Cancer Treatment

Surgery is frequently used to both diagnose and treat cancer. 

Why is cancer surgery performed?

For the following reasons, cancer surgery is frequently necessary:

Avoiding cancer. In some cancers, an organ may be removed before a cancerous tumor develops. In this way, surgery helps to prevent cancer.

Diagnosis. Through surgery, a tissue sample for testing may be obtained. The sample is examined in a lab to determine whether it is cancerous. Other tests may be used to look at the cells' genetic make-up. The test's results have an impact on how you should be treated.

Staging. After cancer surgery, the extent of the cancer and its potential for spread may be determined. This data is used to establish the cancer's stage. Based on the stage of your malignancy, your doctor can decide whether you need intensive therapy and how serious your condition is.

First-choice treatment. The main treatment for many malignancies is surgery.

Debulking. After surgery, the cancer may not always be completely removed. The surgeon has the most room for removal. This process is referred to as debulking.

Relief from side effects or symptoms Surgery may improve your quality of life. It might take away the pain, for example, if the cancer is pressing against a bone or nerve. With this approach, the intestine-blocking carcinoma might be removed.

Surgery is frequently a part of other cancer treatments. These regimens might include chemotherapy, radiation therapy, and other therapies. Which treatments are most effective for you will depend on the type, stage, and general health of your cancer.

Which techniques are frequently employed during cancer surgery?

When it is technically possible, surgery for cancer aims to completely remove the disease from the body. The surgeon accomplishes this by removing some nearby healthy tissue in addition to the cancer.

The surgeon might remove more lymph nodes from the area. Testing is done to see if there are cancer cells in the lymph nodes. If cancer affects the lymph nodes, it may spread to other bodily organs.

What other ways does cancer surgery function

A wide range of different procedures can be used to treat cancer. Researchers continue to look for new methods. Additional cancer surgical procedures include the following:

Cryosurgery. Two examples of the extremely cold materials used in this operation are a cold probe and liquid nitrogen spray. The cold kills cancerous cells by freezing them to death.

Electrosurgery. This type of surgery uses electric current to kill cancer cells.

Laser treatment. Laser surgery uses light beams to decrease or remove cancer cells.

A Mohs technique. This method gently removes the cancer layer by layer. Each thin layer is stripped off and examined under a microscope to look for signs of malignancy.  

This is repeated until all cancer has been cured. Mohs surgery is used to treat cancers that have spread to delicate skin regions, such as the area around the eye.

Gynecological surgery. With this minimally invasive procedure, multiple tiny incisions are made as opposed to one large one. Surgical tools and a small camera are inserted through the incisions.  

An image from the camera is displayed on a screen. The surgeon makes use of this to guide the tools used to remove the cancer. Because of the smaller incisions, you recover from surgery more quickly and experience fewer complications.

Working robots. The surgeon can perform robotic surgery while standing or lying down. They can see a 3D representation of the area being operated on on a screen.  

The surgeon uses hand controls to guide a robot to move the required surgical instruments in order to complete the procedure. Robotic surgery helps the surgeon in hard-to-reach areas. Patients who undergo this type of surgery may experience less post-operative complications and a shorter recovery period.

Natural Orifice. Natural orifice surgery enables access to the abdominal organs without removing skin. Instead, surgeons pass surgical instruments through a hole that is already present in the body, such as the mouth, rectum, or vagina. For instance, a surgeon could insert surgical instruments in the throat and stomach.  

The small incision makes a hole in the stomach wall. The area around the stomach is then exposed to surgical equipment. The tools may also sample liver tissue in addition to removing the gallbladder.

Natural orifices are uncommonly used in surgical procedures. Surgeons are hopeful that this will help to lessen the risks of infection, discomfort, and other post-operative problems.

Cancer therapy is developing. Researchers are looking at alternatives to invasive surgery.

Medical oncology is the medical discipline that focuses on prevention, screening, diagnosis and treatment of cancer. The physicians of this department are called Medical oncologist and it requires residency training in internal diseases for 4 years followed by Medical Oncology fellowship for 2 years.

Treatment of cancer, an extremely complicated disease, requires surgery, radiotherapy and medical therapy (chemotherapy, hormone therapy, target-oriented treatments, biologic therapies etc.) alone or in combination.

Medical oncology is the department which manages all these treatment options. For example; while a medical oncologist is not required in surgical treatment of an early stage breast cancer, s/he works in coordination with breast surgeon for chemotherapy or hormone therapy before (neoadjuvant) or after (adjuvant) the breast cancer surgery.   

