There are various types of cancer treatments, and the type a patient receives depends upon the cancer type and stage.  We are here to get the answer of How the cancer is treated.

Following are some stages of cancer treatment:

Biomarker testing: 

This testing is a way to look for proteins, genes or other substances called “tumour markers or biomarkers” that can provide data about cancer. Each case has a unique pattern of biomarkers, and relative to that, the treatment type is selected. Some other types of biomarkers help doctors to monitor cancer after treatment as well.

People with blood testing and solid tumours can get biomarker testing. Biomarker testing.

Following are some alternative names for biomarker testing:

  • genomic testing or genomic profiling
  • tumour testing
  • tumour subtyping
  • tumour genetic testing
  • molecular testing or molecular profiling
  • somatic testing

A biomarker test is called a companion diagnostic test when paired with a specific treatment.

How biomarker testing is part of precision medicine? 

Precision medicine is also called personalized medicine. In precision medicine, disease diagnosis, prevention and treatment are tailored to the proteins, genes and other body substances. In cancer treatment, the meaning of precision medicine is using different tests, including biomarkers, to select treatments that are most likely to be effective in a personalized way.

Biomarker testing in some cases is done routinely to identify treatment for patients having certain types of cancer, including breast cancer, non-small cell lung cancer and colorectal cancer.

cancer

How is the biomarker testing done?

The sample of cancerous cells (tumour) is taken during surgery or through biopsy, or in blood cancer, liquid biopsy is done. FDA approved two types of liquid biopsy tests (Food and drug administration), called “FoundationOne Liquid CDx” and “Guardant360 CDx”.

These samples are sent to a lab for biomarker testing, and the treatment plan is decided accordingly. In some cases, a sample of healthy cells is taken compared to cancerous cells to find genetic changes (known as somatic mutations).

How is the biomarker testing done

What are the different types of biomarker tests?

Some biomarker tests look for genetic markers, while others look for proteins or other types of markers. In addition, some tests check for various biomarkers simultaneously and are known as panel tests or multigene tests.For example, the “Oncotype DX test” deals with 21 types of different genes to predict whether chemotherapy will work for someone with breast cancer.

Some tests are specific for certain cancer types, e.g., melanoma, other tests known as “whole-exome sequencing” look at both the genes and outside of genes in cancer.

Some biomarker tests look at the various number of genetic changes in cancer (known as tumour mutational burden). This information helps to figure out the type of “immunotherapy” approach to be selected.

What are the different types of biomarker tests

Chemotherapy: 

Chemotherapy works by slowing down or stopping the growth of the cancerous cells, which divides quickly. It is used in :

  • Treating cancer: For curing cancer and lessening the chances of its return.
  • Easing symptoms of cancer: Foe shrinking painful tumours.

How is chemotherapy coupled with other treatment types?

With other treatments, chemotherapy can aid in either of the following ways:

  • Shrinking the tumour prior to surgery, known as “neoadjuvant chemotherapy”.
  • Destroying cancerous cells that are left after certain treatment with Radiation or surgery, known as adjuvant chemotherapy.
  • Helping other treatments to work better
  • Killing cancerous cells that have spread to other body parts

How Chemotherapy is given?

Chemotherapy is given in the following ways :

  • Intravenous: Directly into the vein
  • Oral: Chemotherapy comes in capsules, pills or liquids.
  • Intrathecal: Chemotherapeutic agent is injected between the layers of tissue covering the spinal cord and brain.
  • Injection: Chemotherapy is given by the shot in muscles, in the fatty part right under the skin
  • Intraperitoneal: Chemotherapy directly goes into the peritoneal cavity (the area in your abdomen containing the organs such as stomach, liver and intestines.
  • Intra-arterial: Chemotherapeutic agent is injected into the artery
  • Topical: Chemotherapy comes in the form of ointment/cream that is rubbed onto the skin.
  • Intra-venous: Chemotherapy is often given intravenously.
  • Pumps: With ports and catheters, pumps are also used for chemotherapy.

How Chemotherapy is given

Hormone Therapy: 

It is a cancer treatment for slowing down the growth of cancerous cells using hormones. It is also known as endocrine therapy.

How Hormone Therapy works:

Easing symptoms: Hormone therapy may be used to alleviate symptoms in men having prostate cancer who can not have radiation therapy or surgery.

Treating cancer: Hormone therapy can lessen the chance of cancer returning or stop its growth.

Hormone therapy types: It falls into two broad groups, one that blocks the body’s ability to produce hormones and interferes with hormones mechanism inside the body.

