requirements in ncm
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ANGIOGENESIS INHIBITORS THERAPY
Key Points
Angiogenesis is the formation of new blood vessels and is controlled by chemicals in the body Tumors need blood vessels to grow and spread Angiogenesis inhibitors prevent the formation of new blood vessels so that the tumor cannot grow The U.S. Food and Drug Administration (FDA) has approved some angiogenesis inhibitors for the
treatment of cancer
Angiogenesis inhibitors have fewer side effects than many other cancer treatments, but they may onlylimit the growth of the cancer, not cure it
Researchers continue to test new angiogenesis inhibitors and to investigate the way these drugs orchemicals work against different cancers
1. What is angiogenesis?Angiogenesis is the formation of new blood vessels. Angiogenesis is a process controlled by
certain chemicals produced in the body. Some of these chemicals stimulate cells to repair
damaged blood vessels or form new ones. Other chemicals, called angiogenesis inhibitors, signal
the process to stop.
2. Why is angiogenesis important in cancer?Angiogenesis plays an important role in the growth and spread of cancer. New blood vessels
feed the cancer cells with oxygen and nutrients, allowing these cells to grow, invade
nearbytissue, spread to other parts of the body, and form new colonies of cancer cells.
3. How can angiogenesis be stopped in tumors?Because tumors cannot grow or spread without the formation of new blood vessels, scientists
are trying to find ways to stop angiogenesis. They are studying natural and synthetic
angiogenesis inhibitors, also called antiangiogenic agents, in the hope that these chemicals will
prevent or slow down the growth of cancer by blocking the formation of new blood vessels.
4. Are any angiogenesis inhibitors currently being used to treat cancer in humans?Yes. The U.S. Food and Drug Administration (FDA) has approved bevacizumab (Avastin) for use
with other drugs to treat colorectal cancer that has spread to other parts of the body,some non-small cell lung cancers, and some breast cancers that have spread to other parts of
the body. Bevacizumab was the first angiogenesis inhibitor proven to delay tumor growth and,
more importantly, extend the lives of patients.
The FDA has also approved other drugs with antiangiogenic activity as cancer therapies for
multiple myeloma, mantle cell lymphoma, gastrointestinal stromal tumors (GIST), and kidney
cancer.
Researchers are also exploring the use of these drugs to treat other cancers.
5. What are the advantages of angiogenesis inhibitors?Angiogenesis inhibitors usually have only mild side effects and are not toxic to most healthy
cells. Tumors do not seem to develop a resistance to angiogenesis inhibitors, even when given
over a long period of time, unlike the resistance seen when chemotherapy drugs are used.
Angiogenesis inhibitors seem to help some chemotherapy drugs and radiation therapy work
more effectively when given in combination.
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6. What are the limitations of angiogenesis inhibitors?Angiogenesis inhibitor therapy may not necessarily kill tumors, but instead may keep tumors
stable. Therefore, this type of therapy may need to be administered over a long period. Because
angiogenesis is important in wound healing and in reproduction, long-term treatment withantiangiogenic agents could cause problems with bleeding, blood clotting, heart function,
theimmune system, and the reproductive system.
7. Does angiogenesis inhibitor therapy have any complications or side effects?A patients immune system may be compromised, making the patient more susceptible
toinfection and causing wounds to heal poorly, if at all. Patients may experience reproductive
problems, and damage to the fetus is likely if a patient becomes pregnant while taking the
antiangiogenic drug. Heart problems and high blood pressure could be made worse and
bleeding or blood clots could increase.
Since angiogenesis inhibitor therapy is still under investigation, all of the possible complications
and side effects are still unknown.
8. What does the future hold for angiogenesis inhibitor therapy?Other angiogenesis inhibitors are currently being tested in clinical trials (research studies) but
have not yet been shown to be effective against cancer in humans. If these angiogenesis
inhibitors are proven to be both safe and effective in treating human cancer, they may be
approved by the FDA and made available for widespread use.
The list below includes cancers that are being studied in active phase III treatment clinical trials
using angiogenesis inhibitors. The clinical trials are in the National Cancer Institutes (NCI)clinical trials database. For information about how to search the database, see Help Using the
NCI Clinical Trials Search Form.
Types of Cancer in Active Phase III Treatment Clinical Trials of Angiogenesis Inhibitors:
Breast cancer Esophageal cancer Gastrointestinal Stromal Tumors (GIST) Kidney (renal cell) cancer Leukemia Liver (adult primary) cancer Lymphoma Melanoma Multiple myeloma Non-small cell lung cancer (NSCLC) Ovarian epithelial cancer Pancreatic cancer Prostate cancer Stomach (gastric) cancer
BIOLOGIC THERAPY
What is biological therapy?