Moreover, medical oncologists work in coordination with the department of radiation oncology in cancer cases where radiotherapy plays a curative role, no matter surgical treatment is an option or not.

Two Keys to Correct Treatment: Staging and Tumor Councils

The first step of the treatment in medical oncology department is to make the final diagnosis and determine the stage. Cancer cells are classified in two groups depending on their origin: primary and metastatic. Moreover, cancers are also addressed in categories and sub-categories regarding the organs and cells they originate from.   

Final diagnosis of the cancer is made with pathological examination of biopsy specimens after general characteristics and nature of the cancer are revealed out by imaging modalities. The most appropriate treatment option(s) is /are determined after the stage of cancer is identified on the final step.

Staging of the cancer: Staging is somewhat determining the level of progression (metastasis) and aggression. Cancer stages are expressed with Roman numbers (from I to IV). Stage 0 or 1 implies that the cancer is yet to spread from its original location and the cancers in this stage usually respond to treatment well.   

In other words, the chance of cure is higher in low stage cancers. On the other hand, stage IV cancers represent tumors which had already spread (metastasized) to distant tissues and organs.

Medical oncology uses the option of medication therapy for treatment of cancer. These include chemotherapy, hormone therapy, targeted therapies and biologic therapy.

Chemotherapy: Chemotherapy is the generic name of drugs which are used to terminate and/or limit the division and growth of cells which divide or grow in an uncontrolled manner due to genetic or environmental factors. While chemotherapy can be used alone, it can also be administered before and after a surgical treatment or in combination with radiotherapy, whenever required (combination treatment).   

Anti-cancer drugs or chemotherapeutic agents can be administered via oral (tablet, capsule or solution), intravenous, intramuscular, subcutaneous routes or directly into the tumor/lesion (intralesional).

The effectiveness of chemotherapy drugs is based on the fact that cancer cells multiply in an uncontrolled manner. In other words, chemotherapy drugs have higher effect on cells that divide and grow in an uncontrolled manner in comparison to healthy cells.  However, chemotherapy drugs also affect the healthy tissues and cells of the body.

The chemotherapy itself does not cause pain for the patient.

Side effects of chemotherapy drugs include a wide spectrum of complaints depending on the anti-cancer drug and overall health of the patient. Side effects of chemotherapy drugs originate from effects of the treatment on healthy cells of the body.

Hormone therapy: Certain cancers, such as prostate and breast cancers, are susceptible to hormones. Certain hormones play a role in development of these cancers and they are, therefore, responsible for their uncontrolled division and growth. 

The purpose of this treatment is to suppress the level of hormone which leads to abnormal division of cancer cells in the body in order to regress and destroy the cancer. Similar to chemotherapy, the side effect profile depends on the drug and certain patient factors (gender, overall health etc.).

Biological therapies: Biological treatment is used to slow down and/or stop division and growth of the cancer cells by activating the native factors that form the defense mechanism of the body (antibodies, interferon etc.). This type of treatment is still intensely studied in clinical trials and certain agents are still in experimental stage.

Targeted therapies: This is one of the most important innovations that the modern medicine gained in treatment of cancers. The treatment mechanism is based on killing the cancer cells by binding to certain proteins produced by them. Side effects of this treatment are very low as it only “targets” certain proteins and does not affect healthy cells in the body.

All available means of modern medicine are used for all cancers under management of medical oncology department thanks to global hospital and physician network of Hera Healthcare; in addition, a personalized diet is planned throughout the treatment process and psychological support is provided, whenever needed.

Cancer is No More a Nightmare with Regular Health Examinations

Always keep in mind that the most successful treatment of cancer is prevention and that the success rate is pretty high for cancers detected at early stage and the sole way to detect a cancer at an early stage is health examination at regular intervals.

Please contact us for special counseling.

Radiation Oncology is a discipline of medicine that uses ionizing radiation to destroy and/or kill cancerous cells. This treatment modality is called radiotherapy or radiation therapy. 

Another treatment method is radiation surgery (or radiosurgery) which has been introduced into use in the field of Radiation Oncology thanks to the advancements in physics and computer technologies.

The ionizing radiation used for treatment damages the genetic structure and DNA of the cancerous cells and prevent the abnormal and uncontrolled cell division and growth. 

Thus, the tumor shrinks and/or the cancerous cells are eliminated.

Beams used during treatment are produced and delivered to the cancer focus by the cutting-edge machines. These machines are called Linear Accelerator. This method is called external radiotherapy and it represents the most common radiotherapy technique. The patient feels no pain during external radiotherapy.

