Advantages of Chemotherapy

With wide infection rates and very few cures, cancer is slowly becoming one of the biggest killers of our population's history. However, there have been advancements over the years to help stave off cancer. One of these treatments is chemotherapy.

WhatisChemotherapy?
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Chemotherapy is the use of toxic medications to kill cancer cells in the body. Usually introduced by an IV, once the medicinal liquid enters the body it has the ability to target any cells that multiply quickly. Cancer cells are deadly because of their ability to multiply and spread. However, this means that any other cells in the body that have the ability to multiply quickly are also killed. These cells include bone marrow, reproductive cells and hair follicles. The treatment is given in cycles to allow time for new health cells to reproduce before each additional treatment.

Types
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Because cancer has the ability to become immune to certain chemotherapy chemicals, most treatments involve a variety of chemicals to ensure effectiveness. These chemicals can include antimetabolites, antibiotics, alkylating agents, nitrosoureas and miotic inhibitors. Each of these types of chemicals have unique abilities to do everything from kill the cancer cell itself to hinder its reproduction and spread.

Effectiveness
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One of the advantages of chemotherapy over other cancer treatments is effectiveness. With other treatments, such as radiation, the treatment is focused on a single part of the body. However, with chemotherapy, the drugs are introduced to the entire body. This means that if the cancer has spread or if physicians missed part of the cancer in another part of the body, the chemotherapy will still reach and kill it.

Life
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Another advantage of chemotherapy is a prolonged life span. Without chemotherapy, cancer has free rein to grow and spread throughout the entire body. The longer it has this rein, the greater chance the patient has of the cancer becoming fatal. Chemotherapy does not always completely kill the cancer, but in many cases it controls the spread and growth of the cancer cells. This dramatically increases the life span of the patient. In some cases, the chemotherapy can even put the cancer into remission, allowing the patient to go back to living a normal life.

SymptomRelief
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Another advantage of chemotherapy is the relief of the many painful symptoms that come with cancer. Though chemotherapy is not without side effects, the side effects of the chemicals are temporary in comparison to the symptoms felt from the presence of cancer in the body. As the cancer grows in an individual, it starts to put pressure on nearby organs, nerves and blood vessels. This can cause severe amounts of pain and discomfort. Chemotherapy keeps the cancer from growing and spreading, taking pressure off the organs and other parts of the body and relieving the symptoms in the process.

Many who have been diagnosed with some kind of cancer know that recovery is a long and sometimes painful process. Chemotherapy is a source of both healing and discomfort, but is it really worth the trouble?

Cancer
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Cancer occurs when a group of cells has lost the ability to control growth through mutations. These cells divide rapidly to form tumors, and sometimes cancer cells can spread to other parts of the body.

ChemicalsUsed
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Chemocare.com lists the different types of chemicals used during cancer treatment. These drugs specifically target rapidly-growing cells (for instance, by blocking microtubule formation). They do not distinguish between healthy cells and cancer cells.

Advantages
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The greatest advantage to chemotherapy is its control over the spread of cancer since it is delivered throughout the body in the bloodstream. It is even more effective when combined with surgery or radiation therapy.

Disadvantages
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The worst disadvantage of chemotherapy is the unpleasant side effects such as nausea, hair loss and extreme discomfort. A second disadvantage is that chemicals must be carefully selected depending on the type and stage of the cancer.

CurrentResearch
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The development of drugs that can be specifically targeted to a cancerous growth is a promising area of current research. If the technology can be perfected, the side effects common to most types of chemotherapy may be avoided.

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How Does Chemotherapy Kill Cancer?

ByaneHowContributor

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There are a plethora of options when treating cancer, all of them with distinct advantages and disadvantages. Although chemotherapy is well known for its side effects, it remains one of the most effective tools for defeating cancer cells in the body, especially when used in conjunction with other treatments.

