Friday, 18 January 2019

Cancer Treatment



Today, Cancer is the second leading cause of death globally with an estimation of about 9.6 million deaths in the year 2018 and it is increasing rapidly.
Due to advancements in the field of medicine, the treatment for cancer is also being developed continually. Now, more targeted and effective treatments are available. With such advancements, the outcomes have also improved.
There are various types of Cancer therapies available. The type of treatment directly depends upon the type of cancer and its advancement as the cancer treatment is a personalized treatment and so it can vary for every individual.

 Surgical treatment (Surgery)
In this procedure, a surgeon or Surgical oncologist removes the tumor and nearby tissues from the body during an operation. This is the oldest type of cancer treatment and is still effective for many types of cancer. There are many reasons to undergo surgical treatment during cancer, such as for cancer diagnosis, staging, removal, debulking, palliation, reconstruction, and prevention. Today, there are minimally invasive procedures and surgeries including Laparoscopic surgery, Laparoscopic surgery, Cryosurgery, Endoscopy, etc.

Radiation Therapy (or Radiotherapy)
Radiotherapy uses high-energy rays to treat cancer by killing the cancer cells and shrinking the tumors in the body. At high doses of radiation, the DNA of the cancer cells damages resulting in either the death of the cancer cells as the DNA damages beyond repair or slow in the growth rate. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Even after the end of radiation therapy, the cancer cells keep on dying for weeks or months. It can be given both externally (aims radiation at the affected area through the machine) and internally (works by injecting radioactive the material- solid or liquid, in the body). Radiotherapy is applied for either curative treatment, or for palliative treatment.

Chemotherapy
It uses certain drugs to kill cancer cells or to stop them from dividing and spreading to the other parts of the body. It is one of the most common treatments for cancer which cures cancer or eases its symptoms. For some individuals, it may be the only treatment they receive, but mostly Chemo is applied along with other treatments. If it is applied before the other treatment to lessen the tumor size, it is called neoadjuvant chemotherapy and if used after other treatments to destroy any remaining cancer cells, it is called adjuvant chemotherapy.

Targeted Therapy
It is the foundation of precision medicine. In targeted Cancer therapies, the specific proteins and genes responsible for the growth, division, and spread of the cancer cells are targeted or blocked. It works against cancer in many different ways such as:

  • Helping the immune system to destroy cancer cells by providing a marker,
  • Stop cancer cells from dividing by interfering with the signal proteins,
  • Stop signals that help form blood vessels (angiogenesis) by providing angiogenesis inhibitors,
  • Deliver toxins, chemo drugs or radioactive materials to cancer cells using monoclonal antibodies,
  • Cause necrosis of the cancer cells.


Hormonal Therapy (Hormone Treatment or Endocrine Therapy)
It is a type of Targeted Cancer therapy. It is used to treat those cancers that use hormones to grow such as Prostrate Cancer, Breast Cancer, Ovarian Cancer, etc., by blocking or lowering the number of responsible hormones in the body to slow or cease the growth of cancer cells. Hormone Therapy can be given orally (as pills or medicine), through injection (given by a shot in a muscle or skin), or surgically (to remove organs that produce hormones).

Immunotherapy (or Biological Therapy)
It helps the immune system to fight against cancer using biological substances by restoring and improving the function of the immune system. There are several types of immunotherapy, including monoclonal antibodies, Cancer vaccines, Non-specific immunotherapies, T-cell therapy, and Oncolytic virus therapy. Certain immunotherapies can mark cancer cells making it easier for the immune system to find and destroy them. Other immunotherapies boost the immune system to work better against cancer.

Transplantation (Bone marrow Transplant or Stem Cell Transplant)
It restores the blood-forming stem cells (WBCs, RBCs and, platelets) as in the case of leukaemia, multiple myeloma, or some types of lymphoma. It is also useful in blood diseases. In this procedure, healthy stem cells are injected in the vein to enter the bloodstream and travel to the bone marrow to restore the blood cells. The stem cells that are used in transplants can be taken from bone marrow, bloodstream, or umbilical cord. 

Friday, 14 December 2018

Cancer Nanotechnology


Nanotechnology is the manipulation of matter to be applied as materials, functionalized structures, devices, or systems (approximately the 1-100 nanometer range) at the atomic, molecular, or macromolecular scales with varied and new properties. It has great potential in almost, every sector, ranging from healthcare to construction and thus, is a rapidly outstretching area of research.
In the healthcare industry, the application of nanotechnology is termed as Nanomedicine, promising the revolution of medical application from the drug delivery to diagnosis and treatment and in many areas of Research and Development. The greatest advantage of nanomedicine is that the size of the nanomaterials is the same as that of the biomolecules and other biological structures and so can be useful for both in vivo and in vitro research and applications.


