Steps Towards Cure In Cancer

Cancer Care Treatment in Hebbal, Bangalore
  • Dr. Kumara Swamy,

    Sr. Consultant & Head - Radiation Oncology

Learning about the diagnosis of cancer is a tough passing phase to handle. During the process of cancer diagnosis and deciding on treatment, naturally, mind will be filled with anxiousness and tension. Presented below are the steps to cope up with the situation and undergo the treatment effectively. Taking a pace back and readying for the prolonged treatment ahead will not only help in undergoing the treatment more efficiently but also in improving the cure rate. The steps towards cure starts at the very day of diagnosis of cancer.

Step 1: Overcome the long-term fear

  • Long-term Fear affects the wellness of the person and outcomes.

  • Overcoming the negativity is really important while managing chronic diseases like cancer.

  • One can increase the chance of cure and control by improving the body immunity and homeostasis. Part of this depends on the treatment and the other part is under your control.

  • It’s best to entrust with your doctor the complexity of treatment after due discussion about options of available treatments and focus on the strategies that things you can act to better the success of the cure. For this, first step even before seeking the treatment is – management of mind and emotions.

Step 2: Replace the fear with “action”.

  • An action doesn’t mean, rush to end it!

  • Malignant neoplastic disease may require 10-15 years to reach the diagnosis phase. Even the early stage cancer (Stage 1) would have required many years to grow before it shows up in tests. (That is why life style changes in the prevention of its initiation are the correct strategy to reduce the incidence of cancer in the society.)

  • It doesn’t matter waiting for a couple of weeks for proper diagnosis and staging before starting the treatment. Surveys have shown that certain delay hasn’t affected any desired results except in rare situations.

Step 3: First “action step” is to confirm, understand and plan

  • One can seek an opinion from more than one lab and physician (even if appears contradictory – not to worry- consensus is always an evolution). The information you get, might make some kind of difference in the treatment.

  • Don’t be disappointed if the tests are not favourable. Remember, what is unfavourable today may be favourable tomorrow.

  • Lab technology is growing phenomenally to identify the root cause of cancer i.e. faulty “receptors”. Receptors are like innumerable “mouths,” which are not in the normal cells. The specific medicines can be sent, based on the receptor status, inside the cancer cell to kill or disarm it.

  • Recent trends in treating cancer is in the direction of “personalised medicine”, where the strategy is to build the profile of cancer in an individual and tailor make the treatment of the specific person.

  • Newer tests can be discovered in the future, to identify the effectiveness of a drug. If the drug is for the prevention of recurrence, then the availability of previous material becomes critical to examine the usefulness of a drug. For this reason, always keep a set of slides and blocks of the biopsy safely, if required in a bio-repository in the hospital.

Step 4: Simultaneously, tests needs to be done to have complete data on cancer status

  • The emphasis is on not to worry about the result of tests that you undergo.

  • Stage of cancer is meant for deciding the type of treatment and not to decide on or to give decisive information about the cure.

  • In early stage cancer chances of cure are better, yet in a few it can come back. In the advanced stage, even though the chances of cure come down, it cannot be ruled out. It’s futile to explore this statistical chance and apply to self. Contrarily, worrying about it can bring down the chances of cure by making one fearful and immunologically weaker.

  • Common tests are

    • CT scans

    • PET-CT (Positron Emission Tomography-Computerized Tomography) scan is the one where the whole body is analyzed for a detailed analysis.

    • MRI is another test option which might be needed.

    • Detailed examination of biopsy samples for diagnosis and receptor status.

  • Different images/tests give different patterns of information, combinations of which when put together form the basis of the scheme of management of cancer for you.

  • Also, common examinations are performed to test the status of body organs, such as cardiac, liver and renal functions. The findings of these tests can influence the treatment.

  • Possibly other test includes evaluation of body's inflammation & immunological response.

Step 5: Treatment options

  • Cancer might need combinations of treatment.

  • Most of the time it’s a combination of surgical operation, radiation therapy and chemotherapy. For many persons with this planned treatment the cancer is likely to be eliminated. For lymphoma, blood and related cancers chemotherapy/immunotherapy may be the sole treatment. An evolved form of chemotherapy is oral tablets, targeted therapy and immunotherapy, and are increasingly replacing the traditional chemotherapy.