1. Basics
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Chemotherapy is the process of using drugs to treat a disease, and it works against cancer by damaging cells in the body that are undergoing the process of division. The cancer-fighting drugs can be injected directly into the bloodstream, or taken as a tablet or capsule. Once in the bloodstream, the chemotherapy drugs travel around the body in order to damage and kill the cancer where it has spread.

CancerCellsvs.NormalCells
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Chemotherapy gains its advantage over cancer cells because it attacks cells that are dividing. Cancer cells are constantly splitting and growing, especially in the initial stages of the cancer. Chemotherapy drugs disrupt the process of dividing by attacking the control center of division: the nucleus. Chemotherapy drugs can damage the genes that are copied within the nucleus during division, or they can

damage cells when they are physically splitting. Most normal body cells do not split often, and when they do it is in a more controlled way than cancer cells. Chemotherapy is especially effective against rapidly dividing cells.

Effectiveness
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The effectiveness of the chemotherapy depends almost entirely on the type of cancer. It can be a very effective deterrent or even cure with Hodgkin's lymphoma or testicular cancer. In other cases, the chemotherapy can be used in conjunction with other treatments, like surgery, to stop the reemergence of cancer cells. This method is effective against breast or bowel cancer.

Remission
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Chemotherapy is effective at achieving the remission of cancer cells. Remission is not strictly a cure; it occurs when there is little proof of the existence of cancer cells in the body, and there is a small chance of its reemergence. The more time that passes, the less chance the cancer will come back. Partial remission occurs when the cancer cells can still be found within the body, but chemotherapy has stopped the cells from growing and splitting. Complete remission occurs when the cancer is not found at all.

SideEffects
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Because chemotherapy does disrupt the process of cell division, it unfortunately can also disrupt cells in the body that are constantly in division. For example, the bone marrow, hair follicles and skin are constantly dividing, so the chemotherapy can cause their division processes to stop. Fortunately, the damage does not last after the chemotherapy has run its course, and normal cells can replace the damaged cells after treatment.

What is Radiation Therapy? Radiation therapy (irradiation) is the use of high energy x-rays to kill cancer cells. It can be used in combination with chemotherapy, surgery or other biologic agents. Why is Radiation Used? Radiation therapy is used to cure cancer, reduce the risk that cancer will return in a certain area or palliate the symptoms of cancer. Radiation therapy can also be used to treat some benign conditions such as keloids and to prevent cardiovascular re-stenosis.

What is Cancer? Cancer is a group of many diseases identified by an uncontrolled growth and spread of abnormal cells. These abnormal cells can invade other bodily tissues causing them to malfunction or cause pain. How Does Radiation Therapy Work? Radiation therapy works by damaging the DNA within cancer cells interfering with the cells ability to grow and reproduce. Cells that are growing and multiplying are especially sensitive to the effects of radiation. This is why radiation works so well in cancer. Cancer cells reproduce more frequently than normal cells, so they are more susceptible to the damage from radiation. Normal cells are also affected by radiation, but they are able to recover from radiation damage. When radiation is given for cancer, care is taken to make sure as much normal tissue is protected as possible. Benefits of Radiation Therapy Radiation therapy can be used to treat almost any type of cancer anywhere in the body. It can be given during any phase of the treatment process depending on the particular disease and goals of treatment. Radiation can be used alone or in combination with other things to treat cancer. It can be used before surgery to shrink the cancer to provide for a more complete resection. It can be used after surgery to treat any residual microscopic disease. The effects can be additive when radiation is given along with chemotherapy. And it can be consolidative when given after chemotherapy. Risks of Radiation Therapy. As with any treatment there are risks involved. This is also true of radiation therapy. While damaging cancer cells, radiation can also damage normal tissue. This damage of normal tissue is what causes side effects. The side effects will vary depending on what part of the body is treated and the dose that that part of the body receives. Your radiation oncologist will precisely plan your treatment to kill as many cancer cells as possible while sparing as much normal tissue as possible.

