Cancer treatment: modern methods of cancer treatment, oncology treatment, cancer therapy

Just a few years ago, a diagnosis of cancer often sounded like a death sentence. But oncology, like any field of medicine, does not stand still. The classic triad of cancer treatment - surgery, chemotherapy and radiation therapy - has now been supplemented with new techniques. Modern oncologists have at their disposal a wide arsenal that helps save many lives, and in cases where this is impossible, significantly prolong the patient’s life and relieve painful symptoms.

An oncologist develops a treatment program based on the type, location, stage of the tumor, and the patient’s health condition. A team of specialists works with the patient, which may include oncologists, therapists, chemotherapists, radiologists, anesthesiologists, psycho-oncologists, rehabilitation specialists, and oncological surgeons.

This article will discuss the main methods of treating cancer; we will briefly discuss each of them and talk about important points.

Oncology treatment depending on the stage of the disease

To classify the tumor process, various indicators are used, such as structural and anatomical features, size and growth rate, localization and risk of metastasis.
In total, there are five stages of development of cancer. Depending on the stage at which the disease is detected and treatment is started, a treatment plan is drawn up, and the prognosis is determined.

The earlier the oncology treatment is started, the higher the chances of a complete recovery and the less aggressive and extensive the therapy will be.

Stage 0 - tumors of any location. The boundaries of the lesion do not extend beyond the boundaries of the epithelial layer of cells from which the tumor originated. With timely and adequate treatment, such cancer can be completely cured.

Stage I - cancer spreads within the organ. If such a tumor is identified and removed in time, the prognosis is generally favorable.

Stage II - almost all tumors at this stage are within the boundaries of the organ, but with greater penetration deep into or large sizes. Here the prognosis depends on the type of tumor and its location.

Stage III - the tumor continues to progress, giving metastases to regional lymph nodes, but, as a rule, there are no distant metastases yet. This may offer hope for prolonging life. But the overall prognosis depends on a number of factors: the type of tumor, its anatomical features, dysfunction of neighboring organs, concomitant diseases and the general condition of the patient.

Stage IV - common. Large primary lesions, often growing into neighboring organs, impaired blood supply, damage to regional and distant lymph nodes, general intoxication. To alleviate the condition, palliative and symptomatic treatment is carried out.

The Oncological Institute has developed screening programs to detect cancer at early preclinical stages. It is enough to devote just a few hours a year to your health to make sure that nothing threatens your life, or to begin oncology treatment as early as possible.

Genetic Engineering

Research in the field of oncology does not stop being carried out. Scientists are looking for new opportunities and making discoveries. There is still a lot of work to be done. New cancer treatments are based on maximizing the preservation of healthy tissues and cells with a moderate level of interference with the body. Genetic engineering in this aspect has a great future. Laboratories around the world are trying to correct the functioning of genes and cells. It should look like this. Initially, the genetic material is transferred into cells, which are grown in culture under the right conditions. Then they are injected into the desired organ of a person with cancer. If genetic engineering succeeds in this method, it can be used to treat any organ.

New cancer treatments must be tested over time and proven to be effective. In this case, it will be possible to talk about their widespread use among patients. At the Sofia Oncology Clinic, cancer treatment occurs at different stages of the disease. Technical equipment allows the following methods to be used:

hypofractionated and large-fractionated radiation therapy;
chemotherapy and radiation therapy;
biopsy and resection of the thyroid gland;
surgical interventions.

Effective cancer treatments give patients longer prognoses. Depending on the stage of the cancer, a complete cure with a transition to long-term remission is possible. Contact the oncology department for consultation and diagnostics. To make the correct diagnosis and choose a treatment method, a council of doctors meets every time. Team development of a treatment plan for a patient allows for a thorough study of each individual case. When considering severe cases, specialists from leading foreign clinics are involved. Health is the most important thing, so if you have any suspicious symptoms, get tested.

Treatment of cancer using surgery: from radical operations to organ-preserving ones

Surgery continues to be the standard of care for cancer treatment with very satisfactory results. Oncologists have achieved great skill in this area.