The branch of Nanotechnology concerned with the application of nanomaterials (for tumor imaging and drug delivery) and its approaches for the diagnosis and treatment of cancer is termed as Cancer Nanotechnology.
  • Drug Delivery
In cancer, uncontrolled abnormal cells grow rapidly and destroy the normal and healthy adjacent tissues and cells and often spread into other parts of the body via lymph and blood (Metastasis). Drugs and treatments associated with cancer often lead to various side effects but through nanotechnology, there have been possibilities of drug delivery and its action to specific tumor cells and on the healthy adjacent cells thus, lowering the overall drug consumption and side effects. Abraxane is one of the most popular nanotechnology-based drugs that are commercially available to treat Breast cancer and pancreatic cancer.
  • Imaging and Diagnosis
Nanotechnology-enabled imaging agents and cancer drugs enhance and improve the images produced by Ultrasound and MRI. Some of the examples of such nanoparticles include Quantum Dots in conjunction with MRI can produce great images of tumor sites. Cadmium Selenide, when injected into the body, seep into the tumors and glows when exposed to the Ultraviolet light thus, guides for the accurate site of the tumor.
  • Treatment and Therapy
Researches are going on Cancer Nanotechnology for creating the new therapeutics which is far beyond the drug delivery. The multiple types of biomolecules encapsulated nanoparticle in conjunction with ligands can be useful for therapeutic effect enabling combination drug delivery, multi-modality treatment and combined therapeutic and diagnostic, known as “theranostic,” action.

It can also be used for the development of research tools for the advanced study of cancer which may include in vitro tumor models and use nanoparticle probes to study cellular drug responses and mechanisms.

Thursday, 29 November 2018

Cancer Biomarkers and Targets


Biomarkers or molecular markers are the biological molecule present in the blood, cell lines, and tissues and in other body fluids as an indicator for the normal as well as the abnormal processes of the body and also works as a measurable indicator of any underlying biological condition or disease. Various types of biomolecules such as DNA (genes), RNA, proteins or hormones, can serve as biomarkers, as they all take part in various metabolic processes of the body.
Biomarkers play an essential role in the field of Oncology. It is said that the understanding of Cancer biomarkers is key to developing a right treatment plan for an individual. But notably, Biomarkers are not limited to Cancer. There are several biomarkers for heart diseases, infections, multiple sclerosis, and many other diseases.

Cancer biomarker refers to any molecule or metabolic changes inside the body that is characteristic of the presence of Cancer in the body. It may be produced by the tumors itself or by other cells and tissues, in response to the presence of Cancer in the body.

Cancer biomarkers may include proteins and other biomolecules, gene mutations, missing genes, and various gene rearrangements. Each of them works and reacts differently within the body.

In clinical research, and medicine, Cancer biomarkers are primarily used in three ways:
  • For the diagnosis of the condition as in the case of early-stage Cancers,
  • To predict how aggressively Cancer will grow and are therefore useful for assessing prognosis, 
  • For the prediction of a patient’s response to the treatment.

The function of Cancer Biomarkers
  • Risk assessment: Offers a quantitative way to determine predisposal of an individual for the particular type of Cancer. For example- overexpression of the HER2 protein, hypermethylation of MYOD1, CDH1, and CDH13 for Cervical Cancer, etc.,
  • Diagnosis: determining the origin of Cancer whether they are primary or metastatic by screening the chromosomal alterations found on the cells.
  • Prognosis and prediction of the treatment: when an individual has been diagnosed with Cancer, certain biomarkers determine the aggressiveness of an identified Cancer. Such biomarkers include HER2/neu gene amplification for breast Cancers, elevated estrogen receptor (ER) and/or progesterone receptor (PR) expression, etc.
  • Pharmacodynamics and pharmacokinetics: As each individual have a different genetic makeup, they respond to treatments, and drug differently. In some cases, a certain drug can result into a dangerous condition, such as in case of Individuals with mutations in the TPMT gene to metabolize a large amount of a leukemia drug, potentially causes a fatal drop in white blood count for such patients. Hence, Cancer biomarkers are used to determine the most effective treatment regime.
  • Monitoring treatment response: Such biomarkers shows how a treatment is working overtime and how well an individual is responding to the treatment.

Friday, 23 November 2018

Hematology-Oncology


Hematology, also known as Haematology, is a medical subspecialty which deals with the study of prognosis, diagnosis, cause, prevention and treatment of the diseases and conditions (like Hemophilia, blood clots, blood cancers) related to blood and its components, such as blood cells, haemoglobin, blood proteins, bone marrow, platelets, blood vessels, spleen, and the mechanism of coagulation. The physician who specializes in the diagnosis, treatment and/or prevention of blood diseases is called hematologist and those who work in hematology laboratory are called hematopathologists. Whereas, Oncology is a branch of medicine concerned with the diagnosis, prevention, and treatment of all the types of cancer and specialist is known as the oncologist.

