Surgery

Surgery is the physical removal of all or part of the cancer and nearby tissue. This is considered local treatment because it only affects that specific area. You may need surgery to find out if the diagnosis is cancer, how advanced the cancer is, to remove the cancer, and/or to look inside to make sure the cancer is gone after the treatments (second look). The size and extent of the tumor will determine if surgery is an option. Surgery will only remove cancer in that area (local disease). This means if the cancer has traveled to another area, it may still grow. Surgery may also be needed if the tumor is putting pressure on organs and causing problems. The surgeon will know if he/she got all the cancer because healthy tissue will completely surround the tumor.

Surgery can be done by directly cutting the tissue, using laser beams, freezing the tumor to destroy it (cryosurgery), or using heat current (electrosurgery). Side effects of surgery depend on the location of the tumor and other factors such as age, physical condition, type of surgery, and other medical conditions that may interfere with healing. The most common side effect of surgery is pain or discomfort. Pain relief is usually temporary lasting a few days to a few weeks. Medications, meditation, and therapy may relieve pain. Fatigue is another common effect after surgery.

Chemotherapy

Chemotherapy is a medication that travels throughout the whole body in the bloodstream (systemic treatment) to attack cancer cells in most areas of the body. The advantage to systemic treatment is that any tiny microscopic cancer cells that have not been detected will be killed or slowed. Because some drugs work better together than alone, more than one drug may be given for treatment (combination chemotherapy).

Sometimes chemotherapy is the only therapy a patient receives. More often, however, chemotherapy is used in addition to surgery and/or radiation therapy (adjuvant therapy). There are several reasons why chemotherapy may be given in addition to other treatment methods. For instance, chemotherapy may be used to shrink a tumor before surgery or radiation. It also may be used after surgery and/or radiation to help destroy any cancer cells that may remain.

Your oncologist decides which drug or drugs will work best for you based on experience and research. The decision depends on what kind of cancer you have, where it is, the extent of its growth, how it is affecting your normal body functions, and your general health. The dose (amount of medicine prescribed) is based on your height and weight, then carefully calculated. This is why you need to see the oncologist often and have your weight checked. The dose may be increased or decreased depending on weight changes, severity of side effects, and response to treatment.

You may get your chemotherapy at home, your doctor's office, a clinic, a hospital's outpatient department, or inpatient. The choice of where you get chemotherapy depends on which drug or drugs you are getting. When you first start chemotherapy, you may need to stay at the hospital for a short time so that your doctor can monitor side effects closely and make any adjustments needed.

Your chemotherapy schedule depends on the kind of cancer you have, goals of the treatment, the drugs used, and how your body responds to them. You may get chemotherapy every day, every week, or every month. Chemotherapy is often given in on-and-off cycles that include days of treatment alternating with rest periods so that your body has a chance to build healthy new cells and regain its strength. Your doctor can estimate how long you will be getting chemotherapy, but this may change if you need to skip a treatment due to unforseen circumstances. Sometimes, your doctor may delay a treatment based on the results of certain blood tests. Your doctor will let you know what to do during this time and when it's safe to start your treatment sessions again.

Depending on the type of cancer you have and the drug or drugs you are getting, your chemotherapy may be given in one or more of the following ways:

1. By mouth (orally, or PO) in pill, capsule, or liquid form. You will swallow the drug, just as you do many other medications.

2. Into a muscle by an injection with a needle (intramuscularly, or IM).

3. Under the skin by an injection with a needle (subcutaneously, or SQ. or SC).

4. Directly into a cancerous area in the skin by an injection with a needle (intralesionally, or IL).

5. Topically. The medication will be applied onto the skin.

6. Into a vein (intravenously, or IV). You will get the drug through a thin needle inserted into a vein, usually on your hand or lower arm.

7. Into a thin tube (catheter) placed in parts of the body.

a. A central venous catheter is placed in a large vein. Sometimes, it is attached to a port, a small plastic or metal container placed surgically under the skin.

b. An intrathecal (IT) catheter is used to deliver drugs into the spinal fluid.

c. Intracavitary (IC) catheters can be placed in the abdomen, bladder, liver, pelvis, or chest.

Chemotherapy may be given over longer periods by a pump which controls how fast the medicine is given. External pumps remain outside the body. Some are portable and allow a person to move around while the pump is in use, and others are not and may restrict activity. Internal pumps are placed surgically inside the body, usually right under the skin. They contain a small reservoir (storage area) that delivers the drugs into the catheter. Internal pumps allow people to go about most of their daily activities.