Operations for the treatment of tumor diseases can be:

Radical. Complete removal of the primary tumor and its metastases is provided. After such an intervention, there are no tumor foci left in the body that can be determined by any diagnostic method.
Palliative. After such surgical treatment, tumor foci may remain in the body. The main task is to prevent severe complications associated with tumor growth (bleeding, compression of neighboring organs and vessels, sharp narrowing of the lumen or reduction of the organ cavity).

Recent advances in surgical (including robotic) technology make it possible to expand the number of organ-preserving operations, the number of interventions that are performed in one stage, reduce postoperative complications and shorten the rehabilitation period.

In addition, the number of cases of cancer treatment when the surgical method was used as an independent method has now increased to 54.3%. It is especially effective for kidney cancer, skin melanoma, and thyroid cancer.

In combination with other methods in the Russian Federation, surgical treatment of tumors is performed in 85% of cases. This suggests that surgery is leading the way in the treatment of malignant neoplasms. Endoscopic, including laparoscopic, methods have begun to be used much more often, which cause less trauma to the tissue surrounding the tumor and make it possible to preserve the organ. Of course, specialists, first of all, assess the individual clinical situation, stage, extent and type of cancer, and the patient’s condition. And only then, collectively (at an oncoconsilium), do they make a decision in favor of open surgery or endoscopic intervention.

It has also been proven that the result of treatment for skin melanoma depends little on how widely the tissue in the tumor area is excised, that is, it is enough to retreat only 1–2 cm (and not up to 15 cm, as was previously accepted).

The attitude towards the treatment of breast cancer has also changed - from radical mastectomy (complete removal along with a group of lymph nodes) to breast-conserving surgery and one-stage plastic surgery.

Instruments (such as an electric knife) are used to help more strictly follow the principles of surgical treatment, such as

Ablastics is resection (excision) of the affected organ within healthy tissue to reduce the risk of tumor cells spreading through the blood vessels.
Antiblastics - destruction of cancer cells that remain in the surgical area by washing with special solutions or irradiation.

Modern technologies make it possible to expand the number of indications for surgical treatment with organ preservation and make operations for local or metastatic malignant tumors that were previously impossible to operate more radical. All this became possible when large centers, such as the Oncology Center, began to create entire teams of specialists (surgeons, chemotherapists, radiologists) who deal with the complex treatment of one patient.

Surgery

During the operation, the surgeon removes the tumor tissue and affected nearby lymph nodes. The goals of surgical treatment may be different:

Removal of the entire tumor.
Removal of part of the tumor (cytoreductive surgery). It won't cure cancer, but it will help make chemotherapy and other treatments more effective. Palliative surgery is usually performed in advanced stages of cancer. They help reduce pain and partially restore the functions of the affected organ.

Sometimes you can resort to minimally invasive laparoscopic intervention, in other cases you have to make a large incision. This depends on the size and location of the tumor. With large tumors, it is necessary to remove a lot of tissue or even entire parts of the body, for example, the mammary gland. In the future, reconstructive plastic surgery and prostheses help restore appearance.

In cases where this is possible, modern surgeons do without a scalpel and resort to cryosurgery (destruction of a tumor using low temperature), laser surgery, photodynamic therapy (injection of a special drug into the tumor that makes it sensitive to light, followed by irradiation).

Radiation therapy in the treatment of oncology

Radiation therapy, as part of complex or combined therapy, is now used in 60–70% of cases of cancer and leads to recovery in half of the patients. Methods are constantly being improved in order to achieve the greatest result in tumor removal with minimal impact on healthy tissue.

Radiation therapy uses ionizing radiation. It may differ in the mechanism of biological action, penetrating ability and energy distribution. In clinical practice, photon radiation is most often used, which includes:

Gamma radiation is radiation from radionuclides that penetrates to a depth of 1 m or more.
X-ray (using X-ray machines) - radiation due to the transition of electrons in the nucleus from orbit to orbit.
Bremsstrahlung is produced using proton accelerators.

Corpuscular radiation (from nuclear particles) is also used. Types: beta radiation, positron radiation, alpha particles.

The main sources of ionizing radiation are natural and artificial radionuclides (radioactive substances) and special devices - accelerators, neutron generators, X-ray machines.