Advantages of surgery:

If the cancer is confined within the prostate the operation should be curative. The chances of cure relate directly to the PSA, tumour stage, and Gleason grade which indicate the likelihood of microscopic spread outside the prostate - the main cause of cancer recurrence after surgery. The expected success rate therefore varies from person to person and your specific circumstances should be discussed in detail with your urologist. The prostate is examined under the microscope to determine the true nature and extent of the cancer. Many people are surprised to learn that the prostate biopsies that diagnosed the cancer are not always an accurate reflection of the amount and grade of cancer they

have. This is because they are only a very small and essentially random sample of the prostate and can be difficult to interpret or can miss significant areas of cancer, underestimating the volume or grade of the disease. Surgery allows thorough examination of the prostate and this then gives a better idea of how likely it is that the cancer has been cured. The PSA drops to undetectable levels immediately. Following surgery, the PSA falls to zero, or undetectable levels within 6-8 weeks. This gives reassurance that there is no evidence of remaining cancer cells. PSA levels are then monitored over the next 10 years, and as long as it remains undetectable, the patient can be reassured of treatment success. Radiotherapy may be offered for cancer recurrence. If there is a recurrence of the cancer in the area where the prostate was removed, radiotherapy may be given to treat this. Surgery treats outlet obstruction. In addition to removing the cancer, in men with an enlarged prostate a prostatectomy also removes this cause of urinary obstruction, treating symptoms such as difficulty starting and poor flow.

Disadvantages of surgery:

Wound discomfort. The laparoscopic approach causes minimal discomfort, hence its appeal. Wound problems are therefore rare and post-operative pain can be effectively controlled by simple painkillers Urinary incontinence. Leakage of urine on coughing, straining or physical activity may initially occur following removal of the catheter (the tube in the penis draining urine into a bag). This is because re-joining the urethra (tube you urinate through) and bladder during a radical prostatectomy causes bruising, swelling, and impaired function of the muscle that keeps the urethra closed (the urinary sphincter). Fortunately permanent damage to the sphincter is uncommon, and the younger, fitter, and slimmer the patient, the faster the continence returns. This healing process is sped up by performing regular pelvic floor exercises to strengthen the continence muscles. Long term continence rates differ amongst surgeons. The small number of patients who are still not pad-free at 12 months may require a further procedure to restore their continence. Impotence. The nerves that supply the penis for erections pass along either side of the prostate and are therefore removed with the prostate in a non-nerve sparing radical prostatectomy. This approach is general recommended in patients with PSA over 10, Gleason score >7, or locally advanced tumours, in whom the cancer can spread microscopically along nerve fibres and may not be completely removed if the nerves are left behind. This allows the widest possible margin of tissue around the prostate to be removed to avoid the risk of leaving cancer cells behind, however leads to loss of normal spontaneous erections. While oral medication to restore erections will not work with damaged nerves, there are multiple other options to achieve erections and it is important to remember that all men can be made artificially potent after radical prostatectomy somehow. Those patients with normal erections and lower risk disease may be candidates for a nerve-sparing radical prostatectomy in which the nerves are dissected from the side of the prostate and left intact. This gives the greatest chance of return of

potency, and the younger and fitter the patient, the faster erections return, although it can take up to 1-2 years in some patients.

Cancer: Choosing a Treatment Program

Whatarethedifferentkindsofcancertreatment? Thethreemostcommontypesofcancertreatmentaresurgery,radiotherapyandchemotherapy. Treatmentisaimedatremovingthecancercellsordestroyingthemwithmedicinesorbyothermeans. Surgery Surgeryisawaytophysicallyremovethecancer.Surgerycanbeverysuccessfulintreatingsomekinds ofcancer,butitisn'tanoptioninallcases.Ifthecancerisintheformofamalignanttumor(atumor thatspreads)butthetumorisstillinoneplace(localized),itmaybepossibletosafelyremovethetumor andanysurroundingaffectedtissue.Surgerymaynotbepossibleifthecancerhasspreadtootherareas ofthebodyorifthetumorcannotberemovedwithoutdamagingvitalorgans,suchastheliverorbrain. Differenttypesofsurgeryareusedtoremovecancer.Someoftheseinclude:

Lasersurgery.Beamsoflightandsometimesheatfromalaserareusedtotargetanddestroy cancercells. Laparoscopicsurgery.Verysmallincisionsaremadeinthebody,andthedoctorusesatiny cameratoseeinsideyourbody.Thecamerasendssignalstoavideoscreensothatyourdoctor canseethetumorandyourorgans.Thedoctorusesasurgicaltooltoremovethetumor. Mohssurgery.Layersofcancercellsareremovedoneatatime.Eachlayerisexaminedbefore thedoctorremovesthenextlayer.Inthisway,onlythediseasedlayersareremovedand healthytissueremainsintact. Cryosurgery.Cancercellsarefrozenanddestroyedusingaverycoldmaterial,suchasliquid nitrogen.

Radiotherapy RadiotherapyusesradiationintheformofaspecialkindofXray,gammaraysorelectronsto damagecancercellssothattheycan'tmultiply.Thereisusuallynopainduringthiskindoftherapy. Dependingontheareathatistreated,sideeffectsfromradiationdamagetonormaltissuesmayoccur. Yourdoctorcantellyouwhattoexpect.Radiotherapyissometimestheonlytreatmentneeded,orit maybeusedwithothertherapies.Acombinationofsurgeryandradiotherapymaybeusedfortumors thatgrowinoneplace. Chemotherapy Chemotherapyusesmedicinestoattackthecancercells.Theword"chemotherapy"sometimescausesa lotoffearbecausethesideeffectscanbesevere.However,notallpeopleexperiencesevereside effects.Thesideeffectsofchemotherapycanoftenbetreatedwithothermedicines. Chemotherapyisusuallyusedwhenthecancerhasspreadtootherareasinthebody.Chemotherapy

canalsobeusedincombinationwithsurgeryandradiation.Sometimesthetumorissurgicallyremoved andthenchemotherapyisusedtomakesureanyremainingcancercellsarekilled. OtherTreatments Anotherkindoftreatmentisbiologicaltherapy(alsocalledimmunotherapy).Thistreatmentisusedto triggerthebody'simmunesystemtoproducemorewhitebloodcells,calledlymphocytes(say:limfo sites).Twokindsoflymphocytescanattackandkillcancercells:TcellsandBcells.Immunotherapyaims toboosttheabilityoftheTcellandBcelllymphocytestokillcancer.Thiskindoftherapycanalsobe usedincombinationwithsurgery,radiationtherapyorchemotherapy. Hormonetherapyissometimesusedtotreatbreastorprostatecancer,ofteninadditionto chemotherapyorradiotherapy.Hormonetherapyinvolvestakingdrugsthatcontainotherhormonesto blocktheeffectsofestrogenandtestosterone,alsohormones.Thesedrugsarenecessarybecausethe hormoneestrogencanmakebreastcancertumorsgrowfaster.Similarly,thehormonetestosteronecan makecanceroustumorsintheprostategrowfaster.Inothercases,surgerytoremovetheovariesorthe testiclesmaybeused.Removingtheseorgansreducestheamountofestrogenortestosteroneinthe body. Otherspecializedtreatmentsmaybeavailable.Yourdoctormaytalktoyouaboutthesetreatmentsif theyareanoptionforyou. HowdoIdecidewhattreatmentoptiontouse? Yourdoctor,orateamofdoctors,willhelpyouunderstandyouroptionsandwillrecommendoptions fortreatment.Youmaynothaveachoiceinthetreatment.Manyfactorsareinvolved,includingthe stagethatyourcancerisin,whatorgansareaffected,andthetypeofcancerthatyouhave.Some cancers,suchasskincancer,areeasiertotreatthanothers.Yourageandhealth,aswellasthepotential sideeffectsoftreatment,mayalsobefactorsinhowmuchcontrolyouhaveoveryourtreatmentplan. Youandyourdoctorwillwanttoconsiderboththeadvantagesanddisadvantagesofeachtherapy.In addition,youandyourdoctorwillwanttodiscussalternativetherapiesincaseyourcancerdoesn't respondtotreatment. Whodoeswhatinmytreatmentprogram? Cancertreatmentcanbeverycomplex.Thekindofcanceryouhave,thestagethatit'sin,andthe treatmentprogramyougothroughaffectsthekindsofhealthcareprofessionalsyoullsee. Yourfamilyphysicianmayoverseeyourtreatmentandrehabilitationprograms,andcanhelpanswer questionsyouhave.Sometimesanoncologistmaymanageyourtreatmentprogram,butyourfamily physicianmaytakeoveroncetherapyiscompleted.Anoncologistisadoctorwhospecializesintreating peoplewithcancer. Asurgeonmaydotheoperationtoremoveasmuchcanceroustissueaspossible.Apathologistwill