Biological therapy) is a type of treatment that works with your immune system. It can help fight cancer
or help control side effects (how your body reacts to the drugs you are taking) from other cancer
treatments like chemotherapy.
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What is the difference between biological therapy and chemotherapy?
Biological therapy and chemotherapy are both treatments that fight cancer. While they may seem alike,
they work in different ways. Biological therapy helps your immune system fight cancer. Chemotherapy
attacks the cancer cells directly.
How does biological therapy fight cancer?
Doctors are not sure how biological therapy helps your immune system fight cancer. But they think it
may:
Stop or slow the growth of cancer cells. Make it easier for your immune system to destroy, or get rid of, cancer cells. Keep cancer from spreading to other parts of your body.What is my immune system and how does it work?
Your immune system includes your spleen, lymph nodes, tonsils, bone marrow, and white blood cells.
These all help protect you from getting infections and diseases.
When your immune system works the way it should, it can tell the difference between "good" cells that
keep you healthy and "bad" cells that make you sick. But sometimes this doesn't happen. Doctors are
doing research to learn why some immune systems don't fight off
diseases like cancer.
White blood cells are an important part of your immune system. When
your doctor or nurse talks about your white blood cells, he or she mayuse words like:
Monocytes (MON-o-cites) are types of white blood cells. Lymphocytes (LYM-fo-cites) are types of white blood cells. B cells are kinds of lymphocytes. T cells are kinds of lymphocytes. Natural killer cells are kinds of lymphocytes.What are some questions to ask my doctor or nurse about biological
therapy?
Why do you recommend biological therapy for me?Your treatment choices depend on the type of cancer you have, how far your cancer has
spread, and the treatments you have already tried. For some people, biological therapy is the
best treatment choice.
Will biological therapy be my only treatment?Some people only need biological therapy. Others also get chemotherapy and radiation
treatment. Talk with your doctor about the kind of treatment you will be on and how it can
help.
Where do I go to get my treatment?Some biological therapies are pills or shots that you can take at home. Others are given through
an IV, and you must go to the hospital or clinic to get them. If this is the case, find out how long
you will need to stay at the hospital or clinic.
How often will I get my treatment?Treatment schedules vary. Biological therapy may be given once a day or a couple of times a
day. Others are given less often--sometimes once a week, or perhaps just once every month or
two. Your doctor will tell you how often you will get your treatment and how long you will need
to be on it.
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How much will my treatment cost?Talk with your nurse, social worker, or doctor about the cost of your treatment. Make sure to
ask if your insurance company pays for biological therapy.
What side effects can I expect?Just like other forms of cancer treatment, biological therapy sometimes causes side effects.Side effects can include:
o Rashes or swelling where the treatment is injected.o Flu-like symptoms such as fever, chills, nausea, vomiting, loss of appetite, fatigue,
bone pain, and muscle aches.
o Lowered blood pressure (blood pressure goes down).What are cancer vaccines?
Cancer vaccines are a form of biological therapy. While other vaccines (like ones for measles or mumps)
are given before you get sick, cancer vaccines are given after you have cancer. Cancer vaccines may help
your body fight the cancer and keep it from coming back.
Doctors are learning more all the time about cancer vaccines. They are now doing research about how
cancer vaccines can help people diagnosed with melanoma, lymphoma, and kidney, breast, ovarian,
prostate, colon, and rectal cancers.
What are the names of some biological therapy?
There are many kinds of biological therapy. Here are the names of some common ones with ways to say
them and brief statements about how they are used in cancer care.
Treatments for cancer:
BCG or Bacillus Calmette-Gurin (ba-SIL-us KAL-met gay-RAIN) treats bladder tumors or bladdercancer.
IL-2 or Interleukin-2 (in-ter-LOO-kin 2) treats certain types of cancer. Interferon alpha (in-ter-FEER-on AL-fa) treats certain types of cancer. Rituxan or Rituximab (ri-TUX-i-mab) treats non-Hodgkin's lymphoma. Herceptin (her-SEP-tin) or Trastuzumab treats breast cancer. Treatments for controlling side effects: Neupogen (NU-po-jen) or G-CSF increases white blood cell counts and helps prevent infection
in people who are getting chemotherapy.
Procrit, Epogen, or Erythropoietin (e-RITH-ro-po-i-tin) helps make red blood cells in people whohave anemia.
