Cancer Treatment Strategies

See also Diagnosis of Cancer

See also types of cancer

(1) Surgical debulking: If surgical removal is possible, this is a favored treatment strategy. However, surgery may miss micrometastases.

(2) Radiation: Radiation therapy is a majuor treatment modality for cancerand about 60% of cancer patients will recive it at some time during the course of their disease. Brachytherapy (interstitial or intracavitary radiactive seed implantation) is used to treat cancer of the head and neck, breast, and genitourinary tract.

Among the population over 80, radiation is the most widely used treatment modality for ancer. Patients may be denied aggressive (curative) therapy because of concerns of toxicity. However, evidence shows that side effects in the elderly is comparable to those observed in younger patients.

(3) Chemotherapy: Most, if not all, chemotherapeutic agents kill cancer cells through the induction of apoptosis. This treatment strategy suffers from problems like drug toxicity and drug resistance (due to increased drug metabolism, increased DNA repair mechanisms and decreased drug import into cells).

However, side effects can be managed. For patients age 70 and older, hemopoietic growth factors should be used prophylactically. Patients' hemologbin should be maintained at 12 gm/dl or higher. Mucositis (inflammation of the mucous membranes) should also be aggressively treated in older individuals, with fluid resuscitation as soon as the pateint becomes unable to eat or diarrhea develops.

(4) Hormonal Therapy: is effective in breast, prostate, and endometrial cancer. The selective estrogen receptor modulators (SERMs), tamoxifen and toremifene, have been the mainstay of the treatment of hormone-receptor rich breast cancer both in the adjuvant and the metastatic setting. One added benefit of these compounds is prevention of osteoporosis. Another SERM, raloxifene has been approved for prevention of osteoporosis. Both tomoxifen and raloxifene prevent breast cancer in women at risk.

(5) Angiogenesis Inhibition:The formation of new vessels for tumor growth is a hallmark of cancer. As a result, there is currently great interest in inhibiting angiogenesis as a treatment strategy.

(6) Metalloproteinase inhibitors:

(7) Inhibit Signal Transduction:

• PTK Inhibition: PTK is essential to signal transduction and has been the focus of many inhibition attempts. Gleevec has been shown to inhibit the specific PTK of chronic granulocytic leukemia, which is encoded by the BCR/abl oncogene. This oral agent has been shown to induce a hematologic remission in about 90% of patients with CGL in chronic phase and is considered the drug of choice for the management of this disease.
• Farnesyl transferase inhibitors: Farnesyl transferase is also important for signal transduction.

(8) Tumor Immunology: