Cancer – specific types

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Specific types of cancer

There have been significant medical advances in the management of a number of the more common cancers which I will detail on this page. I would encourage you to read 1st the overview of cancer and conventional and complementary therapies (click here) before going to this page of specific cancers.   This page is focussing mainly on the newer conventional therapies.

 

Breast Cancer

This is the leading cause of death in western women, and an aggressive multidisciplinary approach has resulted in a reduction in breast cancer mortality.  There is much debate on the value of mammography, whether this simply diagnoses cancers early, or is finding more ductal cancer with a much better outlook, thus any increase in life expectancy may be due to the earlier diagnosis. Mammography itself by squashing and radiation might actually worsen breast cancer prognosis, or whether the investigations and treatment are always necessary, and might have an increase in mortality by themselves.  However this is not a topic I want to discuss in this paper.
There are a number of types of breast cancer:

1. Newly diagnosed with no evidence of spread – recomended treatment is breast-conserving therapy – lumpectomy plus radiation therapy. This requires complete surgical removal of the tumour and moderate dose radiation to eradicate any residual disease. In some cases mastectomy is performed instead of lumpectomy. (While there is debate on the benefits of radiotherapy, currently this is the recommended treatment.)
Additional therapies – following analysis of the breast cancer tissue, other treatments might be recommended
* patients with hormone receptor positive breast cancer (HER2) are usually treated with tamoxifen
* chemotherapy is offered to patients with large tumours, aggressive histological picture, or with lymphatic invasion
2. Metastatic breast cancer – with conventional medicine, chemotherapy treatment for metastatic breast cancer is disappointing. No randomised clinical trial as demonstrated that it prolongs survival compared to the best supportive care alone click here.  Its purpose is to "alleviate symptoms and maintain and improvement or quality of life, despite the toxicity associated with the treatment". There are a variety of forms of chemotherapy both endocrine and chemo drugs, and the oncologists will have the latest information on the best treatment for an individual.
Because of the disappointing results from chemotherapy in patients with metastatic breast cancer, we would encourage you to read very carefully and follow the recommendations on the cancer page of the site. With good diet, supplements, herbs etc. and improved quality of life, major changes have been observed, and give by far the best chance of long-term survival. I would anticipate in the not too distant future new therapies for all forms of cancer will become available, enabling us to treat cancer much the same as we treat infections with antibiotics. (Our grandparents feared bacterial infections (tuberculosis, scarlet fever etc.) much the same as we fear cancer. Our children will probably look back much in the same way to cancer. Therefore staying alive and well for as long as possible is undoubtedly the approach all cancer patients should be taking.
3. Ductal cancer in-situ - this is a much more benign form of breast cancer, confined to the breast ducts and lobules, and differs from other forms of breast cancer. Its incidence has increased hugely since the introduction of mammography, (in the 1970s 6 per hundred thousand women were diagnosed, and in 2004 32 per hundred thousand women). It is uncommon in women less than 30 and the risk of developing metastases and/or death in a patient diagnosed with pure ductal carcinoma is rare (less than 1%)  The recommended treatment for this condition is lumpectomy or mastectomy if necessary, and there is debate about the value of radiotherapy. Chemotherapy is not indicated.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

Colon Cancer

The diagnosis is usually made by colonoscopy, and the decision on which form of treatment is made on a number of factors following physical examination, x-ray imaging including CT scans, and tumour markers (CEA) found in the blood.

Depending on these the cancer is rated from stage I to stage IV.

Treatment recommendations -

  • Cancer localised only to the bowel - surgery is the curative treatment.
  • Chemotherapy after surgery can eradicate micro metastases, and increases the cure rate. This has been best demonstrated in patients with stage III (note positive) disease. In these cases a six-month course of oxaliplatin-based chemotherapy is generally recommended. The benefit of chemotherapy in stage II is controversial
  • Patients with metastatic disease are not considered surgical candidates, and palliative chemotherapy is generally recommended.
  • Sometimes patients with isolated metastases in the liver can benefit from removal of these.
  • Follow-up – for patients with stage I, periodic physical examination and colonoscopies recommended, for stage II or 3, periodic physical examination, CEA measurements, CT scans and periodic colonoscopies are indicated.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

Lung Cancer

Lung cancer is the most common cause of death from cancer in both men and women, but since the reduction in smoking the frightening rise in this disease has plateaued. 95% of all lung cancers are classified as either small cell cancer or non-small cell cancer. The type of cancer makes a big difference in both the treatment and prognosis. Initially it is crucial to both identify the type of cancer and also to assess whether it has spread, using CT, MRI and sometimes PET scanners.