Who receives hormone therapy: It is used to treat breast and prostate cancers. The type of hormone therapy depends on the cancer type, how far it is spread and how it will impact other health problems.

Hormone Therapy to be used with other cancer treatments: 

Hormone therapy and other cancer treatments make the tumour smaller before Radiation or surgery, which is called neoadjuvant therapy. Whereas in “adjuvant therapy”, the risk of cancer returns after main treatment is alleviated.

How Hormone therapy is given:

Hormone therapy is given orally (pills), injected in vessels or through surgery.

Immunotherapy to treat cancer: 

It is a type of cancer treatment that helps the immune system to fight cancer. Immunotherapy comes under the category of biological therapy.

How does immunotherapy work against cancer?

The immune system detects and destroys abnormal cells and prevents the growth of many cancers. For example, in some cases, immune cells are found around tumours. These are “tumour-infiltrating lymphocytes”. These cells recognize and kill the cancerous cells.

In cancer therapy, Tumour-infiltrating lymphocyte cells are removed, and grown in large numbers (in the laboratory), given back to the patient to aid the immune system kill the cancer cells.

How does immunotherapy work against cancer

 What are the different types of immunotherapy?

Several kinds of immunotherapies are used for treating cancer; names are mentioned below:

  • Immune Checkpoint Inhibitors:
  • T-cell transfer therapy
  • Monoclonal antibodies (therapeutic antibodies)
  • Treatment vaccines
  • Immune system modulators

Radiation Therapy: 

In Radiotherapy, high doses of Radiation are used in order to shrink tumours and kill cancer cells.

How Radiation works against cancer:

The high dose of Radiation damages the DNA of cancerous cells, and when DNA is damaged beyond repair, cancer cells stop dividing and die. Though this process takes a long time, these life-less cells are broken down and removed by the body.

Types of Radiation Therapy:

Two main types of radiation therapy are:

  • External Beam Radiation Therapy

Radiation beams are sent on the affected part of the body from many directions externally. It is a local treatment which means it treats a specific part of the body. For example, targeting only the chest area in case of lung cancer.

  • Internal Radiation Therapy

It is the treatment in which the radiation source is inserted or administered inside your body, which can be in either a solid or liquid state. In the case of solid sources, internal radiation therapy is called brachytherapy. In this treatment, seeds, capsules or ribbons containing the radiation source are placed inside the body, near the Tumor.

Brachytherapy: Solid source internal radiation therapy is called brachytherapy. Brachytherapy is used to treat cancers of the breast, prostate, cervix, eye, head and neck.

How Radiation works against cancer

Systemic therapy: Liquid source internal radiation therapy is called systemic therapy.

The radiation source travels through the blood to the tissues in systemic radiation therapy, killing cancerous cells. Then, it takes an IV (intravenous) line or orally.

Using radiations with other cancer treatments:

Sometimes other cancer treatments are coupled with radiation therapy, .such as chemotherapy. Immunotherapy and surgery.

When radiation therapy is combined with surgery, it can be :

  • Given before surgery to shrink cancer size.
  • Given during surgery, it hits the affected area only, without affecting the healthy skin and muscles in its way.
  • Given after surgery to kill remaining cancerous cells.

Stem cell transplant: 

The stem cell transplant is used to restore the blood-forming stem cells in patients who have lost theirs due to very high doses of radiation or chemotherapy. The stem cells are crucial for blood formation, and the main types of blood cells involved in this are :

  • White blood cells, which are an important part of the immune system
  • Red blood cells, which carries oxygen to be delivered to your body tissues
  • Platelets, which help in coagulation, blood clotting.

The types of cell transplants: 

 In this process, you receive the healthy blood-forming stem cells through a needle in your vein. These cells are taken from the bloodstream, bone marrow or umbilical cord. Then, these stem cells travel to your bone marrow travelling through the blood.

Transplants can be:

Allogeneic: The stem cells are taken from the donor.

Autologous: The stem cells are taken from the patient himself.

Syngeneic: The stem cells are taken from an identical twin.

How the stem cell transplant works: 

The transplanted stem cells work indirectly by helping the patient produce his stem cells (which is usually compromised due to high doses of chemotherapy and Radiotherapy).

In some cases, stem cell transplant works against cancer directly. For example, in the case of leukaemia or multiple myeloma, the effect of “graft-versus-tumour” occurs after allogeneic transplants. The “graft versus tumour” phenomenon works in the way that white blood cells from the donor attack the cancer cells left in the body after high dose treatments, hence improving the success of treatments.

