TREATMENTSSurgical Oncology (Surgery)Types of SurgerySlide 4Risks & Side EffectsChemotherapyHow is Chemotherapy given?Side Effects of ChemotherapyRadiation TherapyX-ray Therapy is givenRadiation Side EffectsBone Marrow Transplant2 Types of TransplantTransplant Side EffectsGraft vs. Host DiseaseGraft vs. Tumor EffectTransplant Side Effects (cont..)PsychotherapyCosts of Cancer TreatmentsSlide 20Which one is most effective?TREATMENTS•Surgical Oncology•Chemotherapy•Radiation Therapy•Bone Marrow Transplant•Complementary Medicine•PsychotherapySurgical Oncology(Surgery)•____________ form of tx for cancer.•First step in tx b/c used to dx & tx.•Alone cures cancer.•Used in conjunction w/ other txs.Types of Surgery•Staging Surgery–Determines the extent of the disease–Most accurate assessment of how far the cancer has spread•____________ Surgery–The removal of a tumor when it appears to be confined to one area–Done when there is hope of taking out all the cancer–Primary treatment of cancer–Used alone or in combination w/ other treatmentsTypes of Surgery•Debulking Therapy–Removal of as much of the cancer as possible–Usually done when removing cancer entirely would cause too much damage to organs or surrounding tissue.•Diagnostic Surgery–A tissue sample obtained to determine if cancerous or to determine the type of cancer–Confirmed by looking at cells under a microscope•Preventative (Prophylactic) Surgery–Removes tissue that is _______________________ but likely to become.Risks & Side Effects•Pain (most common)•Infection at the site of the wound•Bleeding internally or externally•Damage to internal organs and blood vessels•Reactions to anesthesia•Problems with other organs•Blood clots•Slow recovery of other body fxnsChemotherapy•Defined as the use of medications or chemicals with cancer fighting abilities –Anticancer agents–Interfere w/ the cancer cells’ ability to grow or multiply–Identification of disease important because some work best for certain diseasesHow is Chemotherapy given?•IV (intravenous)•Oral•Intramuscular•Intrathecal (IT)•Intraperitoneal (IP)•Implanted Intravenous PortSide Effects of Chemotherapy•Damage to normal cells as well as cancer cells–Hair follicles–Cells in gastrointestinal tract–Bone Marrow•Can cause graft rejection•Hair loss (alopecia)•Mouth sores•Difficulty in swallowing, nausea, diarrhea, infection, anemia•Increase risk of bleedingRadiation Therapy•X-ray Therapy•High energy that comes from special machines or radioactive sources•Destroys cells or keep them from growing or dividing•Effective way to treat many kinds of cancer in almost any part of the body•½ of all patients treated with radiation•Combined with other treatmentsX-ray Therapy is given•__________________–Swallowed or injected into the body–Admitted to the hospital 3-7 days•Externally–Doses of radiation given to carefully defined area–Directs the x-ray particles at the cancer and the normal tissue–Given in small doses–Once a day over a period of 3 to 7 wks–Tx during outpatient visit.Radiation Side Effects•Can hurt _________________•Generally limited the region of the body being treated•Skin reaction, reddening irritated, dry or sensitive •Hair loss•Nutritional problems•FatigueBone Marrow Transplant•Bone Marrow–Spongy substance inside our _______ bones–Made up of hematopoietic stem cells–These cells are given (transplanted) from donor to patient2 Types of Transplant•Autologous Transplant–Structures of cells derived from you and your body•Allogeneic Transplant–Transplanted cells are coming from donor–_____________ means cells come from identical twinThe cells must be “matched” to the patient which is done by Human Leukocyte Antigen (HLA)Transplant Side Effects•Destruction of the bone marrow leading to low blood counts–Include bleeding due to low platelet cts–Infections due to low blood cell cts–__________ due to low red blood cell ctsGraft vs. Host Disease•Donor’s cells attack the _______________•Can affect the skin (rash, intestinal tract (diarrhea), and liver•Can occur anytime after transplant•Treated with immunosuppressing medications including steroids and antithymocyte globulin (Atgam)Graft vs. Tumor Effect•Good •Donor’s cells attack any remaining cancer cells•Producing new blood cells•Carefully manage this balanceGraft failure occurs when the donors cells fail to start working. If engraftment has not occurred by 42 days after transplant, graft has failed.Transplant Side Effects (cont..)•Pulmonary complications–Generally caused by _______________Psychotherapy•Psychological interventions•Can effectively reduce ______________ in patients undergoing treatment•Includes counseling to alleviate stress•Improve patient well-being•Does increase or extend the life of cancer patients.Costs of Cancer TreatmentsTable 1: National Cancer Treatment Expenditures in Billions of Dollars – 1963-1995.YearCancer Treatment SpendingTotal Health Care SpendingPercent of Cancer Treatment Spending to Total1963$1.3 billion $29.4 billion 4.40%1972$3.9 billion $78 billion 5.00%1980$13.1 billion $217 billion 6.00%1985$18.1 billion $376.4 billion 4.80%1990$27.5 billion $614.7 billion 4.50%1995$41.2 billion $879.3 billion 4.70%Data source: Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annual Review of Public Health 2001;22:91-113. Cancer Progress Report 2001 (http://progressreport.cancer.gov/)National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human ServicesTable 2: Estimates of National Expenditures for Medical Treatment for the 13 Most Common Cancers – Based on Cancer Prevalence in 1996 and Cancer-Specific Costs for 1995-1998, Expressed in 1996 Dollars.Percent of all new cancers (1998)Expenditures (in 1996 dollars)Percent of all cancer treatment expendituresAverage Medicare payments per individual in first year following diagnosisBreast 18.2% $5.4 billion 13.10% $9,230 Colorectal 11.7% $5.4 billion 13.10% $21,608 Lung 12.5% $4.9 billion 12.10% $20,340 Prostate 13.6% $4.6 billion 11.30% $8,869 Lymphoma 4.2% $2.6 billion 6.30% $17,217 Bladder 4.0% $1.7 billion 4.20% $10,770 Cervix 2.3% $1.7 billion 4.10% $13,083 Head/Neck 3.3% $1.6 billion 4.00% $14,788 Leukemia 2.1% $1.2 billion 2.80% $11,882 Ovary 1.7% $1.5 billion 3.70%