Peripheral Venous Access

Most intravenous chemotherapy can be given by a needle or catheter in the arms. The benefits to this are that patient sedation not required, it is easily removed at completion of therapy, and it causes less chance of infection.

Central Venous Access Catheters

Many people have little or no trouble having the IV needle in their hand or lower arm. However, if a person has a hard time for any reason, or if it becomes difficult to insert the needle into a vein for each treatment, it may be possible to use a central venous catheter or port. They are often called "CVP lines" or "subclavian catheters." This avoids repeated insertion of the needle into the vein.

Central venous catheters and ports cause no pain or discomfort if they are properly placed and cared for, although a person usually is aware that they are there. If you do feel discomfort, report it immediately to your doctor or nurse. These catheters are usually sutured (stitched) in place, and if made of silicone or polyurethane, can be used up to two or three months. This type of catheter may be safely used for immunosuppressed patients that cannot tolerate surgery for other kinds of ports. These types of catheters are available in single, double or triple tubes (lumens) to allow other medications to be given at the same time.

Midline Catheters

Another type of catheter is the Midline Venous Access Device. This over-the-needle catheter may be inserted through the veins. It decreases the number of restarts often necessary with catheters used in the hand and forearms. Because the veins in the upper arm are larger than those of the hand and forearm, strong medicine gets diluted better so irritation of the veins is reduced. This is an excellent choice if intravenous therapy lasts four to six weeks.

Peripherally Inserted Central Catheters (PICC)

Made of a flexible, soft material such as silicone, polyurethane or other polymer, the PICC line is inserted into a vein at the inner elbow and threaded into the venous system. The benefit to this is that it may be inserted by a nurse in a variety of settings including the hospital physician's office, clinic or at home, eliminates potential complication risks of neck and chest insertions, is cheaper to do as it can be inserted without patient sedation or additional surgery, and removal at completion of therapy is easy. The down side of this catheter is that the location of catheter limits patients' mobility, swimming is not permitted, requires sterile dressing procedures, and needs to be maintained with heparin flushes every day.

Tunneled Catheters

These radiopaque silicone rubber catheters are characterized by a cuff attached to the catheter. These catheters are tunneled into the tissue underneath the skin. In about seven to ten days the cuff, made of Dacron, and the subcutaneous tissue begin to stick together creating a secure anchor for the catheter and a barrier against infection for approximately thirty days.

The newest tunneled catheter is the Groshong, made of thin-walled, translucent silicone with a radiopaque strip and a three-way valve at the end. This valve remains closed when not in use and allows for easy infusion or blood withdrawal. The catheter must be flushed once a week with saline when not in use.

The catheters are available in single, double or triple lumens, reduce risk of infection, are easily repaired if a catheter is damaged, and swimming and bathing are allowed after the tunnel is well healed. It requires surgery, hangs outside the chest, requires clean or sterile dressing changes, requires daily heparin flushes (except Groshong catheters that require weekly saline flushes), and may require simple surgery to remove.

Implanted Port

Implanted ports contain titanium or polyurethane and are inserted under the skin in the chest during a one day surgery. When ready to use for blood samples or intravenous therapy, a special non-coring needle is inserted through the skin into a rubber-like disk directly under the skin.

Another device available is the "PAS-PORT" which is a combination of a peripherally inserted catheter and implanted port. A catheter is inserted under the skin in the forearm and a catheter is threaded through a vein in the inner elbow. Use and maintenance of the PAS-PORT is very similar to that of the chest implanted ports.

Because implanted ports are used only when needed, a port is an ideal choice for patients requiring chemotherapy. When the port is not in continuous use, it needs to be flushed with high concentration heparin every month to keep it unclogged.

All central venous catheters and ports have benefits and risks. All can increase your risk for air bubbles causing blocked veins and arteries, blood clots, the tip of the catheter moving out of place, clogs or infection. One of the first ways you will know something is wrong is if the nurse can't withdraw blood or infuse fluids.

Chemotherapy Drugs and Common Side Effects

It is a good idea to know what drugs you are given and when the first and last doses were. This will help if you ever see a doctor in another office or emergency room that does not have access to your medical records. You can place a check mark or circle the drugs you have received. Each drug has two names, the chemical name and the trade name in parentheses. You only need to know one of the names.

