
http://www.oncolink.com/treatment/article.cfm?c=12&s=88&id=255 http://patient.cancerconsultants.com/targeted_therapy.aspx?tierID=830&linkID=42139&id=31373

Integrative Therapy

The term “integrated therapy” is often used interchangeably with what is called “complementary and alternative therapy,” but there is a very important difference to be noted. Professionals who practice integrative medicine blend their methods appropriately with mainstream methods of treatment. Integrative therapy is not used in place of conventional treatment, but as a part of your cancer treatment to promote well being and alleviate side effects of chemotherapy, surgery or radiation. The purpose of integrating these modalities into your cancer treatment is to treat the whole person and not just the condition you see your oncologist for.

Your oncologist or his/her staff may know of practitioners in your area to refer you to. When you decide to see a practitioner of integrative therapy, be sure to inform your oncologist of the treatments you will be receiving.

• Acupuncture is a technique of inserting and manipulating very ﬁne needles into speciﬁc energy points in the body. The stimulation of these points may encourage the restoration of health and well being. Acupuncture is primarily good for treating pain.

• Acupressure is a traditional Chinese medicine technique based on acupuncture. It involves stimulating the energy points with pressure using the hands and ﬁngers. Acupressure may work by releasing endogenous opioids into the bloodstream.

• Aromatherapy is the skilled and controlled use of essential oils in a positive, healing way to maintain health and well- being on a physical and emotional level.

• Biofeedback provides information about physiologic processes the patient was previously unaware of and allows the patient to gain more control over symptoms and side effects.

• Massage involves applying structured pressure to the soft tissues of the body to achieve a beneﬁcial response. Therapeutic massage therapy can be applied to parts of the body or the whole body to relieve stress, manage pain and improve circulation.

• Naturopathic medicine is a school of medical philosophy that seeks to maintain health and treat disease by assisting the body’s own capacity to recover from illness and injury. Licensed naturopathic doctors try to avoid surgery and synthetic substances in their treatments and strive to treat the patient as a whole person using natural foods and remedies, counseling and environmental medicine.

To learn more about integrative medicine, speak to your doctor and his/her staff, or check the following websites. Remember to contact your oncologist whenever you have questions or concerns regarding your treatment.

http://www.cancer.gov/
http://www.cancer.org/docroot/ETO/ETO_5.asp
http://nccam.nih.gov/
http://nccam.nih.gov/clinicaltrials/factsheet/
www.medlineplus.gov

Common Misconception