Non-small cell lung cancer – (squamous cell, large cell or adenocarcinomas) - surgical resection offers the best opportunity for long-term survival and cure, where possible. In stage I (no spread) no further therapy is recommended, but for more advanced forms of cancer, surgical removal followed by chemotherapy improves survival. If the patient is not fit for surgery, then localised radiotherapy can be used. In patients with widespread malignancy, chemotherapy and surgery if necessary to relieve symptoms is the treatment recommended.
Chemotherapy – the current recommended regimens consist of cisplatin (a platinum containing anti-cancer drug which binds to the DNA of cancer cells and causes them to die),or carboplatin plus another agent ( vinorelbine, gemcitabine, or docetaxel ). This chemotherapy does have side-effects (nausea and vomiting, fatigue, peripheral neuropathy, hearing loss), but it has been shown to significantly improve survival.

Small cell lung cancer is usually detected when the disease has spread significantly. For this reason surgery is usually not indicated, but this cancer is very responsive to both radiotherapy and chemotherapy. Like non-small cell cancer platinum-based chemotherapy (cisplatin) plus another agent (there are a variety of combinations that are used) can make a dramatic improvement to quality of life and survival. Radiotherapy to the chest is often recommended. Without treatment the outlook is very poor, with treatment it is a great deal better. In some cases preventive radiotherapy to the brain is given just in case there has been some spread into the head.

Although the outlook for patients with lung cancer especially if it has spread is not good (1 to 2 years) five-year survival is not unusual with aggressive treatment and supportive therapies, and by that time it is very likely newer and better and more effective drugs particularly immunotherapies will be available for this disease. We would also encourage you to read the section on cancer on this site, looking at the various complementary therapies which can make a huge difference both in the management and treatment of the cancer, but also improved quality of life.

 NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

Lymphoma

Lymphoma describes tumours developing from the white blood cells (lymphocytes). There are many subtypes, depending on how they appear under the microscope, but the 2 main categories are Hodgkin's lymphoma and non-Hodgkin's. About 90% are non-Hodgkin's. They can vary from very slow growing tumours that are simply watched, to aggressive rapidly fatal tumours if not treated. The more rapidly dividing tumours in fact respond better to chemotherapy and radiotherapy, with a much higher cure rate. On the whole 70 to 80% of patients with lymphoma survive 5 years and longer.

The classification does make a difference in the outlook and treatment, and includes Hodgkin's lymphoma, non-Hodgkin's lymphoma (currently they are classified into T-cell or B-cell lymphomas; but some have names such as Mantle cell). Depending on the location, spread and type of cell, treatment can vary from simple watching in the case of the slow growing tumours, to aggressive chemotherapy and radiotherapy which has a very high success rate.    Some of the chemotherapy can be very strong, but the potential benefits of curing the condition make them worthwhile. We would encourage you to read the booklet (coping with chemo) on this website to help you through this time. Major advances in chemotherapy, immunotherapy and other treatments are making the outlook of this previously fatal disease very much better.

Because of occasional long-term effects from chemotherapy (secondary malignancies, cardiac disease, hyperthyroidism) doctors often follow patients up long-term to check that these have not occurred.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

Melanoma

Melanoma is the most serious form of skin cancer, is incidence increases with age. The majority of melanomas are superficial spreading moles on the skin (70%), nodular melanomas (about 15%) nodules or polyps, and other forms of melanoma. The ABCDE rule is used to identify potential melanomas – asymmetry (one half is not identical to the other half), border irregularities, colour variation, diameter greater than 6 mm, evolving (changing in size shape or colour). The "ugly duckling" sign – with a pigmented lesion looks different from other pigmented lesions around it can also raise the suspicion of melanoma.

A biopsy is necessary whenever a melanoma is suspected, preferably an excisional biopsy that includes the entire lesion with 1 to 3 mm margins of normal skin around and below the lesion.

The treatment of melanoma which has spread is a very rapidly advancing science, with new agents appearing almost weekly. The treatment will also vary on the agents available in different countries, and expertise of local services.
⦁ One or very few secondaries should be evaluated for possible surgical removal.
⦁ A number of forms of chemotherapy are now available and a much better and more effective than the earlier treatments which showed little benefit. These new agents include checkpoint inhibitor immunotherapy (pembrolizumab or nivolumab) sometimes in combination with a specific antibody (ipilimumab)
⦁ about half of all melanomas have a mutation on the BRAF gene, and inhibiting this gene with drugs ( vemurafenib or dabrafenib) significantly increases survival.

This is a disease that very frequently affect young people as well as older ones. With the rapid advance in research, it is impossible to advise on the best treatment as new agents come to hand, but undoubtedly aggressive therapy can make a difference in metastatic disease, a condition which previously had been uniformly fatal.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

 

Multiple Myeloma

Myeloma is a cancer involving the proliferation of a single clone of plasma cells (immune cells formed in the bone marrow) which results in extensive localised destruction of the bones causing fractures, it can also cause high calcium, kidney failure, anaemia and infections. "Premalignant" stages of myeloma (monoclonal gammopathy and smouldering myeloma) do not require treatment, but without active treatment, true multiple myeloma patients have a very poor outlook.
Because of this and the efficacy and expense of treatment, patients are evaluated extensively upon diagnosis with blood counts, bone marrow biopsies, x-rays, frequently including CT and MRI scans.