  • Prepare yourself, mentally, at this stage to deal with multiple doctors and treatment over a prolonged time.

  • The decision about particular type treatment for you is not decided casually or solely based on experience. It is based on the knowledge accumulated over the years of treatment benefits of millions of patients treated earlier and recent technological discoveries put together. Advice for a particular line of treatment for you is, by and large, based on international guidelines and individual doctors experience.

  • General approaches: Although specific treatment varies from person to person, in general, philosophy and science of cancer management is as follows.

    • For the growth that is visible in the image (CT/PETCT/MRI scans): Surgery is by far the first choice immediately or after radiotherapy and/or chemotherapy. If surgery is not possible or refused, then radiosurgery or radiation therapy would be the next options. Sometimes chemotherapy is administered first to reduce the size of growth before surgery or radiation therapy.

    • An area of high-risk invisible disease: This is around the visible disease and in the lymph nodes adjacent to the growth. This area has a higher number of invisible cancer cells. This is likewise taken out by operation. In modern times, to save the organ and retain the function, only visible disease with minimal normal tissue around the cancer is removed by surgery and remaining cells, further away, are eliminated by radiation therapy (organ preservation surgery).

    • An area having occasional invisible cancer cells: They are located further away from the immediate vicinity of visible cancer mass in imaging, having an occasional number of cancer cells. The dose of radiation needed to get rid of these is commonly less than above 2 areas.

    • Visible disease in remote regions of the body (stage IV) – Chemotherapy is the main treatment. If there are a limited number of sites, then surgery or radiosurgery can be added. Also, when the disease is widespread, if the response to chemotherapy is good and after chemotherapy if only few metastases remain, then also surgery or radiosurgery can be added,

    • Invisible disease elsewhere in the body (not seen on imaging): Since one cannot visualize hidden cancer cells with the best of the imaging investigations available today, it is assessed by probability based on the worldwide voluminous literature accumulated of other patients treated over decades. The probability of having such cancer cells anywhere in the body could be a) high, b) medium, c) low or d) very low. Chemotherapy is advised when probability of such invisible disease in the other regions of the body is high to low. A very low probability may not require chemotherapy, except in select situations. The high probability may require relatively aggressive chemotherapy. Surgery/Radiation therapy or radiosurgery to selected sites in various organs may also be required when becomes visible in a limited number of places, at a later date, in some situations.

Step 6: Treatment process

  • If the treatment recommended for you is only surgery, it will be concluded in a short period. Sometimes, initially only surgery would have been planned, but may require additional therapies based on histological examination of the surgical specimen.

  • Radiation sessions with or without chemotherapy together (4-6 doses) can require as much as 5-8 weeks. Here, chemotherapy is given to improve the effect of radiation and usually is at a lower dose level.

  • Radiosurgery, when recommended, usually lasts 3-5 sittings and may take 1-2 weeks.

  • Chemotherapy of 4-6 cycles can take 3- 5 months.

  • Usually, the total duration of treatment is 6-7 months when all 3 are given.

  • Choice: If you want a safe treatment, rendered with a target of no side effects, the control of cancer may not be up to the optimal expectation. All effective treatments will have a range of side effects, although probability & intensity of side effects have come down dramatically in recent years.

Step 7: Follow-up and Self Improvement

  • It’s important to understand that even if the disease has disappeared, once the diagnosis of cancer is established, there may or may not be a threat to life in the near or far future. It’s safer to presume that there is a threat for ever and take the following precautionary steps. This realism helps in coping with the mental & physical after effects of cancer as easily as its treatment in the long-term and consequently to improve the cure rate.

  • The focal point should be on prevention of side effects and bringing down the chances of side effects, after the completion of treatment.

  • A regular follow-up is necessary to monitor the effects of treatment.

  • It’s important to notice the side effects of treatment early to prevent the long-term effects.

  • Generally, follow-up is every 3 months (starting from 1 ½ months from the first follow-up visit after completion of treatment) first year, every 6 months 2- 3 year and every year after. It is really desirable to adhere to this schedule, routinely. The objective of follow-up is primarily to evaluate the health status and secondarily to catch the side effects early, if any. It is necessary to review the emotional aspects, physical activity and dietary counselling every 3 months at a survivorship clinic (refer to survivorship blog for details).