There are over 200 different types of cancer such as prostate cancer, melanoma cancer, breast cancer, lung cancer and many more. Blood cancer is also one of them. It includes conditions such as Hodgkins and non-Hodgkins lymphomas, leukemias and multiple myelomas. The subspecialty of Hematology, overlapped with the medical oncology deals with such conditions. This branch of internal medicine is known as Hematology-Oncology and the physicians who specialize in the diagnosis, treatment, and prevention of blood diseases and cancers are known as Hematologist-Oncologist. They do not usually treat operable cancers but rather focuses on blood cancer.

Types of Blood Cancers:
  • Lymphoma: It is a cancer of the lymphatic system (a part of the immune system), Occurs when the abnormal lymphocytes or White Blood Cells start diving rapidly and spread throughout the lymphatic system. It often begins with the lymph nodes and can arise from any part of the body. They are of mainly two types - Hodgkin lymphoma and non-Hodgkin lymphoma.
  • Leukemia: It is a cancer of the white blood cells. It is the most common type of blood cancer, originates from the abnormally rapid growth of the WBCs in the bone marrow. It destroys normal blood cells and so, the person becomes prone to infection. It is named according to the type of WBC which is affected and whether it is acute (faster growing) or chronic (slower growing).
  • Myeloma: also known as multiple myelomas, is a cancer of plasma cells (Antibody-producing cells that fight against infection and disease. It occurs when the abnormal plasma cells, or myeloma cells, multiplies rapidly in the bone marrow and form tumors in the bones which prevent the bone marrow from producing normal or healthy blood cells. For the single plasma cell tumor, the condition is called isolated plasmacytoma. When two or more tumors exist, it is termed as multiple myeloma.


Friday, 16 November 2018

Neuroradiology or Neuroimaging



Neuroradiology is a subspecialty of the radiology concerning the diagnosis and characterization of the abnormalities associated with the central and peripheral nervous system, head, neck, and spine using the medical imaging techniques.
Neuroradiology uses the techniques of neuroimaging for the direct or indirect image of the structure and function of the nervous system with the minimal invasion and Physicians who specialize in the execution and elucidation of neuroimaging in the clinical setting are known as neuroradiologists.  Earlier, the diagnosis and identification of effective therapies for the diseases related to nervous system brain and spine were limited due to the lack of the reliable criteria for the determination of its response and progress but the assessment of the imaging techniques in the field of neurology has made it possible.

The various imaging techniques incorporated in neuroradiology includes:
  • Computed axial tomography: It is generally used for the structural imaging of the brain for the detection diagnosis of gross (large scale) intracranial disease (such as a tumor) and injury. CT scan or CAT scan uses a series of x-ray scans which is measured by the computer program for the numerical integral calculation of the absorbed X-ray beams.
  • Magnetic resonance imaging: It uses magnetic fields and radio waves to produce high quality two- or three-dimensional images without the use of X-rays or radioactive tracers or radiopharmaceuticals. It is used for the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection, and vascular irregularities that may lead to stroke. MRI can also detect and screen degenerative disorders such as multiple sclerosis.
  • Functional magnetic resonance imaging: It is a functional imaging technique relies on paramagnetic properties of oxygenated and deoxygenated hemoglobin to see images of changing blood flow in the brain associated with neural activity.
  • Positron emission tomography: It is a useful imaging technique for the diagnosis, the planning of treatment and the prediction outcome in various neurological diseases by providing non-invasive quantification of brain metabolism, receptor binding of various neurotransmitter systems, and changes in regional blood flow.
Some other techniques involved in neuroradiology imaging or neuroimaging are Magnetoencephalography, Diffuse optical imaging, and cranial ultrasound.

Advantages and Disadvantages
  • Functional magnetic resonance imaging has the minimally-to-moderate risk as compared to other imaging methods and due to its BOLD-contrast phenomena but this technique cannot be used for the individuals with medical implants or devices and metallic items in the body as magnetic resonance (MR) emitted from them can cause failure of the screening.
  • The greatest concern associated with Computed axial tomography scan is exposure of the patients to levels of radiation 100-500 times higher than traditional x-rays to produce better resolution imaging.
  • As the PET scan relies on the foreign substance (radiopharmaceuticals) injected into the bloodstream traveling through the body, the amount of radiation exposure to the patients are relatively small but there is the slightest chance that the radioisotopes used can lead to allergic reactions in some individuals.