Following this investigations there are 2 alternative treatments – Bone marrow transplant (usually reserved for those less than 70 years) or chemotherapy.

Transplant patients receive Initial therapy for 2 to 4 months to reduce the number of tumour cells in the bone marrow, stem cells are then collected followed by high dose chemotherapy (some patients receive stem cells from donors, but the majority have their own return to them.) Following transplant, long-term follow-up and one of the chemotherapy agents is usually given.
Non-transplant patients – chemotherapy within newer agents has now become extremely effective although expensive. A variety of new drugs are frequently given together.
Lenalidomide plus low dose dexamethasone; bortezomib (Velcade) is very effective and is best given as a subcutaneous injection. High steroids (dexamethasone) and sometimes other chemotherapy agents can also be given.
Combinations that are frequently tried include:  bortezomib, lenalidomide and dexamethasone (VRD); bortezomib, cyclophosphamide and dexamethasone (VCD); bortezomib, thalidomide, dexamethasone (VTD); and lenalidomide plus low-dose dexamethasone (usually retained for frail or older patients).

Following successful control of the myeloma, maintenance therapy usually lenalidomide plus dexamethasone until progression or significant toxicity develops.

Using these approaches, the survival of patients with myeloma is increased from months to many years, and with the development of new therapies long-term recovery and control of the condition is very possible.

Patients with myeloma should be encouraged to be as active as possible in order to maintain bone density but avoid excessive risks of trauma. Patients should be given bisphosphonate therapy to strengthen the bones, this significantly reduces the number of skeletal effects.
There are also a number of complimentary therapies that might be considered, and in particular curcumin (500 to 1,000 mg twice daily) could also be beneficial. We would encourage you to read carefully the article on cancer looking at other complementary therapies that could be useful.

In addition to the supplements recommended on the "Cancer" page, there is increasing interest in the benefits of curcumin   One study from the BMJ a patient resistant to other therapies took 8 grams of curcumin at night and this appeared to put her into remission.
There is also a belief that drinking green tea can make the light chains in myeloma less damaging to the heart and kidneys.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies. 

Prostate Cancer

Prostate cancer is the 2nd most common cancer in men, its management varies depending upon a number of factors. There is great debate on prostate screening (click here) but once the diagnosis has been made, the decision needs to be made on what therapy if any is the best.
The 3 factors which need to be considered are:
1. The extent of the disease - whether the cancer is in only the prostate or has spread, determined by CT scan and MRI scan
2. The appearance of the cancer under the microscope – prostate biopsies grade the cancer into its aggressiveness and likelihood to spread using the Gleason score (grade 1 being the most " benign" and number 5 the most aggressive.) A new composite Gleason score has been recommended by the World Health Organisation 2016 and adds together the primary and secondary Gleason patterns seen on histology. This composite score is now being used to decide on treatment in many centres.
3. Serum PSA level

From these the recommendations for treatment are usually made:
⦁ very low risk – composite Gleason score less than 6, PSA less than 10ng/ml, with tumour only seen in one side of the prostate gland. For most of these patients observation and monitoring PSA levels is all that is required.
⦁ Low risk – tumour only in the prostate gland, PSA less than 10 and composite Gleason score less than 6. For these the choices active surveillance only, radiotherapy or radical prostatectomy. These patients have a very good long-term outlook, and all of these therapies appear to be equally successful.
⦁ Intermediate risk – more extensive tumour in the prostate gland, PSA between 10 and 20 and composite Gleason score of 7. These patients should either have radiotherapy, or radical prostatectomy.
⦁ High-risk – tumour has extended beyond the capsule of the prostate gland, PSA greater than 20 and composite Gleason score of 8 to 10. These patients have radiotherapy plus brachy therapy (localised radiation) and/or radical prostatectomy with extended pelvic lymph node dissection.
⦁ Very high risk – tumour invading adjacent organs, composite Gleason score 8 to 10. These patients have radiotherapy plus brachy therapy and radical prostatectomy with pelvic lymph node dissection. If the PSA falls and then rises, this could suggest spread elsewhere.
⦁ Disseminated metastases – when the cancer has spread, there are still a number of treatments which can significantly reduce symptoms and improve survival - these include  medical orchidectomy (using hormones which block testosterone such as Abiraterone), removal of the testicles, and in some cases chemotherapy(docetaxel)

The outlook depends very much upon the grade of the tumour, the vast majority of prostate cancers are slow growing and do not spread, hence the recommendation that we should not be screening people for the cancer with PSA and rectal examinations as has been done in the past because of the large number of false positives, people being treated with a don't need to be and complications associated with treatment being more dangerous than not treating at all.

In addition to the treatments above, I would strongly recommend that you read the article on cancer on this website looking at all the other alternative therapies available as well.

NB This page is concentrating mainly on medical treatments, please also read the page on cancer for therapies you can do, supplements, nutrition and other complementary therapies.