Remote, contact and internal irradiation is possible, in which radionuclides are administered intravenously or orally.

With external beam radiation therapy, the source of radiation (mostly photon) is 80–100 cm away from the tumor. With contact radiation, called brachytherapy, the source is at a close distance, up to 30 cm, from the tumor focus or in direct contact. This is a more gentle type of therapy. The main types of contact irradiation: intracavitary, interstitial, application (on the surface of the body).

Under the influence of ionizing radiation, free radicals are formed that damage cells, DNA reproduction and cell division are also disrupted, which leads to the destruction of the tumor. At the same time, there is an instant action and a delayed one.

In combination with surgical methods of cancer treatment, the following is used:

preoperative - to reduce the viability of tumor cells before surgery;
intraoperative - irradiation of the tumor area during surgery to prevent the development of relapses and metastases;
postoperative radiation therapy - to prevent metastases after non-radical tumor removal.

In order to make the body’s overall reaction to radiation therapy less pronounced, modern techniques are complemented by methods of tumor visualization, including 3D, as well as fixation devices. This helps to target the tumor most accurately.

Radiation therapy also goes well with drug treatments for oncology.

Robotic systems

The daVinci robot-assisted surgical system is a device for performing surgical operations. It consists of 2 blocks: the first is intended for the surgeon-operator, and the second, a four-armed robotic manipulator, is an actuator (one of the robot’s “arms” holds a video camera that transmits an image of the operated area, the other two reproduce the movements performed by the surgeon in real time , and the fourth “arm” performs the functions of a surgeon’s assistant).

The surgeon is located at the console, which allows you to see the operated area in a 3D image with multiple magnification. It uses special joysticks for control. Information about the progress of the operation was entered into the computer program. If the surgeon makes a mistake or his hand trembles, the robot will stop and refuse to carry out a false command.

Robot-assisted da Vinci systems are widely used by surgeons in the USA, Israel and Germany. There are 25 such surgical robots installed in Russia, including 6 in Moscow. With their help, oncologists perform operations on the brain, liver, prostate gland, stomach, lungs and other internal organs. These are minimally invasive interventions, after which the rehabilitation period is reduced and the survival rate of patients suffering from malignant neoplasms of various localizations is increased.

Chemotherapy

Chemotherapy methods for treating cancer (both monotherapy and combined use of drugs) are associated with the effect of drugs on tumor cells in certain phases of their development.

Depending on the place of chemotherapy in the treatment of tumor disease, there are:

Adjuvant chemotherapy is an addition to the main (surgical or radiation) method of treatment. Prescribed in case of a high risk of developing metastases or relapse - a second tumor, when the primary lesion has already been removed.
Non-adjuvant chemotherapy, which is given before the tumor is removed surgically or otherwise. The goal is to reduce the volume of the formation in order to perform a less traumatic operation, possibly organ-sparing.
Primary chemotherapy for inoperable cancer or the development of multiple metastases. The goal is to prolong the patient’s life while maintaining its quality. The least toxic drugs that are easy to administer are used.

During polychemotherapy, drugs with different mechanisms of action are selected.

Cytostatic therapy is possible, when the drug slows down the development of the tumor, and cytotoxic, if cancer cells are destroyed.

Depending on at what stage and how the chemotherapy drug acts on the cell, it is classified into one group or another:

Alkylating agents : chlorethylamines, disulfonic acid esters, nitrosmethylurea derivatives, platinum compounds, triazines. They act on cells that are actively dividing, regardless of the phase of the cell cycle. Mechanism of action: damage to the DNA of an atypical cell, mutation and death. They have a wide spectrum of activity, so they can be prescribed for the treatment of any sensitive tumor (breast, bronchial, gastrointestinal, head, neck and brain cancer). Their disadvantage is that they are highly toxic to healthy cells. Particularly important is the suppression of hematopoiesis, which is very difficult to cope with. In addition, these drugs can cause kidney failure and other problems in the urinary system.
Antimetabolites : folic acid antagonists, pyrimidine, purine, adenosine analogues. They are similar in structure to substances that are involved in the production of DNA and RNA; they are integrated into them and disrupt the synthesis of nucleotides, as a result of which the cell dies. They act especially well on cells that are dividing intensively. Used to treat malignant tumors of the stomach and intestines, breast, bones and soft tissues. They also inhibit hematopoiesis and lead to intestinal damage.
Antitumor antibiotics : dox and o rubicin (with the widest spectrum), bleomycin, mitomycin and others. Actively act on cells of slowly growing tumors. They exhibit a variety of effects - from disrupting DNA reproduction to inhibiting the activity of certain enzymes. Effective for the treatment of tumors of the breast, musculoskeletal system, lymphomas. Toxic to hematopoiesis and cardiac muscle.
Antimitogenic : vinca alkaloids, taxanes. They stop or disrupt mitosis (division) of cells, resulting in their death. Used for chemotherapy of breast and ovarian cancer, bronchopulmonary system. Toxic reactions include hematopoietic disorders, neurological disorders, intestinal paralysis, and allergic manifestations.
Inhibitors of DNA topoisomerases I and II : camptothecin derivatives, epipodophyllotoxins. The mechanism of action is to disrupt the functioning of enzymes that are involved in DNA synthesis, which leads to the interruption of cell division and their destruction. Effective for the treatment of colon, lung and ovarian cancer. Just like other cytostatics, they inhibit hematopoiesis and can cause severe diarrhea.

The latest treatment methods against cancer

Scientists are developing many techniques against cancer. However, in practice it is permissible to use only certain schemes. Often, new technologies do not fully identify possible consequences and side effects. Cost also affects the use of the method. It is impossible to determine the behavior of altered T cells prematurely. However, successful discoveries in the oncological field make it possible to improve currently existing methods.

Luminescence and photodynamic therapy

Luminescence is actively used by scientists in the development of new diagnostic procedures and tumor treatment:

Fluorescent nanoprobes – surgical intervention causes injury to the human body due to poor visualization of the location of the pathogenic focus. In 2021, scientist Haiyin Liu developed a scheme that involves glowing a cancer cell, which allows one to obtain a clear image of the cancerous formation. Antibodies attach to the affected tissue and illuminate the area in the infrared range. Healthy tissue turns green or blue. Using this technology, the surgeon evaluates whether all cancer cells have been eliminated and identifies remaining metastases.
Photodynamic therapy - the study of a bioluminescent method of destroying pathogenic formations is at the experimental stage. The procedure involves altering the tumor growth to produce a photosensitizing gene and a “glowing” luciferase cell. According to research, photosensitivity responds to luminescent influence, which provokes self-destruction of pathological foci.
The use of mutant viruses - as a result of experiments, Andrew Brown formed a genetically modified herpes virus that infects only cancerous tissue. At the boundaries of the virus, luciferases are present, which illuminate the infected area. If the scientist proves the high effectiveness of the method in practice, herpes will replace the tomography procedure.

Gene and viral therapy

Human immunity is capable of independently resisting cancer. However, cancer hides under the guise of healthy native human cells, which makes it difficult to recognize the focus. Scientists have managed to connect patient lymphocytes with CD19 receptors; retroviruses penetrate the cell’s DNA structure. As a result, the opened growths destroy the modified lymphocytes.

In Russia, drugs for gene therapy have been developed - AntionkoRAN-M and AntionkoRAN-F. Two genes penetrate into the patient’s body: they destroy the malignant process and activate the protective function of the immune system. However, research requires large investments, which makes it difficult to obtain a new drug.

CRISPR/Cas9 technology

This technique is developed based on the unique behavior and characteristics of bacteria. The DNA of a bacterial cell contains information that reveals the characteristics of all existing viruses that captured the body of the ancestors of bacteria. The encoded data about viral organisms is called CRISPR. When a bacterium pairs with a virus containing a genome from the microorganism’s database of information, the Cas9 protein destroys it. Today, experiments are underway regarding the possibility of recording the characteristics of the structure of tumor formations through CRISPR, and destroying the lesion using Cas9.