Friday, 9 November 2018

Radiation in Medicine



Radiation is the transmission or traveling of the energy through space or a material medium in the form of waves or particles. Ultraviolet radiation from the Sun is the most familiar form of radiation that we know. Except for the UV radiation, there are some higher-energy kinds of radiation, collectively known as Ionizing Radiation (such as α, β, or γ radiation) that are present on Earth and we all are exposed to it in minute doses through rock, soil, space, and air. But exposure to the higher levels of such radiation is harmful and dangerous and thus, the exposure should be controlled. The use of radiation in the medical field has made a huge evolution. Today, about one-third of the entire medical specialties involve radiation or radioactivity, right from the diagnosis - to the treatment.
Radiation is used in both nuclear medicine and radiology, but the difference is:
  • In general radiology, the X-rays enters the body from the outside source through space and creates a fixed or still image of the body, while in Nuclear medicine; a small amount of radioactive material (radiotracers, or radiopharmaceuticals) is administered internally, via injection, swallowing or inhalation inside the body into the bloodstream. This radioactive material travels through the area to be examined and produces γ-rays which are detected by the computers to create images.
  • The traditional imaging systems of radiology (X-rays, Ultrasound, CT scans, MRI) creates only a fixed or still image of the body showing the anatomy or structure of the body, while the nuclear imaging techniques (PET, SPECT) show the physiological function of the area to be investigated by producing two-dimensional or three-dimensional images.
  • In addition, through Nuclear medicine imaging techniques, a specific organ or tissue can be examined such as brain, lungs, and heart, unlike in general radiology imaging procedures where it produces the image of the whole area such as the chest cavity or abdominal cavity.
Advantages:
  • Both of these medical imaging specialties are used to diagnose and determine the severity of the disease and are involved in their effective treatment.
  • These imaging procedures are non-invasive or have the minimal invasion, less risk, shorter recovery time and are less painful than the surgical treatments.
  • It also improves the cancer diagnosis with early detection and also involves its effective treatment (known as radiation oncology).
Disadvantages:As with all the medical procedures, radiation techniques also involve a level of risk but the benefits are significantly greater than any risk involved.
  • Exposure to the radiation in such techniques carries with it a minute increase in the risk of developing cancer later in life, especially to the radiologists and physicians.
  • In nuclear medicine, there is a small level of risk associated with the radiotracers administered into the body such as allergic reactions which are very rare as the type of the radioactive materials used by the specialist, depends on the medical history of the patient.


Friday, 2 November 2018

Interventional Radiology in Cancer treatment


Worldwide, cancer has the second highest mortality rate of all the disease. It consists of a large group of diseases involving the abnormal growth of cells rapidly. Today, there are many types of cancer treatments available depending upon the type of cancer and its advancement. Some patients receive only one type of treatment but mostly, the patients receive a combination of the treatments.

The three major treatments and therapies of cancer include:
  • Surgical treatment: In this procedure, surgeons remove cancer from the body through the operation using anesthesia. The procedure is complicated and painful.  
  • Chemotherapy: It involves drugs to kill or retards the growth of the cancer cells in the body.
  •  Radiation therapy: It uses high radiation energy to kill cancer cells and shrink the tumors in the body. Among all the treatments, the radiation therapy has a minimal invasion in the body but the main disadvantage is that there is a limit to the amount or lifetime dose of radiation body can safely receive. Also, radiation may kill the nearby healthy cells.

Interventional radiology is a medical specialty in which the highly trained physicians and radiologists perform minimally invasive procedures for the diagnosis and treatment of the various diseases. In the cancer treatment, it has reduced the risk, complications, pain and recovery time for the patients by replacing surgery and chemotherapy. Due to these, it is increasingly occupying the major role in the care of patients.

The specialty includes imaging techniques such as X-rays, Ultrasound, MRI, CT-scan and various other instruments to diagnose and treat the patients non-surgically using the catheter placed inside the body.

Diagnosis of Cancer
The appropriate treatment requires definite timely diagnosis and the accurate staging of cancer. With the IR technology, it is now possible to perform biopsies for histologic confirmations of the tumors with less or minimal invasion to the surrounding structures. The direct visualization through the imaging techniques permits the highly accurate diagnosis with a low complication rate. In addition, the cross-sectional images produced helps to define the lesion location, accessibility, and suitability for biopsy.

Treatment of cancer
It includes a wide range of procedures, from placing catheters to the extremely advanced procedures such as radioembolization, radiofrequency, Ablative Techniques and other techniques to treat such as colorectal, breast, gallbladder, pancreas, esophageal, stomach, lungs, melanoma and sarcomas. All these procedures involve minimal invasion and reduced complication rate.

Side effects

IR techniques and procedures may reduce the side effects that are typically associated with the traditional procedures of cancer treatment that are surgery, chemotherapy and radiation therapy. But there may be side effects such as fatigue and pain.