Another method is internal radiotherapy (or brachytherapy). The radioactive material is placed inside or nearby the tumor temporarily or permanently. Internal radiotherapy does not cause pain.

The radiotherapy is planned and performed by radiation oncologists and physics engineers. In the past, intact tissues were also exposed to the devastating effects of radiation along with the tumor tissue. In addition, long-term exposure was inevitable when it was necessary to deliver high-dose of radiation to the tumor.

Today, the beams used for treatment are focused on the tumor with very high accuracy thanks to advancements in physics and computer technologies, and thus, the effects on the intact tissues can be minimized. Furthermore, the beams can be delivered with very high accuracy (below one millimeter), as breathing-related movements of organs, where the tumor originates from, are taken into consideration.

Encircling the cancer in all directions: Conformal Therapy

Another striking development in the radiation therapy is the integration of Linear Accelerators, the devices that generate and emit the ionizing radiation, with imaging devices. In this way, a three-dimensional image of the tumor is obtained and the radiation beams are shaped to conform to the target volume (conformal radiotherapy).

The advancements in Linear Accelerator technology enable the production of the high-dose radiation in a short time. 

Thus, both the duration of sessions can be shortened and the high-dose radiation can be delivered to the tumor in a single session.

In treatment of cancer, the radiotherapy can be used alone or combined with surgery or chemotherapy or applied before and after such treatments. Also, the radiotherapy is performed during the surgery for certain cancers and this method is called intraoperative radiotherapy. The purpose of the radiotherapy is to shrink the tumor before the surgery and eliminate possible microscopic cancer foci after the surgery. 

Also, it can be a definitive therapy when combined with chemotherapy. In case the definitive therapy is not possible for a particular cancer, the radiotherapy can be considered to improve quality of life (alleviation of pain, management and prevention of bleeding) (palliative therapy).

Patient-specific Treatment Plan

Radiotherapy uses various techniques, including but not limited IGRT, IMRT, conformal radiotherapy, stereotactic brain surgery and total body irradiation. These techniques depend on the Linear Accelerator of the device and each machine has unique superiorities.

After the final diagnosis of cancer is made, it is investigated whether the patient is a good candidate for radiotherapy and radiation oncologist decides the best radiotherapy technique for the patient. 

Later, 3-dimensional images of the tumor are obtained through computerized tomography and the volume of the tumor is determined.   

The radiation oncologist determines the necessary dose for the tumor focus in cooperation with the physics engineer. This phase is called simulation and planning.   

The skin where x-ray beams will pass through is marked. Although indelible pens are used for this purpose, the patient should take care of these marks. In case the marks erases, the patient should never mark the skin again.

Then, the decision is made regarding the number of sessions and days required to deliver the pre-determined total dose and necessary appointments are scheduled. Radiotherapy is performed five days a week. Weekends are spared, so the patient can rest and the tissues can regenerate.

The patient presents to Radiation Oncology Clinic on the scheduled date. Radiotherapy plan is entirely reviewed before each session. The patient is transferred to the radiotherapy room and lies on the table of the Linear Accelerator. If required, thermoplastic masks and head frames are used to ensure immobility.   

The patient stays in the room for 15-30 minutes, but the radiation beams are delivered to the tumor for only a few minutes. Even though the radiation technician stays in a separate room during the radiotherapy, he/she can continuously communicate with the patient through a microphone and speaker.

Although the machine works a little bit loud while the patient is positioned and the beams are delivered, the patient cannot hear or see the radiation. Moreover, radiotherapy does not cause pain.

Although treatment is scheduled in sessions, the radiation oncologist evaluates response to treatment in every week and makes necessary modifications.

In internal radiotherapy (or brachytherapy), the patient emits radiation for a while after the treatment, and the patient is, therefore, isolated from other people for a certain time. On the other hand, the patient does not emit radiation after external radiotherapy.

Side effects of the radiotherapy are directly related to the target area of the radiotherapy. The radiation oncologist and nurse cooperate with other medical disciplines for management of these side effects, when needed. In addition, patients are informed about the potential side effects before and during the treatment. 

Blood workups can be ordered as well to supervise overall health of the patient and evaluate the effects of treatment on the body.

All available means of modern medicine are used for all cancers under management of medical oncology department thanks to global hospital and physician network of Hera Healthcare; in addition, a personalized diet is planned throughout the treatment process and psychological support is provided, whenever needed.

Always keep in mind that the most successful treatment of cancer is prevention and that the success rate is pretty high for cancers detected at early stage and the sole way to detect a cancer at an early stage is health examination at regular intervals.

Please contact us for special counseling.