1. Cancer Treatment Options: Medical Interventions Where Health Care Professionals Go for Information Review Date 2/12 O-0535 Contributed by Jason Machowsky, MS, RD, CDN, CSCS

2. This presentation provides general information about cancer treatment options. Consult with your health care professional if you have any questions or for additional information because each case is unique. Where Health Care Professionals Go for Information

3. Conventional Treatment Options Surgery Chemotherapy Radiation therapy

4. Surgery Sometimes used to diagnose, treat, or prevent (prophylactic) cancer Extent of surgery and potential for anesthesia depends on condition Preoperative testing sometimes needed to determine appropriateness and ability to recover from surgery

5. Surgery (cont’d) “The best chance of a cure from many types of cancer is to remove all of the cancer as soon as possible after diagnosis. If you have a solid tumor, sometimes surgery alone will cure the cancer, but you may need chemotherapy, radiation therapy, or other treatment, too. Your health care team will discuss your best treatment options with you.” Source: American Cancer Society Web site

6. Surgery (cont’d) Minor surgeries and biopsies have lower risk than major surgery/incisions Risks are generally low, but may include: –During surgery: Bleeding, damage to internal organs, and reactions to anesthesia or drugs used –After surgery: Pain, infection, bleeding, and slow recovery of other body function (ie, bowels)

7. Chemotherapy Use of medicines or drugs to treat cancer/disease Unlike radiation or surgery that targets a particular area, chemotherapy works throughout the body and can kill cancer cells that have spread to other parts of the body, far from the original tumor

8. Chemotherapy (cont’d) Goals of chemotherapy: Cure, slow growth, kill any spreading cancer cells, and relieve cancer symptoms May receive chemotherapy orally, via the skin, or injected into the body

9. Chemotherapy (cont’d) Potential side effects: –Anemia –Fatigue –Hair loss –Increased risk of bleeding, bruising, and infection –Nausea and vomiting –Appetite changes and/or weight change

10. Chemotherapy (cont’d) Potential side effects (cont’d): –Constipation and/or diarrhea –Mouth, gum, and throat problems –Nerve or muscle problems –Skin and nail changes –Bladder, kidney, or urine problems

11. Radiation Therapy Local exposure of the body to high energy particles or waves (X-ray, gamma rays, electron beams, etc) to destroy or damage cancer cells Often performed multiple times for the same cancer

12. Radiation Therapy (cont’d) Many types of radiation therapy treatments are available—selection depends upon the cancer and severity Sometimes given orally or intravenously (IV), but still usually has only local effects Given alone or in conjunction with other treatment

13. Radiation Therapy (cont’d) Potential side effects: –Fatigue –Skin problems –Hair loss –Blood count changes –Eating problems –Damage to healthy cells –Small, but increased risk of another cancer

14. Taking Care of Yourself During Radiation Get rest Eat a balanced and nutritious diet Take care of your skin at the treated area Tell your doctor about all medications before treatment

15. Progressive Treatment Options Targeted therapy Immunotherapy Hyperthermia Lasers Photodynamic therapy Bone marrow and stem cell transplants Molecular targeted therapy

16. Targeted Therapy Drugs that specifically target cancer cells by identifying cancer-specific gene changes Can typically attack cancer cells with little damage to normal cells, resulting in different and usually less severe side effects than traditional chemotherapy

17. Targeted Therapy (cont’d) Used for many types of cancer to cure, slow growth, kill metastases, or relieve symptoms Types of targeted therapy: –Enzyme inhibitors –Apoptosis-inducing drugs –Angiogenesis inhibitors

18. Targeted Therapy (cont’d) Side effects and severity vary based on the person and type of cancer treated Potential side effects: –Skin problems (ie, rash, dry skin, and itching) –Changes in hair growth or color –Changes around the eyes –High blood pressure –Bleeding and clotting issues

19. Targeted Therapy (cont’d) Potential side effects (cont’d): –Nausea and vomiting –Constipation –Mouth sores –Shortness of breath –Cough –Fatigue –Headache –Hand and foot swelling

20. Immunotherapy Uses your own immune system to fight cancer by stimulating your own immune system (active) or supplementing with immune system components (passive) May treat some cancers on its own, but typically used in conjunction with other treatments

21. Immunotherapy (cont’d) Examples include monoclonal antibodies, vaccines, and immunomodulating agents Certain immunotherapy agents are approved to treat certain cancers Side effects depend on type of immunotherapy performed

22. Immunotherapy (cont’d) Side effects may include: –Fever –Chills –Weakness –Headache –Nausea and vomiting –Diarrhea –Low blood pressure

23. Immunotherapy (cont’d) Side effects may include (cont’d) : –Rashes –Bleeding –Fatigue –Joint pain –Thinning hair

24. Hyperthermia Currently experimental and not widely used (under clinical trials) May use high temperatures in localized areas to destroy small tumors Raises regional or total body temperature to promote better effects of chemotherapy or radiation therapy