examinethetissuethatisremovedduringabiopsyorsurgerytocheckforsignsofcancer.Radiation oncologistsadministerradiationtreatment.Theradiationoncologistisoftenhelpedbydiagnostic radiologists,radiotherapytechnologistsandradiationphysicists,whoplantreatmentandcheckthe radiationdosagestoensurethattreatmentisassafeaspossible. Oncologists,familyphysiciansandinternistsoftenprescribechemotherapymedicines,hormonesand otherdrugs.Laboratorytechniciansornursesmaydrawyourbloodfortests. Nutritionistsevaluateyourdietandhelpyouplanyourmealsduringandaftertreatment.Physical therapistscanhelpyoukeepyourmuscletoneandrestoreyourabilitytomovearoundifthereareany changestoyourbodyfromtreatment.Psychologists,psychotherapistsandothercounselors,suchas clergyorsocialworkers,canhelpyoutalkthroughyourfeelingsandmanagetheemotionalreactionsto yourcancerandcancertreatment.Pharmacistsmixthecomplicatedmedicationsandcheckthatyouare gettingthecorrectdosages. DisadvantagesofGeneTherapy

The basis of gene therapy is find a gene that is not functioning right and to insert a healthy portion into that gene. To find these genes, scientists must perform genetic tests or genetic screening to see i f the gene that causes for example, cystic fibrosis, is present. This genetic testing is producing much controversy and raising many ethical and legal problems. Many believe that this is an invasion of privacy. They believe that if prenatal tests are performed that these could lead to an increase in the number of abortions. Many people that hear a positive test for a disease are now are faced with a dilemma. That dilemma is in finding adequate insurance to cover the treatments, which could be gene t herapy, or living out their lives knowing that they carry a gene for a disease. This positive test has placed them in a high risk group that they may have not been in if they had not been tested. This high risk tag makes insurance coverage almost imposs ible to find. The insurance that will cover them may be extremely expensive. So, choosing to have the test may be a question of whether they think their current insurance will cover them or not. Many young couples may find out that they are carriers of a disease, and now must decide if they want to have a child that could be born with a genetic disease. Still another problem is regulation of the uses of gene therapy. Our society is obsessed with the idea of youth and beauty. If scientists could ide ntify the gene that contributes to youth or beauty, then the technique of gene therapy could be monopolized by the cosmetic industry to enhance beauty or to "turn back the clock." The problem with this is whether baldness, height, or beauty should be

eno ugh of a reason to require gene therapy. Federal regulation will have to come into play in deciding whether a big nose is as important of a genetic problem as cystic fibrosis and which requires gene therapy. Gene therapy at a Crossroads
AdvantagesofGeneTherapy