Date of first dose:

Date of last dose:

Hormone Therapy

Some types of cancer depend on hormones for their growth. Hormone therapy is usually given to treat cancers that depend on hormones to grow such as some breast and prostate cancers. Doctors prescribe certain medications that prevent the body from making these hormones that feed the cancer or sometimes the doctor recommends surgical removal of the organs that make these hormones such as the ovaries or testicles. Hormone therapy is a systemic treatment when medications are used and local treatment when surgery is performed to prevent hormone production.

Hormone therapy can cause some side effects, depending on the specific drug or surgical procedure. Commonly used drugs include Tamoxifen (for breast cancer), DES or diethylstilbestrol (for breast and prostate cancers), and Megace (for kidney and uterine cancers). Side effects for women taking Tamoxifen may include nausea and vomiting or symptoms of menopause, such as hot flashes, weight gain, irregular periods, vaginal dryness, and infertility or ability to reproduce. In men, hormone therapy may cause impotence, loss of sexual desire, or infertility. These effects may be temporary or permanent.

Radiation

Radiation, also called radiotherapy, is treatment using special high energy X-rays to focus on specific areas of the body affected or potentially effected by cancer so that cancer cells will stop growing. This is a local treatment. Radiation can be external (teletherapy)(from a machine that points rays through the skin to tissue affected by cancer or internal (brachytherapy) by placing (surgically implanting) a small container of radioactive material near or in the tumor.

External radiation is usually done on an outpatient basis in a hospital or clinic. It treats a specific area. Your first or second appointment with the radiation oncologist will involve a simulation where they will tattoo you with tiny dots so the treatment can be given in the exact location each time. The actual treatment itself lasts a few seconds to minutes. It involves you lying on a table and a machine similar to an X-ray machine will deliver the radiation. It is a pain free procedure. The schedule can vary, but usually treatments are done daily for five days a week for several weeks. People who have external radiation are not radioactive during or after each treatment.

Internal radiation requires a hospital stay for a few days or weeks. The implant may be temporary or permanent. Visitors and hospital staff must follow special precautions to protect themselves from radiation exposure since the patient is radioactive while the implant is releasing radiation. Once the implant is removed, there is no radioactivity in the body. A sealed radioactive chemical is inserted temporarily or permanently into hollow areas, tissues, or on the body's surface. Unlike external radiation, which gives a specific daily dose of radiation within a short time, implants release a specific dose of radiation continuously over several hours or days. While external radiation spreads radiation more evenly, to a larger area of tissue, implants give a highly concentrated dose in or near the tumor site and much lower doses to nearby tissue. When the implant is removed, there is no radioactivity in your body.

Radiation therapy side effects depend on the part of the body treated, dose and length of treatment. Fatigue, nausea, loss of appetite, diarrhea, rash or redness of the skin, immunosuppression where the white blood cell count falls below the normal level making the body helpless to fight infection. Most effects last a short time, but others may be permanent.

Biological Therapy

It is also called immunotherapy. This method of treatment uses biological response modifiers (BRMs) that use the body's natural ability to fight infection and illness. This can be used as a treatment, or in addition to treatments such as chemotherapy to protect the body from some side effects of other treatments. Biological therapy has its own side effects depending on the type of medication used (Interferons, Interleukins, Tumor Necrosis Factors). Flu-like symptoms like chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, diarrhea or rash are most common and usually stops a few weeks after the last treatment is given.

Colony Stimulating Factors (CSF)

These are injections are usually given during chemotherapy when your blood cell count is too low too often or if the medication you are receiving is known to cause the cell count to drop too low. Certain medications will affect your white count, hematocrit, or platelets. It forces the body to make these cells faster than so you can receive the dose you need without having to skip chemotherapy or lower the dose.

The shots start twenty-four to forty-eight hours after chemotherapy is given. You will receive the shots daily in the hospital, clinic, or at home if you or someone else can be taught to give the injections to you. Most of the time, you will get the shots for nine to twelve days depending on the results of blood work which will show how well your body is responding to the medication. Your blood levels may still drop low, but not as low as they would have without the shots.

Most people tolerate the shots well. You may feel a stinging when the injection is given. If this bothers you, you can put something cold over the area. Now and then, people may get headaches, muscle aches, and bone pain. It may only happen for a few days during the first series of shots. What you are feeling is the body releasing the baby cells from inside the soft part of the bones into your bloodstream so they can become adult cells faster. Often, the arms, legs, and spine are involved because that is where the biggest bones are. Most doctors will tell you to take Tylenol a half hour before receiving the shot. Others may have you take the shots before bedtime so you can sleep off the discomfort. Speak to your doctor to find out what you can do to be more comfortable.