25. Hyperthermia (cont’d) Careful control of temperature, time, and location is important, but not always easy to do

26. Hyperthermia (cont’d) Local side effects may include: –Pain –Infection –Bleeding –Blood clots –Swelling –Burns and blistering –Local tissue damage

27. Hyperthermia (cont’d) Regional/whole body side effects may include: –Nausea and vomiting –Diarrhea –Potential, but rare, problems with the heart, blood vessels, and other major organs

28. Lasers For very careful surgical work, such as cutting through body tissue or repairing the retina Different types include CO 2, argon, and neodymium Shrinks or destroys a tumor with heat May activate a drug as part of photodynamic therapy

29. Pros: –More precise than scalpels –The heat can help sterilize during cutting and reduce infection risk –Less bleeding, swelling, pain, or scarring –May shorten operating time, even outpatient –Often less invasive –Healing time typically shorter Lasers (cont’d)

30. Drawbacks: –Few doctors are trained to use lasers –Lasers are expensive and large compared to other surgical instruments –Strict surgical safety precautions required –May require multiple treatments to fully eliminate a cancer

31. Photodynamic Therapy Uses specialized photosensitizing agent drugs, typically injected into the bloodstream, and light to kill cancer cells Drug is absorbed over time by the cancer cells and light is applied to: –Create a chemical that kills the cells –Destroy cancer-feeding blood vessels –Alert the immune system to attack cancer cells

32. Photodynamic Therapy (cont’d) As effective as surgery and radiation in certain cancers, but can only impact areas reached by light (skin and linings of organs) Drugs on market: –Porfimer sodium –Aminolevulinic acid (ALA) –Methyl ester of ALA

33. Photodynamic Therapy (cont’d) Pros: –No long-term side effects when used properly –Less invasive than surgery –Usually quick, outpatient treatment –Can have precise targeting –Can repeat at the same site –Little or no permanent scarring –Costs less than many other treatments

34. Photodynamic Therapy (cont’d) Drawbacks: –Not always appropriate for deeper or significantly spread cancers –Not used for those with certain blood diseases or who are allergic to porphyrins –Skin and eyes may stay sensitive to light for some time, from 30 days – 3 months –Swelling in the treated area

35. Photodynamic Therapy (cont’d) Side effects depend on the drug and treatment site, but may include: –Nausea and vomiting –Fever –Dehydration –Headache –Hiccups

36. Photodynamic Therapy (cont’d) Side effects depend on the drug and treatment site, but may include (cont’d) : –Shortness of breath –Coughing up blood –Pneumonia –Bronchitis

37. Bone Marrow and Stem Cell Transplants Can help with certain leukemia, myeloma, and lymphoma treatments May use to replace bone marrow destroyed by disease, including blood-related cancers, chemotherapy, or radiation Stem cells are grafted into the patient after a high dose of radiation/chemotherapy May come from patient or matched donor

38. Bone Marrow and Stem Cell Transplants (cont’d) Tests are required to determine appropriateness for procedure Patients who do best are usually: –Younger –In early stage of disease –Have not already had many treatments

39. Bone Marrow and Stem Cell Transplants (cont’d) Insurance may not cover or cover well In-patient hospital stay necessary Significant demand placed on the body, possibly including central venous line placement

40. Bone Marrow and Stem Cell Transplants (cont’d) Possible short-term side effects : –Fever and chills –Shortness of breath –Hives –Chest tightness –Low blood pressure

41. Bone Marrow and Stem Cell Transplants (cont’d) Possible short-term side effects (cont’d): –Coughing –Chest pain –Low urine output –Weakness

42. Bone Marrow and Stem Cell Transplants (cont’d) Possible long-term side effects, including 1 year later: –Graft-versus-host disease –Infections –Lung, kidney, liver, and heart problems –Low thyroid levels –Fatigue –Memory loss –Depression

43. Bone Marrow and Stem Cell Transplants (cont’d) Possible long-term side effects, including 1 year later (cont’d) : –Cataracts –Slowed growth (children) –Reproductive problems –Secondary cancers –Changes in social relationships and feelings

44. Molecular Targeted Therapy High specificity medications designed to inhibit proteins, genes, and pathways unique to cancerous cells Can help fight or delay progression of the disease Still new to the market and clinical trials Availability depends on type of cancer

45. Molecular Targeted Therapy (cont’d) Usually used in combination with traditional therapies Fewer side effects than other options: –Diarrhea –Skin rash –Fatigue

46. References and Resources American Cancer Society ®. Treatment types. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTy pes/indexhttp://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTy pes/index. Accessed February 23, 2012. For more references and resources on cancer, visit the Oncology Center at http://rd411.com/. http://rd411.com/