The advantages of gene therapy far out weigh the disadvantages. The advantage of the technique, is to give someone that is born with a genetic disease or who develops cancer the chance at a normal life. I thin k this is an advantage that far out weighs any of the disadvantages that have been presented against gene therapy. Giving someone a chance at a normal life should be enough for many of the people that oppose this technique to change their minds. I bel ieve the reason that these people are opposed to gene therapy is because they see it as something foreign and scary. The reason people are scared is because they do not understand the technique. I think if scientists educate our society, many people wou ld change their minds. I believe that if the people that oppose this technique were ever faced with cancer or a child born with a genetic disease, they would change their views. These skeptics would choose gene therapy, especially if it would save a lo ved one's life. In the coming future, gene therapy will play an important part in many people's lives.
CancerTherapy,Definitive Definition Definitivecancertherapyisatreatmentplandesignedtopotentiallycurecancerusingoneora combinationofinterventionsincludingsurgery,radiation,chemicalagents,orbiologicaltherapies. Purpose Theprimarypurposeofdefinitivecareistoestablishacureandtodestructandremoveallcancercells fromtheinfectedperson. Surgeryisnotonlyadiagnostictool,butalsousedfortumorremoval.Thesurgeonusuallyidentifies potentialcandidatesfortumorremovalandrepairsintraoperatively(duringtheoperationprocedure). Surgerycanbecurativeforsomestomach,genital/urinary,thyroid,breast,skin,andcentralnervous systemcancers.Thebestchanceforasurgicalcureisusuallywiththefirstoperation.Itisessentialthat thecancersurgeon(oncologicsurgeon)beexperiencedinthespecificprocedure. Radiationtherapyiscommonlyadministeredtoapproximately50%ofcancerpatientsduringthecourse ofillness.Itcanbeusedasthesolemethodofcurefortumorsinthemouthandneighboringstructures intheoralcavity,vagina,prostate,cervix,esophagus,Hodgkin'sdisease,andcertaintypesofcancerin thespinalcordandbrain.Researchandclinicaltrialshavedemonstratedthatcombinationtreatmentis moreeffectivethanradiationtherapyalone.

Chemotherapyiscurativeforonlyasmallpercentageofcancers.Itismosteffectivefor choriocarcinoma,cancerofthetestis,sometypesoflymphomas,andcancerofskeletalmuscles. Biologicaltherapiesareanewandpromisingdirectionforcancercures.Usuallywhencancercellsgrow theymanagetoderiveabloodsupplythatallowspassageofnutrientspromotingcontinuationof abnormalcancergrowth.Researchthatfocusesondestroyingthesebloodvesselsiscalledangiogenesis. Cuttingoffthebloodsupplyhasbeenshowntodestroytumors,sincethisstopstheflowofessential nutrientsrequiredforcancergrowth.Useofcertaingrowthfactorsalsocanstimulateselfdestructive pathwaysincancercells(apoptosis).Genetherapyisdirectedtowardinhibitingspecificcellularsignals thatpromotecancercellmultiplication.Theimportanceofgenetherapyincomingyearswilllikely increaseasscientistsmadeprogressin2002and2003aremappingthehumangenes(TheHuman GenomeProject)andidentifyingnewwaystofightandperhapscurecancer.Byusinggenetics,they hopetofindnewwaystoactivatehumandefensesagainsttumorcellsanddelayviralattacksoncells. Manytrialswereunderwayin2003thatshowedgreatpromise.Oneofthesein2003combinedgene therapyandchemotherapytostopbreastcanceranditsspread(metastasis). Precautions Surgicalresectionrequiresanexperiencedsurgeon,preoperativeassessment,imagingstudies,and delicateoperativetechnique.Careshouldbetakenduringtheproceduretoavoidunnecessarytumor manipulation,whichcancausecancercellstoinfiltrateadjacentstructures.Ifmanipulationisexcessive, cellscanenternearbyareasforfutureregrowth.Accurateisolationofthetumoralsocanhelpavoid contaminationofthesurgicalarea.Earlyligationofthebloodsupplytothetumorisanessential componentofasurgicalcure. Radiationtherapyrequiresextensivetreatmentplanningandimaging.Caremustbetakentolocalizethe cancerfieldwhileattemptingtosparedestructionofnormaltissue.Thisrequiresimagemonitoringand exactpositioningduringradiationtreatmentsessions. Chemotherapyusuallycausesdestructionofnormalcells,andcancercellscanbecomeimmuneto chemicaldestruction.Sideeffectsandpatienttoleranceissuestypicallyareanticipatedanddosagesmay havetobespecificallyaltered.Veryfewchemotherapeuticagentsoffercurativeresponses. Biologicaltherapiesmaycausepatienttoxicityresultinginextensivesideeffects.Thiscanoccursince theoptimaldosemaybeexceedinglyelevatedabovepatienttolerance. Description Surgery Surgicalremovalofthetumormustbeperformedwithcareandaccuracy.Thesurgeonmustavoid overmanipulationofthesurgicalfield.Toomuchmovementwithintheareacancausecancercell displacementintosurroundingtissue.Ifthisoccursandnofurthertreatmentisindicated,thetumor maygrowagain.Thesurgeonalsoshouldperformanassessmentconcerningtissueremovalaroundthe cancersite.Tissuearoundthesitemaynotbyinspectionseemcancerous,butadjacentstructuresmay havecancercellsandsurroundingtissueremovalisusuallypartoftheoperativeprocedure.Piecesof

