Choosing the right treatment options for Blood Cancer

June 20 06:08 2023 by admin Print This Article

Overview

Blood cancer is a complex condition and how it develops or progresses varies from patient to patient. Treatment options are innumerable and includes both traditional and modern methods. Further, the goal or aim of treatment varies, based on various factors. These innumerable considerations make decision-making a complex matter for the patient and his/her family members. In this article, we will throw some light on this matter. These are merely to be used as guidelines, and is not a substitute for professional medical help.

Treatment options for Blood Cancer

In earlier articles, we have covered the pathology, types, symptoms and diagnosis of blood-cancer. When it comes to treatment, there are various options.

• Wait and watch: Not all patients need treatment right-away. This plus the fact that cancer treatment comes with a lot of side effects. So if the doctor believes that there is no added benefit of starting treatment right-away, or there are no troublesome symptoms, he/she doctor may not recommend active treatment. He/she will then suggest a ‘wait and watch’ approach and will start treatment only when its needed.
• Surgery: Surgery is rarely a treatment option for blood-cancer. But in some types of blood-cancer, the spleen may be badly affected and has to be removed. In such a case, the doctors will do an incisional surgery to remove the spleen (called splenectomy).
• Stem-cell transplantation: Also called bone-marrow transplant or hematopoietic progenitor cell transplantation. In this procedure, healthy blood-forming stem-cells are infused into the body. These stem-cells may be harvested from the bone-marrow, umbilical cord-blood or circulating (peripheral) blood. The stem cells may come from the patient (autologous stem-cell transplant) and is collected before chemotherapy or radiation therapy. Or they may come from a matched donor (allogeneic stem-cell transplant).
• Radiation therapy: This therapy is used for different reasons: to destroy leukaemia cells in the blood, to reduce discomfort caused by an enlarged spleen, liver, or swollen lymph nodes, or can be used to treat pain from bone damage caused by cancerous cells growing in the bone-marrow. It may also be given in low doses just before a stem-cell transplant.
• Chemotherapy: This is the first line of treatment for several types of leukaemia, and involves injecting several drugs in a particular sequence and/or concentration. The different medications act on the cancer cells in different ways, so different combinations of these drugs are given to destroy cancer cells as much as possible. In addition to cancerous cells, some healthy cells may also be affected. Then there are side-effects of this therapy.
• Targeted therapy: Similar to chemotherapy, targeted therapy also uses combinations of drugs to destroy cancer cells. However unlike chemotherapy which affects healthy cells, in targeted therapy, the treatment targets cancerous cells only, and healthy cells are left unharmed. There are different types of targeted therapies such as monoclonal antibodies (MABs), cancer growth inhibitors, TKIs (tyrosine kinase inhibitors) and others, which are used along with other treatment options.
• Immunotherapy: As the name implies, this is aimed at boosting the immune system through medication, so that the immune system can identify and destroy cancer cells effectively. Several types of immunotherapies are used in combination with other treatments and one of them is donor infusion treatments (also called donor lymphocyte infusion, or DLI).
• (CAR) T-cell therapy: A significant type of immunotherapy is called chimeric antigen receptor or CAR-T-cell therapy. In this, T-cells, which are part of the body’s immune system are manipulated to locate and kill cancer cells. During the procedure, T-cells are taken from the patient, infused with the receptor gene (the CAR) in a laboratory. These receptors help the T-cells attach to the cancer cells. The manipulated cells are then infused back to the body.
• Blood transfusion: In this procedure, healthy blood cells taken from a healthy person with matching blood, are infused into the patient to replace blood-cells destroyed by the disease or its treatment.
• Hormone therapy. Some cancers are sustained by certain hormones in the patient’s body and examples of this include breast cancer and prostate cancer. By removing those hormones from the body or by blocking the effects of those hormones chemically, the cancer cells are forced to stop growing.
• Cryoablation: In this procedure, cancer cells are killed using cold temperatures. During the procedure, a thin and long needle called cryoprobe is inserted through the skin and directly into the cancerous tissue. Then, cooling gases are pumped into the cryoprobe which helps freeze the tissue. Then the tissue is allowed to thaw or melt. This freezing and thawing cycle is repeated several times in the same treatment session, which helps kill the cancer cells.
• Hyperthermia: This is the exact opposite of the above procedure. Here, as the name implies, cancer cells are killed using hot temperatures. The cancerous tissue is heated to 113 °F which helps destroy the cancer cells without harming healthy tissues.
• Radio-frequency (RF) ablation: Here, radio-frequency waves are used to heat the cancer cells till they die. In this procedure, a doctor pushes a thin needle or probe, through the skin, or through an incision made on the skin, and into the cancerous tissue. The probe is then energized with RF waves which produces a lot of heat which destroys the cancer cells while leaving the surrounding, healthy cells unharmed.
• Photodynamic therapy: In this treatment, a drug that is activated by light is used to kill cancerous and abnormal cells.
• Clinical trials: new drugs and new therapies are always emerging. However, to certify that they are reliable and safe, clinical trials are done on live patient cases. So, the patient in question can sign up for such clinical trials and experiment with new drugs or therapies.

