Treatments
Understanding Cancer

Cancer treatments are precisely customized to the location and exact type of cancer detected. One woman with breast cancer may receive a particular treatment, while another may be treated with a completely different approach based on the biologic composition of the cancer. Though many mysteries remain, a great deal is known about various types of cancer cells and the types of treatments they respond to. As our technology continues to improve, more knowledge and better treatments are coming about every day.

At Sutter Cancer Centers, patients receive treatments from a multidisciplinary team of specialists who each contribute knowledge from their areas of expertise to develop treatment plans. Physician teams may include a medical oncologist, radiation oncologist and surgeon. In addition, the centers hold weekly tumor conferences to discuss specific cases and draw on a larger pool of specialists to arrive at a recommended treatment plan.

In general terms, treatments fall under three major categories: localized, systemic and blood and marrow (stem cell) transplantation. Localized treatments address the tumor site directly and include surgery, radiation and thermal ablation. Systemic treatments deliver broad therapies through the blood stream and include chemotherapy, biologic therapy and hormone therapy. Blood and marrow transplants replace blood-producing cells that have been destroyed or damaged by high doses of chemotherapy or radiation. Treatments may be administered alone or in combination with other therapies.

Surgery removes the cancerous tumor and often includes some surrounding tissue and lymph nodes that may contain cancer cells. Surgery may be performed through traditional open methods, through minimally invasive methods using probes (endoscopes) with tiny cameras and surgical or laser tools, or using a robotic-assisted surgery system such as the da Vinci® system used for prostate surgery at Sutter Cancer Center, Sacramento. Additional da Vinci system surgeries currently being performed or undergoing clinical trials are covered on www.intuitivesurgical.com.

Radiation uses energy applied externally or internally to reduce or eliminate tumors. In internal radiation procedures (also called brachytherapy), doctors insert tiny radioactive devices (such a needles or seeds) in or near tumors. Prostate seed therapy offered at Sutter Cancer Center, Roseville is a form of brachytherapy.

External-beam radiation aims high-energy rays directly at the tumor site. Many types of machines are used, including the Gamma Knife®, used at Sutter Cancer Center, Sacramento to treat tumors and other brain abnormalities without surgery. Radiation may be used alone, before surgery to shrink the tumor, or after surgery to ensure no cancer cells remain.

More information is available on radiation therapy for cancer in our Health Information Section.

Thermal ablation allows doctors to treat tumors by inserting small, heat-emitting radiofrequency or microwave probes directly into the tumor. Cancer cells are more sensitive to heat than normal cells, allowing heated probes to destroy tumor tissue with minimal effect on surrounding healthy tissue. A great deal of pioneering research on thermal ablation was conducted at Sutter Cancer Center, Sacramento.

Lasers generate a narrow beam of high-intensity light that can be used in thermal ablation and in surgery to make a clean cut with little bleeding. Surface cancers on the skin or organs can also be treated with lasers. This procedure is used in treating ear, nose and throat (ENT) cancers, and bronchial tumors. Another systemic treatment being developed uses photosensitive agents, which the patient takes internally. After the photosensitizing agent has had time to attach to cancer cells throughout the body, laser light activates the agents, which destroy cancer cells.

Heat therapy takes advantage of the fact that cancer cells are more sensitive to heat than normal tissue and are also more responsive to chemotherapy when heated. Those properties are being explored in localized therapy such as thermal ablation (above), and treatments that involve heating a specific area of the body where cancer is present while introducing chemotherapy. For example, a procedure known as a Sugarbaker begins with surgery to remove as much of the tumor(s) as possible then, while the patient is still in surgery, doctors introduce a heated chemotherapy into the peritoneal area (see Sugarbaker Procedure on this Web site).

Chemotherapy is the most well-known cancer treatment. Patients receive one or more anticancer drugs by mouth, by injection, intravenously, through catheters placed in the abdomen or by injection into the cerebrospinal fluid. Chemotherapy is given in cycles with time in between for the drugs to take effect and the body to adjust before the next round of treatments. Anticancer drugs are tailored to the form of cancer and aimed at destroying the cancer cells with minimal affect on other cells. Because it is generally used as a systemic treatment, rather than localized to the tumor site, patients often experience other effects, such as hair loss, nausea, and fatigue. Emerging treatments, such as the Sugarbaker Procedure apply chemotherapy agents directly into the tumor and surrounding tissue.

Hormone therapy is used to destroy cancers that are hormone dependent by eliminating those hormones from the body through drugs or removing the hormone producing organ (such as the ovaries). Because those hormones may also be necessary to other body functions, hormone therapy often has side effects that should be discussed thoroughly with your doctor.

Biologic therapy or immunotherapy motivates the body's existing immune system to attack and destroy cancer cells. This rapidly developing avenue of treatment is also used to alleviate side effects of other treatments. Using naturally occurring and engineered substances placed in the body, immunotherapy either stimulates the entire immune system, places markers on cancer cells that direct white blood cells to attack and destroy them, or vaccinates the body by introducing inactivated cancer cells that help the immune system recognize and destroy them. Though biologic treatments are classified as systemic, they are often narrowly targeted to attack only a specific type of cancer cell.

Genetic therapy is another developing approach to treating cancer by locating and replacing defective genes that allow cancer to form with healthy, functioning genes. Though promising because it would eliminate many of the side effects associated with other forms of treatment, gene therapy raises ethical questions and concerns about the long-term effects.

Blood and Marrow (Stem Cell) Transplants are used in the treatment of many cancers, especially blood-related cancers such as leukemia, lymphoma and myeloma, either to replace defective blood-producing cells (stem cells) or to replace stem cells destroyed by disease or high does of chemotherapy or radiation. Stem cells are immature cells that will develop into mature blood cells, such as white cells, red blood cells, and platelets. Though the term "stem cell" has been associated with research involving cells taken from developing fetuses, everyone manufactures stem cells in the bone marrow. Autologous stem cell transplant is performed by collecting stem cells from the patient and reinfusing them back into the patient after high doses of chemotherapy and radiation. Allogenic stem cell transplants use stem cells taken from a donor whose tissue type most closely matches the patient, usually a sibling. Allogenic transplants have the added benefit of introducing donor immune cells that can help fight cancer but may cause a serious condition called graft-versus-host-disease (GVHD) if the donor cells fight the patients own cells. In rare occasions, stem cells may be taken from an identical twin (syngeneic transplants). Sutter Cancer Center, Sacramento has considerable experience and an excellent reputation for all types of stem cell transplants. More information is available in the Blood and Marrow (Stem Cell) Program section of this Web site and under bone marrow transplant in our Health Information section.