1. TREATMENTS Surgical Oncology Chemotherapy Radiation Therapy Bone Marrow Transplant Complementary Medicine Psychotherapy

2. Surgical Oncology (Surgery) ____________ form of tx for cancer. First step in tx b/c used to dx & tx. Alone cures cancer. Used in conjunction w/ other txs.

3. Types of Surgery Staging Surgery –Determines the extent of the disease –Most accurate assessment of how far the cancer has spread ____________ Surgery –The removal of a tumor when it appears to be confined to one area –Done when there is hope of taking out all the cancer –Primary treatment of cancer –Used alone or in combination w/ other treatments

4. Types of Surgery Debulking Therapy –Removal of as much of the cancer as possible –Usually done when removing cancer entirely would cause too much damage to organs or surrounding tissue. Diagnostic Surgery –A tissue sample obtained to determine if cancerous or to determine the type of cancer –Confirmed by looking at cells under a microscope Preventative (Prophylactic) Surgery –Removes tissue that is _______________________ but likely to become.

5. Risks & Side Effects Pain (most common) Infection at the site of the wound Bleeding internally or externally Damage to internal organs and blood vessels Reactions to anesthesia Problems with other organs Blood clots Slow recovery of other body fxns

6. Chemotherapy Defined as the use of medications or chemicals with cancer fighting abilities –Anticancer agents –Interfere w/ the cancer cells’ ability to grow or multiply –Identification of disease important because some work best for certain diseases

7. How is Chemotherapy given? IV (intravenous) Oral Intramuscular Intrathecal (IT) Intraperitoneal (IP) Implanted Intravenous Port

8. Side Effects of Chemotherapy Damage to normal cells as well as cancer cells –Hair follicles –Cells in gastrointestinal tract –Bone Marrow Can cause graft rejection Hair loss (alopecia) Mouth sores Difficulty in swallowing, nausea, diarrhea, infection, anemia Increase risk of bleeding

9. Radiation Therapy X-ray Therapy High energy that comes from special machines or radioactive sources Destroys cells or keep them from growing or dividing Effective way to treat many kinds of cancer in almost any part of the body ½ of all patients treated with radiation Combined with other treatments

10. X-ray Therapy is given __________________ –Swallowed or injected into the body –Admitted to the hospital 3-7 days Externally –Doses of radiation given to carefully defined area –Directs the x-ray particles at the cancer and the normal tissue –Given in small doses –Once a day over a period of 3 to 7 wks –Tx during outpatient visit.

11. Radiation Side Effects Can hurt _________________ Generally limited the region of the body being treated Skin reaction, reddening irritated, dry or sensitive Hair loss Nutritional problems Fatigue

12. Bone Marrow Transplant Bone Marrow –Spongy substance inside our _______ bones –Made up of hematopoietic stem cells –These cells are given (transplanted) from donor to patient

13. 2 Types of Transplant Autologous Transplant –Structures of cells derived from you and your body Allogeneic Transplant –Transplanted cells are coming from donor –_____________ means cells come from identical twin The cells must be “matched” to the patient which is done by Human Leukocyte Antigen (HLA)

14. Transplant Side Effects Destruction of the bone marrow leading to low blood counts –Include bleeding due to low platelet cts –Infections due to low blood cell cts –__________ due to low red blood cell cts

15. Graft vs. Host Disease Donor’s cells attack the _______________ Can affect the skin (rash, intestinal tract (diarrhea), and liver Can occur anytime after transplant Treated with immunosuppressing medications including steroids and antithymocyte globulin (Atgam)

16. Graft vs. Tumor Effect Good Donor’s cells attack any remaining cancer cells Producing new blood cells Carefully manage this balance Graft failure occurs when the donors cells fail to start working. If engraftment has not occurred by 42 days after transplant, graft has failed.

17. Transplant Side Effects (cont..) Pulmonary complications –Generally caused by _______________

18. Psychotherapy Psychological interventions Can effectively reduce ______________ in patients undergoing treatment Includes counseling to alleviate stress Improve patient well-being Does increase or extend the life of cancer patients.

19. Costs of Cancer Treatments Table 1: National Cancer Treatment Expenditures in Billions of Dollars – 1963-1995. Year Cancer Treatment Spending Total Health Care Spending Percent of Cancer Treatment Spending to Total 1963 $1.3 billion$29.4 billion4.40% 1972 $3.9 billion$78 billion5.00% 1980 $13.1 billion$217 billion6.00% 1985 $18.1 billion$376.4 billion4.80% 1990 $27.5 billion$614.7 billion4.50% 1995 $41.2 billion$879.3 billion4.70% Data source: Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annual Review of Public Health 2001;22:91-113. Cancer Progress Report 2001 (http://progressreport.cancer.gov/) National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

20. Table 2: Estimates of National Expenditures for Medical Treatment for the 13 Most Common Cancers – Based on Cancer Prevalence in 1996 and Cancer-Specific Costs for 1995-1998, Expressed in 1996 Dollars. Percent of all new cancers (1998) Expenditures (in 1996 dollars) Percent of all cancer treatment expenditures Average Medicare payments per individual in first year following diagnosis Breast18.2%$5.4 billion13.10%$9,230 Colorectal11.7%$5.4 billion13.10%$21,608 Lung12.5%$4.9 billion12.10%$20,340 Prostate13.6%$4.6 billion11.30%$8,869 Lymphoma4.2%$2.6 billion6.30%$17,217 Bladder4.0%$1.7 billion4.20%$10,770 Cervix2.3%$1.7 billion4.10%$13,083 Head/Neck3.3%$1.6 billion4.00%$14,788 Leukemia2.1%$1.2 billion2.80%$11,882 Ovary1.7%$1.5 billion3.70%$32,340 Melanoma5.2%$0.7 billion1.70%$3,177 Pancreas2.1%$0.6 billion1.50%$23,504 Esophagus0.9%$0.4 billion0.90%$25,886 All Other18.1%$8.7 billion21.20%$17,201 Total100.0%$41.0 billion100% Data source: Brown ML, Riley GF, Schussler N, Etzioni R. Estimating health care cost from SEER-Medicare data. Submitted to Medical Care. Cancer Progress Report 2001 (http://progressreport.cancer.gov/) National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

21. Which one is most effective? Really can’t say Treatments are used in combination with each other to get best results.