Understanding different cancer treatments

Tuesday October 8 2019

Demonstration. Dr Ausi Kavuma demonstrates how

Demonstration. Dr Ausi Kavuma demonstrates how the new linear accelerator machine is operated at the Uganda Cancer Institute in 2017. PHOTO BY RACHEL MABALA  

By Joan Salmon

For some time now, we have heard about cancer and the thought of it is gory. But worse still are statements such as ‘The cancer has reached stage four and, therefore, the person has a few days to live.’ ‘How did the person pass all the other stages?’ One would ask. “What do these stages even mean?”

Dr Fred Okuku, an oncologist at the Uganda Cancer Institute (UCI), says treatment of cancer requires different treatment methods depending on the type, severity and one’s condition. For example, with all cancers originating from organs, Dr Okuku says, surgery is the first mode of treatment that one might get as the tumour must be cut out.

The decision to cut out the cancer depends on many factors, including the stage, the individual’s ability to stand the surgery, and the patient’s preference, among others.

Chemotherapy
This means chemical therapy, which is meant to rapidly kill growing cancer cells.
“Unfortunately, some normal cells such as hair and nail cells, mucosa [inner lining of the mouth to the anus], skin, inner lining of all organs are also fast growing. That is why individuals undergoing chemotherapy will lose their hair and have their nails affected,” he explains.

Dr Okuku says most cancers with fast growing cells respond well to chemotherapy.

He says chemotherapy may be administered orally, intravenously, under the skin or directly to the brain via the spinal cord. However, Dr Okuku says the method is determined by the cancer type.

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Radiotherapy
The therapy uses rays, which are directed to the masses or tumours to disrupt the growth signals by heating up the DNA in the cancer cells, thus disrupting their growth.

While chemotherapy eventually spreads throughout the whole body, radiotherapy is restricted to a certain part of the body. Dr Okuku shares that some cancers such as that of the cervix are treated with both radiotherapy and chemotherapy.

Other conditions warranting radiotherapy include bone and brain tumours. “Whole body radiotherapy can also be administered to patients undergoing bone marrow transplant,” he adds.

Radiotherapy is of different types, among them external beam radiotherapy (EBRT), where a linear accelerator or a cobalt 60 machine is used to deliver high-energy rays to the contour of the tumour.

The machine moves around the body without touching the patient and aims radiation at the cancer. Some types of focused EBRT target a tumour with higher, more precise doses of radiation, while reducing damage to healthy tissue and nearby organs. As a result, EBRT may help reduce the risk of side effects associated with traditional radiation treatment.

However, Dr Okuku says every patient’s experience during EBRT varies depending on the type of cancer, the size and location of the tumour. Nonetheless, he says there are general expectations for most patients such as not wearing jewelry when the therapy is being administered.

While EBRT is painless, anxiety may cause a patient to move. Dr Okuku says the patient needs to stay still as the treatment is being administered to ensure accuracy.

He says radiotherapy is normally an outpatient procedure and patients may not need to be admitted to hospital. However, Dr Okuku says treatment duration depends on factors such as cancer type and stage. That said, he says it is between two and 10 weeks.

Radiotherapy types
Types of EBRT include: 3-D conformal radiation, intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), tomotherapy, stereotactic radiation procedures and brachytherapy.

Radiotherapy is used to treat breast cancer, melanoma, lung cancer, colorectal cancer, leukaemia, kidney cancer, non-Hodgkin lymphoma and uterine cancer.

This method comes with side effects such as swelling, skin changes, difficulty in swallowing, fatigue, hair loss, tenderness and inflammation.

Another type of radiotherapy is brachytherapy, also called internal radiation. This is where a radioactive implant (pellets, tubes, balloons, or capsules) is put inside the body in or near the tumour in a usually painless procedure. Depending on the type of cancer and treatment plan, a patient may get a temporary or a permanent radiation source that is usually sealed in an implant.
That way, fewer normal cells are harmed. Unlike EBRT, this type of radiotherapy allows for a higher radiation dose to be applied in a smaller area.