tumorandthesurroundingareaareanalyzedmicroscopicallyduringtheoperationforcelltype.An adequateresection(removaloftissue)willrevealnormalcellsinthespecimensanalyzedfromareas borderingthecancerousgrowth.Surgeryalsocanhelptodecreasethetumorbulkand,alongwithother treatmentmeasures,mayprovideacureforcertaincancers.However,surgeryisnotalwaysthebest answer.Itgenerallyworksbestonslowgrowingcancers. Notonlycansurgerybecurativeforsomecancers,butitisanessentialdiagnostictoolthatmustbe assessedintraoperativelysincemicroscopicanalysiswillguidethesurgeonconcerningtumorand surroundingtissueremoval.Thesediagnosticproceduresincludeanaspirationbiopsy,whichinsertsa needletoextract(aspirate)fluidcontainedinsideacancerousgrowth;aneedlebiopsyusesaspecialized needletoobtainacoretissuespecimen;anincisionbiopsyremovesasectionfromalargetumor;and anexcisionbiopsyremovestheentiretumor.Thesurgeonalsocantakesamplesofneighboringlymph nodes.Cancerinsurroundinglymphnodesisanimportantavenuefordistantspreadofcancertoother areas.Ifmicroscopicanalysisdeterminesthepresenceofcancercellsinlymphnodes,thesurgeonmay decidetoperformamoreaggressivesurgicalapproach. Radiationtherapy Similartosurgicalintervention,radiationtherapyisalocalizedtreatment.Itinvolvestheadministration ofionizingradiationtoasolidtumorlocation.Thisgeneratesreactiveoxygenmolecules,causingthe destructionofDNAinlocalcells.Therearethreecommonlyusedradiationtherapybeams:gammarays fromalinearacceleratormachineproduceafocusedbeam;orthovoltageraysareoflessenergy,thus penetratelessandtypicallydeliverhigherdosestosuperficialtissues(efficientfortreatingskincancers); andmegavoltageraysarehighenergyproducingbeamsthatcanpenetratedeeplysituatedinternal organs,whilesparingextensiveskindamage.Twocommonroutescandeliverradiation.Brachytherapy deliversradiationtoalocalareabyplacingradioactivematerialswithincloseproximitytothecancerous site.Teletherapydeliversradiationtoaspecificareausinganexternalbeammachine. Chemotherapy Curativechemotherapyusuallyrequiresmultipleadministrationsofthechemicalagent.Chemotherapy orsystemictherapyisadministeredinthebloodandcirculatesthroughtheentirebody.Thechoiceof chemotherapeuticagentsdependsonthespecifictypeofcancer.Chemotherapyismorecommonly usedformetastatic(malignantcancerwhichhasspreadtootherareasbeyondtheprimarysiteof cancergrowth)disease,sinceveryfewcancersarecuredbysystemictherapy. Biologictherapy Biologictherapiesprimarilyfunctiontoalterthepatient'sresponsetocancer.Thesetreatmentsare mostlyinvestigationsandtherearenumerousresearchprotocolsstudyingtheeffectsofbiologic treatments.Theseprotocolsusuallyhavestrictadmissioncriteriathatmayexcludepotentialcandidates whocanbenefitfromtreatment.Thesetreatmentstendtostimulatespecificimmunecellsorimmune chemicalstodestroycancercells. Preparation Foralltreatmentmodalitiesimagingstudies,biopsy,andconstantbloodanalysisisessentialbefore, during,andaftertreatments.Surgicalcandidatesshouldundergoextensivepreoperativeevaluation