Clinical Trials

These are the latest research findings in cancer treatment offered to cancer patients. It can involve chemotherapy, radiation, surgery, medications individually or in combination. These trials allow the new treatment to be given under carefully controlled and monitored conditions. Often, clinical trials can compare standard treatments (treatments known to work) to newer ones. They find out which ones are most successful in treating certain cancers or how to reduce side effects and improve the quality of a person's life during and after treatment. To be able to enter clinical trials, more X-rays and tests will be done to see if you qualify for the trial.

A study must go through four phases or steps before being approved by the FDA (Food and Drug Administration). In a Phase I study, the treatment being studied is given to a small number of human patients. The researchers must find the best way to give a new treatment and how much of it can be given safety. They watch carefully for any harmful side effects. The research treatment has been well tested in laboratory and animal studies first but no one knows how patients will react. Phase I studies may have many risks for this reason. They are offered only to patients whose cancer has spread and who would not be helped by other known treatments. Phase I treatments have helped some patients.

Each new phase of a clinical trial depends on and builds on information from an earlier phase. If a treatment worked fighting cancer in Phase II, it moves to Phase III. Then it is compared with standard treatment to see which is best. Often researchers use standard therapy as the model to make new and better treatments. In Phase IV studies, the new treatment becomes a standard treatment that is accepted and approved in patient care.

You will be asked to sign an informed consent form. Your signature means that you are given information on the benefits and risks of treatment so that you can decide if you want to participate. In any clinical trial you can always stop treatment anytime without consequences.

Bone Marrow Transplant and Peripheral Blood Stem Cell Transplantation (PBSCT)

Bone marrow transplants (abbreviated BMT) are used to treat leukemia, Hodgkin's disease, lymphoma, melanoma, sarcoma, breast cancer, multiple myeloma, brain tumors, lung cancer, ovarian cancer, and testicular cancer. In the future, there may be new uses for other cancers and illnesses. There are three types of transplants, allogenic (sibling or someone else is the donor), autologous (your own bone marrow is used), and syngeneic (donor is a twin).

For allogenic and syngenic bone marrow transplants, a donor or your brother or sister will need to go to the hospital for one or two days to have a bone marrow aspiration. (See chapter 2). About a pint for a child and a quart for adult will be removed from the hip bone under local anesthesia. The marrow is then treated with heparin to prevent it from clotting while it is harvested. Harvesting means making more. You will then have chemotherapy or radiation to kill cancer cells in your body. The harvested bone marrow will be given by an intravenous infusion 24 to 72 hours after the last dose of chemotherapy (rescue). This requires hospitalization for three to four months. An autologous transplant is the same as allogenic, except that the bone marrow is taken from your own body, then harvested, and your hospital stay is decreased to three to four weeks. Peripheral blood stem cell transplantation involves taking blood from the vein (apheresis), having chemotherapy, then reinfusing the blood through a vein.

Side effects of BMT:

1. Neurological problems such as headache, sleepiness, personality changes, memory loss, confusion, peripheral neuropathy, vision changes, hearing loss, weakness, or slurred speech.

2. Infections from bacteria, fungus, or virus.

3. Graft verses host disease where your body rejects the marrow of your sibling donor.

4. Heart problems.

5. Lung problems like pneumonia, damage, and scarring.

6. Stomach and bowel problems like nausea, vomiting, mouth sores, and diarrhea.

7. Veno-occlusive disease where parts of the liver become clogged and cause a back flow of blood.

8. Urinary problems of the kidney and bladder.

9. Low white blood count, platelets, and anemia.

10. Skin changes and hair loss. (Basically any of the side effects of chemotherapy).

11. Cataracts may develop three to six years after BMT.

12. A second type of cancer may develop.

Instructions for after the transplant:

1. Avoid sun.

2. Skin care.

3. Clean home with antiseptic disinfectant.

4. Do not change cat litter, bird cages, etc.

5. No gardening or repotting soil.

6. Avoid infection.

7. Follow mouth care.

8. Bleeding precautions.

9. Avoid immunizations/vaccinations for you or nearby loved ones.

Other (Unproven Methods)

Often people hear of a "cure for cancer" that is not medical based. These so-called treatments are advertised as breakthrough cures and can trick the public into believing they really work. Unproven methods mean "methods that have not been shown to work in animal studies or in human clinical trials and yet are promoted as effective methods for a cure, palliation (relieve symptoms), and control of cancer." Be very suspicious of these and always consult your doctor before trying any of them.

