Cancer Treatment

What is cancer treatment?

Cancer refers to a group of diseases characterised by the growth of abnormal cells. Cancer treatment is the procedure to remove, destroy or restrict the growth of cancer cells in your body. Oncology is the medical specialty that focuses on the diagnosis and treatment of cancer.

There are many different approaches to treat cancer. The 3 most common approaches are surgery, radiotherapy and chemotherapy. The ideal treatment option is selected based on the location of the tumour, stage of the cancer and other patient factors.

Your doctor may recommend the strategic use of chemotherapy treatment to kill cancer cells, a combination of chemotherapy and radiation therapy to prevent the cancer from spreading to other parts of the body or other combination approaches.

With recent medical advances, we offer treatments such as intensity-modulated radiation therapy (IMRT), which can target a high dose of radiation directly onto the cancer cells while the surrounding healthy tissue is exposed to as little radiation as possible. This results in more effective treatment and fewer side effects.

Types of cancer treatment

Surgery

Surgery involves removing a tumour directly. This is an effective way to remove cancer cells in the body if the cancer is confined to a specific area, especially during the early stages for some cancers.

Your doctor may recommend one of these surgical methods:

• Laparoscopy (keyhole surgery), which is a minimally invasive procedure
• Open surgery
• Robot-assisted surgery which provides more precision

Radiotherapy

Radiotherapy, or radiation therapy, uses radiation to kill cancer cells in a small, targeted area. Your doctor may recommend radiotherapy to:

• Shrink a tumour to make it easier to remove through surgery
• Destroy any cancer cells that were not successfully removed during surgery
• Treat the tumour and reduce the risk of a cancer relapse

Radiation therapies we offer include:

• 3D conformal radiation therapy
• Brachytherapy and implants
• Conventional radiation therapy
• Image-guided radiation therapy (IGRT)
• Intensity-modulated radiation therapy (IMRT)
• Gamma knife radiosurgery
• Stereotactic radiation therapy

Chemotherapy

Chemotherapy, which is known simply as 'chemo' , is the use of drugs to destroy or restrict the growth of cancer cells.

Chemotherapy may be associated with a range of possible side effects, which may affect the patient’s quality of life. These include loss of appetite, nausea, ulcers, fatigue, hair loss, diarrhoea and nerve damage. However, many of these side effects are transient and reversible, and can be treated with effective supportive medications such as anti-vomiting and anti-diarrhoeal medications.

Chemotherapy can be used to:

• Reduce the number of cancer cells or size of a tumour before other cancer treatments. This is known as neoadjuvant or induction chemotherapy.
• Eliminate any remaining cancer cells in the body after surgery and radiotherapy. This is known as adjuvant chemotherapy.
• Prevent the further spread of cancer cells.
• Reduce the risk of a cancer relapse in a different part of your body.

Besides conventional chemotherapy, your doctor may recommend chemotherapy combined with other treatments, such as concurrent chemo-radiation.

Targeted therapy

Targeted therapy, such as oral tyrosine kinase inhibitors for lung cancer and hormone therapy for breast cancer, blocks specific genes and proteins to disrupt the cancer cells’ ability to grow and spread.

Immunotherapy

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. There are different types of immunotherapies:

• Immune checkpoint inhibitors
• T-cell transfer therapy
• Monoclonal antibodies
• Immune system modulators

Bone marrow (stem cell) transplant

A bone marrow transplant is also known as a stem cell transplant or hematopoietic stem cell transplant. It is a form of treatment for:

• Leukemia, a type of cancer affecting white blood cells
• Lymphoma, a type of blood cancer which causes swelling of the lymph nodes
• Myeloma, a type of cancer affecting plasma cells (a specific type of white blood cells that produce antibodies)

Special cancer treatments

Peritonectomy and HIPEC

Peritonectomy (also known as cytoreductive surgery) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined procedure which can be considered in some subsets of suitable cancer patients.

