Management/Treatment of Neoplasms
Written by Rhiana Devadasan
General Principles:
- Depends on type and stage of the tumour (how much it has grown and whether tumour has spread from its original location).
- If there is no spread, then most common treatment is surgery.
- If there is a spread to the local lymph nodes, sometimes these can be removed.
- The use of radiotherapy, chemotherapy, hormonal therapy can implemented before or after surgery to reduce the size of the tumour.
Ablastic and Antiblastic
= Essential to an effective surgical intervention for cancer pathology is the observance of the principles ablastic and antiblastic that should be played regardless of the cancer type, form, growth stage, condition of the patient.
ABLASTIC
- A system for the prevention of cancer recurrences and metastases by radical removal of the tumour by a single block within the healthy tissues together with the regional lymph drainage system.
- Adherence to this principle is possible for cancer in situ’s, which do not extend beyond the cell layer, and cancers in the first and second stage of the disease in the absence of metastasis.
- The third and fourth stages of the tumor, exclude this possibility of intervention, since cancer cells have already begun their spread throughout the body.
ANTIBLASTIC
- Consists of certain measures preventing the further spread of the tumor, i.e. radiotherapy and chemotherapy.
Complex methods of treatment
- CHEMOTHERAPY
- This is the primary modality of therapy in patients with metastasis.
- Goal of treatment = reduce tumor burden to prolong survival.
- ADJUVANT CHEMOTHERAPY
- Chemotherapy given after surgical removal of the tumor (i.e. post-operative chemotherapy)
- Chemotherapy aims to eradicate micrometastatic disease to ↓relapse and ↑ survival.
- It is given to patients which are high risk for recurrence w/o evidence of distant disease
- NEOADJUVANT CHEMOTHERAPY
- Chemotherapy given before surgical removal of the tumor.
- Helps facilitate surgery.
Advantages:
- Causes regression of tumor for easier excision (can more a previously inoperable tumor an operable tumor)
- Treatment of micrometastases without delay of post-operative recovery
- Ability to assess cancer’s response to chemotherapy prior to surgery
Disadvantages:
- Disease can progress into a chemotherapy-resistant tumor i.e. sarcoma.
- Can cause problems when localizing the tumor, margin analysis, lymphatic mapping and staging
- Toxic to healthy cells, hair, bone marrow, lymphocytes and epithelial cells of intestinal lining
- RADIATION THERAPY
- Ionizing radiation causes single or double stranded breaks in DNA or crosslinks DNA.
- This inhibits cell division which triggers apoptosis