When investigating a new treatment, there are certain characteristics of unproven methods that you need to know about before you waste you time and money. Some are:

1. What is the background of the promoter? Does he/she have formal oncology training/licences or just alternative degrees (e.g., chiropractor, naturalist, naprapathist). Do they have meaningless letters after their names?

2. What scientific studies have been done? Are the results of the studies distorted? Do they show so-called success stories? Are there proven and reproducible facts? Is the information classified? Is the "secret cure" known only to the promoter?

3. Are the reports common on TV or in magazines, not medical publications?

4. Does it blame the patient rather than treatment for failures?

5. Are special nutritional changes needed?

6. Are there claims of treatment being harmless, painless, and nontoxic?

7. Are there claims that doctors or the government are trying to keep the cure of cancer from public?

8. Are there attacks on medical and scientific industries?

Motivations for the Use of Unproven Methods

Fifty percent of cancer patients will use unproven methods for a variety of reasons.

1. "I have nothing to lose" or "If won't hurt me, why not try it?".

2. They need hope and will seek out people and methods that promise a cure.

3. They are confused by disagreeing reports of cure rates and frightened by risks and side effects. Many unproven methods promise no side effects.

4. By using a miracle therapy, the patient hopes for a miracle cure.

5. May give a greater sense of control instead of feeling helpless.

6. Pressures to experiment from family and friends.

Unproven Methods:

Antineoplastons

Antonio Agpaoa, the "Psychic Surgeon"

Carey Reams

Chaparral Tea

Contreras Methods

Dimethyl Sulfoxide (DMSO)

Electronic Devices

Foundation for the Study of Degenerative Diseases

Fresh Cell Therapy

Gerson Method of Treatment for Cancer

Hariton Alivizatos, MD (Greek Cancer Cure)

Homeopathy (1850-1900)

Hoxsey Method (1950's)

Immune-augmentative treatment (IAT)(Reported to bolster the immune system)

Independent Citizens Research

International Association of Cancer

Iscador

Issels Combination Therapy by Joself Issels, MD

Ivy's Krebiozen (1960's)

Kelley Malignancy Index and Ecology Therapy

Koch Antitoxins/Koch's glyoxilide antitoxin therapy (1940's to 1950's)

Laetrile (1970's)

The Committee for Freedom of Choice in Cancer Therapy, Inc.

The Immuno-Augmentative Therapy of Lawrence Burton, PhD, Bahamas

Thompsonianism (1800-1850)

Victims and Friends, Inc.

Virginia Wuerthele-Casp Livingston, MD and Eleanor Alexander-Jackson, PhD PPLO Vaccine and Test

Vlastimil (Milan) Brych

The Metabolic Cancer Therapy of Harold W. Manner, PhD

Metabolic therapies include diet changes, chemicals that flush out the colon, vitamins, and minerals. They believe that constipation, or inadequate elimination of wastes from the body, interferes with metabolism (changing food into energy) and healing. The goal of therapy is to add or restrict foods to purge or cleanse the body of so-called toxins (poisons). The Gerson method includes avoiding cancer-causing risks, a positive mental outlook, eliminating wastes from the body, diets high in fruits, vegetables, and potassium and low in fats, oils, animal proteins, and sodium, coffee enemas and additional vitamins, minerals, and enzymes. No one has proven that there are any benefits of these for the treatment of cancer.

Macrobiotic diets are based on the Zen ideas of yin and yang. Each tumor is caused by an imbalance of yin and yang foods in the diet. Balance is reached through cooking techniques and a correct attitude toward life. Diets are heavy in whole cereal grains and vegetables. Excessively "yin" or "yang" foods such as meat, animal fat, eggs, dairy products, certain fruits, coffee, and sugar are avoided.

Macrobiotic therapy may result in poor nutrition, weight loss, vitamin and protein losses, and may cause a serious health problems. With proper planning, however, a vegetarian diet can be nutritional. No evidence shows that macrobiotic diets help in the treatment of cancer.

Megavitamins may be advertized as a cure for cancer. Megadoses of vitamin C, vitamin A, Vitamin B17 and pangamic acid (vitamin B15) have been claimed to have anti cancer effects. Objective studies have shown vitamin C therapies to be worthless and may cause severe kidney damage. Vitamin A has no clear value in cancer treatment, and doses five times the recommended dietary allowance may be poisonous. Pangamic acid is illegal in the United States. Chemicals labeled "pangamate" may cause cancer.