Before enrolling for a clinical trial, the patient should consider things like: required tests and procedures, the number of doctor visits, the duration of these visits and potential side effects of the treatment.

The patient should also be aware of what procedures will be paid for by the clinical trial sponsor (pharma company/research company), what will be paid for by the insurance company and what should be borne by the patient himself/herself.

Types of Cancer treatment

• Primary treatment: The goal here is to completely remove the cancer from the body or kill all the cancer cells. These include surgery, radiation therapy and chemotherapy.
• Adjuvant treatment: The goal here is to kill cancer cells that remain after primary treatment, in order to reduce the chance of a relapse. Includes chemotherapy, radiation therapy and hormone therapy.
• Neoadjuvant therapy: This is done before the primary treatment in order to make the primary treatment more effective, or easier.
• Palliative treatment: These are supportive treatments given to relieve signs and symptoms caused by the cancer itself and the side-effects of treatment. They can be given in parallel to the other treatments for cancer. Includes surgery, hormone therapy, radiation and chemotherapy.
• Hospice care: This provides compassionate care to patients whose condition is incurable and is in the last phase. This helps them live their last days of their life in dignity and comfort.

The doctors’ considerations

 Among the various treatment types and treatment options, the doctor has to choose the most relevant and effective course in the present. His/her decisions are based on a mix of various factors that include:

• The type of blood-cancer
• The present symptoms
• The subtype and stage of cancer
• The patient’s overall health
• Other medical issues the patient may have
• Blood cell counts
• Cell type and genetic test results
• The patient’s personal preferences

The last point is significant and brings us to the next section.

The patient’s considerations

Given the innumerable treatment options, treatment priorities, techno-medical information and choices to be made at every step, the patient and his/her family member can be overwhelmed. There is too much information to process and too many choices to be made. It is important that they step back and reflect on the same.

Step 1: Set the ground rules

• Decide how much you want to know: will you or your family process all the information before deciding?
• Decide how you want to make your treatment decisions: Will you go with the doctor’s recommendations or will you do independent research and choose, once satisfied?
• Have realistic expectations, and not give in to wishful thinking
• Keep the focus on yourself, and not be pressurised to choose a particular treatment option
• Seek help: Do you want a second, or third option, before deciding?

Step 2: What are your goals?

• Cure the disease completely (this depends on the stage)
• Control the symptoms, in case complete cure is not possible
• Comfort – in case there is no response to the treatments

Step 3: Analysing benefits versus risks

• What are the side-effects of each treatment option
• How will the treatment affect your life in the near future and long-run
• What are the financial costs of treatment? Will it be self-funded or is there insurance?
• Your overall health, and how will cancer treatment affect the same
• What or how much is the risk of relapse

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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