Peritoneum cancer is cancer that affects the peritoneum, the ‘outer skin’ lining of the organs within the abdominal cavity, such as the stomach, colon and rectum, small intestines, liver, spleen and pancreas.

Peritoneum cancer can either arise from itself, or when it spreads from the primary cancerous organ. This spread, known as metastasis, occurs commonly in cancers of the colorectal, gastric, ovarian or appendix area. Up to 25% of patients with advanced gastrointestinal and gynaecological cancer develop peritoneum cancer.

Thyroidectomy

A thyroidectomy is the surgical removal of part or all of the thyroid gland. The thyroid gland is a butterfly-shaped gland at the base of the neck responsible for the production of hormones that regulate metabolism.

Thyroidectomy is used as a treatment for:

• Thyroid cancer
• Other major thyroid disorders such as hyperthyroidism, which is an overactive thyroid gland.

Orthopaedic cancer management

Cancer of the bones and soft tissue are relatively rare compared to the most common cancers. One of the treatment approaches is to amputate the entire affected limb.

Orthopaedic surgeons can perform limb salvaging therapy, where it may be possible to treat the bone cancer without the need to amputate the limb.

Limb salvaging treatment involves removing the part of the bones affected by cancer. Bone grafts may be required to replace the removed bone, or in some cases a prosthesis or implant may be used.

Limb salvaging treatment may require the use of chemotherapy and radiation therapy to control and eradicate the cancer cells either before or after the surgery.

Ovarian tissue freezing

Ovarian tissue freezing, also known as cryopreservation, is the removal of ovarian tissue and eggs and freezing them in order to preserve their functionality.

Certain cancer treatments, such as chemotherapy and radiation therapy, may affect the ovaries of a patient. This is especially for breast cancer, ovarian cancer or cervical cancer. A female cancer patient who has gone through these cancer treatments may find that it is more difficult to conceive after the treatment is complete.

Female cancer patients can opt to freeze their ovarian tissue and eggs before cancer treatment.

After cancer treatment is completed, the preserved tissue may be implanted back into the patient’s body, or it may be used for in vitro fertilisation (IVF). In this way, female cancer patients can preserve their fertility and continue to conceive after their cancer is cured. This can be especially useful for young women who have cancer.

Why do you need cancer treatment?

Left untreated, cancer can grow and spread to different parts of your body (metastasis). This can lead to pain, complications and eventually death.

The goal of cancer treatment is to cure the disease and prolong your life span. If a cure is not possible, treatment may help to shrink the cancer or slow its growth for a more positive outcome.

Cancer treatments may be used as:

• Primary treatment to completely remove the cancer or kill all the cancer cells in your body. The most common form of primary cancer treatment is surgery. Chemotherapy or radiotherapy may also be used as the primary treatment if your cancer is especially responsive to these therapies.
• Neoadjuvant therapy, which is treatment used before the primary treatment. Its goal is to make the primary treatment easier or more effective.
• Adjuvant treatment to enhance the effectiveness of the primary treatment. Any cancer treatment can be used as adjuvant therapy to kill any cancer cells that may remain after the primary treatment. Common adjuvant therapies include chemotherapy, radiation therapy and hormone therapy.
• Palliative treatment to relieve the side effects of cancer treatments or signs and symptoms caused by the cancer itself. Many forms of cancer treatment as well as other medication can be used to relieve symptoms. You can concurrently undergo palliative treatment and other treatments intended to cure your cancer.

What are the risks and complications of cancer treatment?

The possible side effects from cancer treatment depend on your cancer and the type of treatment you undergo.

In general, cancer treatment can cause:

• Side effects from chemotherapy, including loss of appetite, nausea, ulcers, fatigue, hair loss, diarrhoea and nerve damage.
• Side effects from radiotherapy, which can damage healthy cells near the cancer. You may experience symptoms such as fatigue, hair loss, or skin changes.

How do you prepare for cancer treatment?

Cancer treatments usually take place over a period of time. Depending on the procedure, your doctor will advise you on how to prepare for your treatment.