Gamma Knife and Cyber Knife

Standard chemotherapy treats the affected and healthy tissue area, which represents a weakness of the regimen. However, oncologists managed to create a new type of radiation therapy - proton therapy. The rays are sent directly to the tumor. Protons kill pathogenic tissues, and nearby neighboring materials are not affected in the process. This eliminates difficult-to-localize cancer of the brain and spinal cord.

High-precision radiation therapy was developed in 1960 in Sweden. The stream of rays was aimed at one place, now the technique is called gamma knife. Over time, John Adler, based on the gamma knife, developed a cyber knife. The computer system corrects the direction of radiation with high accuracy. Through high-precision radiation therapy, small lesions located in hard-to-reach areas are excised.

Targeted therapy

Targeted therapy takes into account the specific characteristics of oncology and uses targeted treatment methods. The protein PD-L1, which hides malignant cells from the immune system, has been identified. In 2021, Russian scientists created the drug Pembrolizumab (Keytruda). The medication blocks the action of the protein and helps the immune system get rid of melanoma, lung cancer and certain types of cancer.

In 2021, a new therapy technology was introduced into the medical field - targeted treatment (targeted). The method involves the action of drugs on tumor molecules, destroying and stopping the development of the growth. The advantage of the targeted scheme is that it does not affect normal structures. The drug spreads throughout the human body, capturing distant areas with metastases and reducing the concentration in the affected part.

The target method is carried out comprehensively and independently. Immunotherapy is prescribed depending on the typology of the malignant process. The procedure activates the patient’s immunity to further fight cancer. A biological agent prescribed personally for the patient is injected into the victim’s body. The substance is reflected on T cells. The technology has not been fully studied. Therefore, it is impossible to accurately say about the presence of side effects and complications - weakness in the body, nausea and vomiting, fever.

Boron Neutron Capture Therapy

Among the latest developments against oncology, boron neutron capture therapy (BNCT) stands out. The technology involves eliminating neck and head cancer. These types of tumors cannot be treated. There are similarities with radiation therapy. However, the distinctive side is the absence of harmful effects on healthy structures. BNCT is performed in two stages. Initially, the patient is administered amino acid and boron. A cancer cell is composed of an amino acid, which helps the substance penetrate the tumor body.

The area is then irradiated with a stream of neutrons, interacting with boron. As a result, a reaction occurs that is similar in effect to a micro-explosion. Only a few clinics undertake treatment of the disease with this regimen. The complexity of the technique lies in the need to use a nuclear reactor as a generator. In Russia, the Institute of Nuclear Physics (SB RAS) conducted similar studies in 2021. Boron neutron capture therapy will be included in the list of medical procedures no earlier than 2022.

X-ray therapy

X-ray therapy is widely used in the treatment of oncology. Russian scientists, based on this scheme, created micro-beam X-ray exposure. The beam is directed to the pathogenic part and covers normal tissue. The technology minimizes injury to the body. The radiation beam is divided into multiple beams and targets only the atypical neoplasm.

Scientists are also analyzing the possibility of using manganese oxide nanoparticles. The elements accumulate in the lesions, destroying the membrane from inside the body. The method is at the testing stage. In the oncology field, intraoperative radiation therapy with the Xoft system is also noted. Carried out during the operation. The cancerous lesion can be irradiated. The method is characterized by low trauma and high cost.

Hormone therapy in the treatment of oncology

One of the areas of chemotherapy is hormone therapy, which is also called endocrine therapy. The fact is that some tumors grow due to hormonal stimulation, so by removing the source of hormones, the development of the malignant process can be stopped. Moreover, such an effect can be achieved surgically (removal of the organ in which hormones are synthesized), with the help of radiation therapy and the administration of medications (hormones and antihormones).

The main purpose of administering hormones is to block pathological signals.

Apply

Antiestrogens - block estrogen receptors. Used in the treatment of hormone-dependent breast cancer.
Aromatase inhibitors - reduce the amount of estrogen in menopausal patients.
Corticosteroids - destroy cells of lymphoid tumors, and are also prescribed to reduce the toxic effect of other cytostatics on the liver and other organs (for nausea and vomiting).
Androgens - suppress the division of cancer cells during metastases of breast cancer.
Antiandrogens - prevent androgens from binding to tissue receptors in prostate cancer.
LH-RH agonists - inhibit the synthesis of testosterone and estrogen.
Progestins - in endometrial cancer, block the development of tumor cells.