The implants are left in one’s body depending on the dose rate they are receiving thus either permanent or temporary implants and the one used is dependent on the cancer type, its location, one’s general health as well as treatment types they have undergone.

For example, high dose rate brachytherapy allows for one to be treated in a few minutes before the implant is removed. On the other hand, low dose rate brachytherapy gives off lower radiation doses for a long time period. For such, one may have to stay in hospital for several days.

Biological therapy
This is a latest mode of treatment where the tumour has to undergo molecular diagnosis before the therapy is applied. For example, if one has lung cancer that cannot be removed surgically, they undergo molecular diagnosis and if some defects or mutations are noticed, then biological therapy is used. Otherwise, chemotherapy is employed.

This type includes monocolonal antibodies therapy, which enlists natural immune system functions to fight cancer. Monoclonal antibodies are laboratory-produced molecules engineered to work as substitute antibodies to restore, enhance or mimic the immune system’s attack on cancer cells.
They are designed to bind to antigens that are generally more numerous on the surface of cancer cells than healthy cells. These drugs may be used in combination with other cancer treatments.

It works in various ways such as flagging cancer cells: Some immune system cells depend on antibodies to locate the target of an attack. Cancer cells that are coated in monoclonal antibodies may be more easily detected and targeted for destruction.

The other way is triggering cell-membrane destruction. This is where some monoclonal antibodies can trigger an immune system response that can destroy the outer wall (membrane) of a cancer cell. Some monoclonal antibodies can block the connection between a cancer cell and proteins that promote cell growth — an activity that is necessary for tumour growth and survival.

This therapy is used to mark cancer cells for attack by the immune system such as in brain cancer, breast cancer, chronic lymphocytic leukaemia, stomach cancer, and ovarian cancer.

Biological therapy also includes tyrosine kinase inhibitors (TKIs), which are in form of pills hence taken orally. A targeted therapy identifies and attacks specific types of cancer cells while causing less damage to normal cells.

Dr Okuku says although some food diets slow and modify the growth and severity of the cancer, diet is not recommended as a specific treatment for cancer. “There is no current evidence that food supplements can cure cancer. In fact, some of these could promote cancer growth. Therefore, patients should contact their oncologist for advice regarding the use of these strategies,” he says.

Dr Okuku says all the major cancer treatment modalities are available at UCI, which is the national cancer referral centre. He adds that the capacity to manage the most complex cancer is growing by the day as more cancer experts are being trained both locally and internationally.

Common cancers
Cancer in HIV patients
Kaposi’s sarcoma Aids associated lymphomas
Children and youth
Burkitt’s Lymphoma Retinoblastoma
Leukaemia
Lymphoma
Breast cancer
Gastrointestinal cancer
Oesophageal cancer
Gastric cancer
Liver cancer
Pancreatic cancer
Gall bladder cancer
Colorectal cancer
Anal cancer
Head and Neck cancer
Thyroid cancer
Ovarian cancer
Endometrial cancer
Lung cancer
Prostate cancer
Renal cancer
Bladder cancer
Testicular cancer
Penile cancer
Skin cancer

October free testing/ discounts
International Hospital Kampala: Prostate cancer at 30 per cent discount, HPV-V brush at Shs125,000, PAP smear (Cervical Cancer) 30 per cent, breast cancer physical examinations.
Alexander Medical Center: Free doctor’s consultation and breast cancer screening, 50 per cent discount on cervical cancer screening (pap smear test) for two weeks.

UMC Victoria hospitals. Free breast cancer screening at Bukoto and UMC Entebbe clinics, free consultation, 50 per cent discount on extra investigation like, breast ultra-sound Shs30,000 and cervical cancer screening at Shs50,000, discount on cervical cancer vaccine.

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