  • After the completion of the planned treatment, at first scan at 3 months or later, the results can come back as “cancer free” (If not, further treatment may be required). This is the first requirement towards a cure. At the same time, this is the most and may be the only important opportunity for consolidating this gain. The gain comes from improving the body immunity.

  • To reiterate, it’s safer to presume that threat persists despite the positive effects of the examinations (this presumption may help to get rid of the inner fear). Besides, this is the proper time to improve the body immunity by incorporating drastic changes in the lifestyle, which might have provoked cancer. Also, this would be the right time to take steps to initiate the reversal process that initiated the “cancer” in the beginning. Based on the “soil and seed theory” of cancer, cancer the “the seed” grows if the human body “the soil” becomes weak.

  • Invoke resilience: Short-term stress, enhances immune-protective processes involved in wound healing, vaccination, and response to anti-infectious and anti-cancer agents. Still, chronic stress is given to suppress these immune reactions. Therefore, one should convert chronic stress to advantage by cognitive behavioural therapy (CBT) techniques.

  • Key points to remember

  • Can one ever be sure that the cancer will never come back?

  • (Reference: https://www.cancer.org/treatment/survivorship-during-and-after-treatment/understanding-recurrence/can-i-do-anything-to-prevent-cancer-recurrence.html)
    • No one can guarantee that, even if the disease disappears completely after the treatment, the cancer will never come back. Your oncologist can give you information about the probability of cure based on the literature. However, after such a discussion, one is likely to worry about the percentage of failure rather than feel confident over the probability of success rate.

    • You may hear the words: “no evidence of any cancer”, “it is gone” or “all the cancer has been removed”. Even so, the basic fact remains that there’s a chance that there are some invisible cancer cells left in the body, in some, that survived the treatment. Unfortunately, they may not be detectable with any test used today, even with upcoming liquid biopsy techniques. Over time, these cells can begin to grow again, ending in recurrence or get wiped out by the immune cells constantly circulating in our body, resulting in cure (assisted by the survivorship program that you follow).

    • There is one more situation, where undergoing rigorous survivorship program will be of use. Getting a second cancer that is not related to the first one, a possibility that exists even after many years. Having one cancer is not a protection against a second or even a third different cancer. Once again, the dedicated survivorship program can ward off this situation.

  • Choices & Options:

    • It is natural to worry about cancer coming back. However, for some people these thoughts become a “fear” that interferes with daily life and getting free of cancer.

    • How to deal with these thoughts?

      • Self-help – Positive Modification of Thought (PMT) with Cognitive Behavioural Therapy (CBT): may be the best method. Here, in simple terms, one sets up an auto-cycle of giving constant input to the mind with “thoughts what one likes most” to replace the “undesirable/fearful intrusive thoughts”. Never ask yourself “What might happen?” – There are always thousands of unpleasant possibilities. Always replace and send the message to the mind, thousands of time with “what should happen (what you want)”. To think always positive may not be possible. But Positive Modification Thought (PMT) with strong pleasant imagery replacing apprehensive thoughts is the best bet and is an established form of Cognitive Behavioural Therapy (CBT). This strengthens the constant internal emotional support, moving away from the variable external support.

      • By distraction & by concentrating on what’s most important for “today”

      • Invoking a strong purpose in life

      • Some or all of the above

      • Others take measures such as joining a peer support group or

      • Seeking the assistance of a mental wellness professional.

    • Studies have shown that regular physical activity can improve feel-good factor, reduce anxiety and or depression (equivalent to mild to moderate anti-depressive medication), boost self-esteem & confidence, along with reduction of symptoms of fatigue, nausea/discomfort, tolerance to pain etc. These benefits can be gained through moderate physical activity on most days of the workweek. Moderate activities are the one that makes your breath as hard as you would do during a brisk walk, yet able to speak comfortably during the activity. This one activity forms the foundation for survivorship program, since it is the basis of motivation for other activities that help in the prevention of recurrence.

  • Also refer to

    • Aster blog on Survivorship Program.

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