Increase in incidence and mortality from cancer in Russia

The structure of cancer incidence is dominated by malignant tumors of the following localizations:

trachea, bronchi, lungs – 13.8%;
skin – 11.0%, together with melanoma – 12.4%;
stomach -10.4%;
breast – 10.0%;
colon – 5.9%;
lymphatic and hematopoietic tissues – 4.4%;
uterine body – 3.4%;
cervix – 2.7%;
ovaries – 2.6%.

The incidence of malignant neoplasms among men is higher than among the female population. In the Russian Federation, about 300,000 adults and 125 children die annually from malignant neoplasms. These are mainly people who have been diagnosed with tumors of the respiratory tract, stomach, colon and rectum. Among the deceased adult patients, 55.5% were men and 45.0% were women. Studies show that cancer treatment began too late, because people did not consider it necessary to see a doctor in a timely manner.

Immunotherapy

One of the most progressive methods of treating cancer, which allows you to act on cancer cells through highly specific mechanisms. Used in combination with other methods of therapy.

Immunotherapy allows the body to form an immune response to the tumor, exhibit a cytotoxic effect, and also increase immune defense.

The following groups of drugs are used:

Immunomodulators (passive immunotherapy) : cytokines (interferons, interleukins), immunoglobulins, substances of microbial origin - to correct immunity.
Monoclonal antibodies (active immunotherapy) - to target surface antigens of tumor cells, which leads to cell death.

Innovative methods for treating brain tumors

To treat brain tumors, doctors at the Yusupov Hospital use minimally invasive surgical interventions. This is possible thanks to the use of such new cancer treatment methods:

computer-aided microsurgery;
use of high-tech endoscopic equipment;
application of robotics;
availability of modern visualization methods.

During neurosurgical operations we use electrophysiological monitoring. It allows you to control the actions of the doctor. Modern microscopic equipment, which provides multiple magnification, facilitates accurate visualization of the tumor boundaries. When removing some tumors, our neurosurgeons use the following modern techniques:

intraoperative fluorescent diagnostics;
spectroscopy using 5-aminolevulinic acid;
cyber knife;
linear accelerator;
robot-assisted surgical techniques.

Targeted therapy

This is a new method of treating oncology and metastases. It is designed to act only on certain targets. These can be hormone receptors, genes, enzymes. Damage also occurs to the structures that feed the tumor, or shutdown of intracellular metabolic processes due to disturbances in the chain of biochemical reactions.

Currently used to treat treatment-resistant cancers, it can significantly increase the effect of treatment in combination with chemotherapy. With drugs for targeted therapy, it is possible to treat even advanced stages.

Proven to be effective in treating breast cancer, lung cancer, melanoma and others.

What types of cancer are there?

Since cancer forms from almost any cell, it can develop anywhere in the human body. There are statistics that show which type of cancer is more common. I would like to emphasize that cancer incidence rates differ between men and women.

The most common types of cancer in men:

First place - lung cancer -27%
Second place – prostate cancer – 18%
Third place – skin cancer – 16%
Fourth place – esophageal cancer – 11%
Fifth place – bladder cancer – 8%

The most common types of cancer in women:

First place – breast cancer – 25%
Second place – uterine cancer – 17%
Third place – colon cancer – 12%
Fourth place – ovarian cancer – 10%
Fifth place – cervical cancer – 8%

There are also types of cancer that occur in both sexes with equal probability, for example:

Pancreas cancer;
Liver cancer;
Laryngeal cancer;
Stomach cancer;
Kidney cancer;
Thyroid cancer.

Foreign doctors pay special attention to the treatment of cervical cancer abroad.

Cancer treatment can be done at Onco

The Oncology Department has all the capabilities for complex treatment of tumor diseases of various types and locations. A whole team of specialists from various fields works on the treatment plan for each patient.

Under the supervision of oncologists, not only tumor therapy is carried out, but also treatment of concomitant diseases, prevention and reduction of side effects, as well as a full course of rehabilitation measures.

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