Surgery:

In this treatment, the cancer part is removed from the body. Mostly the cuts are involved in the process with scalpels and thin knives. But other ways do not involve cuts, including:

  •      Cryosurgery/cryotherapy: 

It is the type of treatment involving extreme cold liquid usage (in argon or nitrogen gas) that destroys abnormal tissues. Cryosurgery is used to treat skin cancer of early-stage retinoblastoma ( eye cancer)

  •      Lasers: 

In this treatment type, powerful beams are used to cut the tissues. Lasers focus on accurate tiny areas for precise surgeries. Lasers are also used to destroy or shrink growths that might turn into tumours.

  •      Hyperthermia: 

It is the treatment type in which precise body tissues are exposed to very high temperatures. The high heat either damages and kills cancerous cells or makes them more sensitive to chemotherapy drugs or Radiation.

  •      Radiofrequency ablation: 

It is the type of procedure involving high-energy radio waves for generating heat and is used for hyperthermia.

  •      Photodynamic Therapy: 

It is the type of therapy treatment involving drugs that are sensitive to certain types of light. When the Tumor is exposed to that specific light, these sensitive drugs become active and reactive, killing the nearby cancerous cells.

Types of surgeries: 

There are various types of surgeries. The type depends upon cancer and tissue involved, and sometimes what the patient prefers.

Surgery may be minimally invasive or open.

Minimally invasive surgery: 

Few cuts are made instead of a large one. A long thin tube having a camera is inserted through the small cut, and this camera projects images from inside of the body onto the monitor, allowing the surgeon to see what he is doing. Finally, special surgery tools are inserted to remove the Tumor.

Open surgery:

The surgeon makes a large cut to remove the Tumor.

Targeted therapy: 

It is the type of cancer treatment that targets the cause of cancerous cells, i.e., the proteins controlling the cell growth, division and spread. It is the root of “foundation medicine”. Scientists learn more and more about the proteins and DNA changes that drive cancer, which helps them to design better treatments to target these proteins.

Types of targeted therapy: 

Most of the targeted therapies are either monoclonal antibodies or small molecular drugs.

  • Monoclonal antibodies(also known as therapeutic antibodies) are the proteins synthesized in a lab. These are specifically designed to be attached on specific targets of cancerous cells. Some monoclonal antibodies work to highlight the tumour site for the immune system more prominently. Other monoclonal antibodies either stop the cancer cells from developing or induce their self-destruction.
  • Small molecule drugs are tiny enough to penetrate the cells easily and reach the targets present inside the cells.

How does the targeted therapy work against cancer: 

As described earlier, most targeted therapies work by interfering with proteins responsible for tumour growth and spreading. It treats cancer in many ways:

  • Help the immune system in destroying cancer cells: 

One of the reasons that cancer cells develop is that they can hide from your immune system. Targeted therapies can precisely mark cancer cells to make it easier for the immune system to identify and destroy them. Other targeted therapies aid in boosting the immune system to work against cancer.

  • Stop cancer cells from growing:

Healthy cells in the body divide to form new cells only upon receiving the signals. This process helps the new cells to form only when it is needed. But in the case of cancerous cells, cells start growing abnormally without the signal because the proteins on the surface of these cells are altered to induce cell division abnormally. Then, the targeted therapies interfere with these proteins, preventing them from initiating the cell division process, which helps control the uncontrolled growth.

  • Stop the signals?

The mechanism of “angiogenesis” is the lead cause of tumour formation, in which the blood vessels are formed and grow beyond normal to nourish the tumour growth. Signals for angiogenesis are produced from Tumor itself. Targeted therapies are known as angiogenesis inhibitors interfere with these signals to prevent the blood supply to tumorous cells. Or these treatments cause existing excessive blood vessels to die, causing Tumor to shrink down.

  • Delivering cell-killing substances to tumour cells: 

In some cases, specific monoclonal antibodies are combined with chemotherapy drugs, toxins and radiations. These monoclonal antibodies attaching to targets on cancerous cell surfaces results in the absorption of cell-killing substances in the cells, leading to their death.

  • Helping death of cancerous cells: 

Healthy cells die in an orderly manner when they are no longer needed, but cancer cells do not follow the self-destruction mechanism on time. Therefore, few targeted therapies involve the mechanism of inducing death to these harmful tumour cells.

  • Starving cancer of the hormones it requires to grow:

Some prostate and breast cancers require hormones of certain types to grow. Hormone therapies target these cells in two ways, i.e., either by preventing your body from producing these hormones or preventing the produced hormones from acting on cancerous cells.

  • How the targeted therapy is given: 

Pills or capsules (small molecule drugs) are given to the patient to swallow. At the same time, monoclonal antibodies are given through a needle in the blood vessel.

 

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