withimagingstudies,bloodchemistryanalysis,stabilizedhealthstatus,andreadinessofstaffforany potentialcomplicationsandcellbiopsyanalysis.Patientswithotherpreexistingchronicdiseasemay requireintensivepostoperativemonitoring. Forradiotherapy,thepatientundergoesextensiveimagingstudies.Additionalplanningstrategies includebeamlocalizationtosparenormaltissues,calibrationoffractionateddoses,andspecific positioningduringtreatmentsessions. Patientswhoreceivecurativechemotherapyshouldbeinformedofpossiblesideeffectsassociatedwith thechemotherapeuticagent.Patientsshouldalsobeinformedoftemporarylifestylechangesand medicationsthatmayoffersomesymptomaticrelief. Patientsundergoingbiologictherapiesareusuallyadvisedofpotentialsideeffects,treatmentcyclesand specifictestsformonitoringprogressaccordingtothespecificresearchprotocol. Aftercare Patientswilltypicallybeevaluatedbyimagingstudies,bloodanalysis,physicalexamination,andhealth improvement.Thesefollowupvisitsusuallyoccuratspecifictimeintervalsduringthecourseof treatment.Surgicalpatientsmayrequirecloserobservationduringtheinitialpostoperativeperiodto avoidpotentialcomplications.Reconstructivesurgerycanbeconsideredtoimproveappearanceand restorefunction.Certainsurgicalprocedures(suchasflapsandmicrosurgeryofbloodvessels)can restorenewtissuestoaprevioussurgerysite. Risks Surgicalrisks Surgicaltherapycanbebothdisfiguringanddisabling.Manynormaltissuescanbeadverselyaffectedby radiationtherapy.Sideeffectsthatcommonlyoccurshortlyafteratreatmentcycleincludenausea, vomiting,fatigue,lossofappetite,andbonemarrowsuppression(adecreaseinthecellsthatprovide defenseagainstinfectionsandthosethatcarryoxygentocells). Radiationrisks Radiationtherapyalsocancausedifficultyswallowing,oralgumdisease,anddrymouth.Additionally, radiationtherapycancausedamagetolocalstructureswithintheirradiatedfield. Chemotherapyrisks Chemotherapycommonlycausesbonemarrowsuppression.Additionally,cellscalledplatelets importantfornormalbloodclottingmaybesignificantlylowered,causingpatientstobleed.Thismay beproblematicenoughtolimitthetreatmentcourse.Bonemarrowsuppressioncanincrease susceptibilitytoinfectionandalsocauseinfertility.Patientscommonlyhaveboutsofnauseaand vomitingshortlyafteratreatmentsessio