IL-11, Interleukin-11, Oprelvekin (oh-PREL-ve-kin), or Neumega helps make platelets (a type ofblood cell).
BONE MARROW TRANSPLANTATION AND PERIPHERAL BLOOD STEM
CELL TRANSPLANTATION
Key Points
Hematopoietic or blood-forming stem cells are immature cells that can mature into blood cells. Thesestem cells are found in the bone marrow, bloodstream, or umbilical cord blood
Bone marrow transplantation and peripheral blood stem cell transplantation are procedures thatrestore stem cells that were destroyed by high doses of chemotherapy and/or radiation therapy
In general, patients are less likely to develop a complication known as graft-versus-host diseaseif thestem cells of the donor and patient are closely matched
After being treated with high-dose anticancer drugs and/or radiation, the patient receives theharvested stem cells, which travel to the bone marrow and begin to produce new blood cells
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1. What are bone marrow and hematopoietic stem cells? Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells
known as hematopoietic or blood-forming stem cells. (Hematopoietic stem cells are different
from embryonic stem cells. Embryonic stem cells can develop into every type of cell in thebody.) Hematopoietic stem cells divide to form more blood-forming stem cells, or they mature
into one of three types of blood cells: White blood cells, which fight infection; red blood cells,
which carryoxygen; and platelets, which help the blood to clot. Most hematopoietic stem cells
are found in the bone marrow, but some cells, called peripheral blood stem cells (PBSCs), are
found in the bloodstream. Blood in the umbilical cord also contains hematopoietic stem cells.
Cells from any of these sources can be used in transplants.
2. What are bone marrow transplantation and peripheral blood stem cell transplantation? Bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) are
procedures that restore stem cells that have been destroyed by high doses of chemotherapyand/or radiation therapy. There are three types of transplants:
Inautologous transplants, patients receive their own stem cells. Insyngeneic transplants, patients receive stem cells from their identical twin. Inallogeneic transplants, patients receive stem cells from their brother, sister, or
parent. A person who is not related to the patient (an unrelated donor) also may be used.
3. Why are BMT and PBSCT used in cancer treatment?One reason BMT and PBSCT are used in cancer treatment is to make it possible for patients to
receive very high doses of chemotherapy and/or radiation therapy. To understand more aboutwhy BMT and PBSCT are used, it is helpful to understand how chemotherapy and radiation
therapy work.
Chemotherapy and radiation therapy generally affect cells that divide rapidly. They are used to
treat cancer because cancer cells divide more often than most healthy cells. However, because
bone marrow cells also divide frequently, high-dose treatments can severely damage or destroy
the patients bone marrow. Without healthy bone marrow, the patient is no longer able to make
the blood cells needed to carry oxygen, fight infection, and prevent bleeding. BMT and PBSCT
replace stem cells destroyed by treatment. The healthy, transplanted stem cells can restore the
bone marrows ability to produce the blood cells the patient needs.
In some types ofleukemia, the graft-versus-tumor (GVT) effect that occurs after allogeneic BMT
and PBSCT is crucial to the effectiveness of the treatment. GVT occurs when white blood cells
from the donor (the graft) identify the cancer cells that remain in the patients body after the
chemotherapy and/or radiation therapy (the tumor) as foreign and attack them.
4. What types of cancer are treated with BMT and PBSCT?BMT and PBSCT are most commonly used in the treatment of leukemia and lymphoma. They are
most effective when the leukemia or lymphoma is in remission (the signs and symptoms of
cancer have disappeared). BMT and PBSCT are also used to treat other cancers such
asneuroblastoma (cancer that arises in immature nerve cells and affects mostly infants and
children) and multiple myeloma. Researchers are evaluating BMT and PBSCT in clinical trials(research studies) for the treatment of various types of cancer.
5. How are the donors stem cells matched to the patients stem cells in allogeneic or syngeneictransplantation?
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To minimize potential side effects, doctors most often use transplanted stem cells that match
the patients own stem cells as closely as possible. People have different sets ofproteins, called
human leukocyte-associated (HLA) antigens, on the surface of their cells. The set of proteins,
called the HLA type, is identified by a special blood test.
In most cases, the success of allogeneic transplantation depends in part on how well the HLA
antigens of the donors stem cells match those of the recipients stem cells. The higher the
number of matching HLA antigens, the greater the chance that the patients body will accept the
donors stem cells. In general, patients are less likely to develop a complication known as graft-
versus-host disease (GVHD) if the stem cells of the donor and patient are closely matched.
Close relatives, especially brothers and sisters, are more likely than unrelated people to be HLA-
matched. However, only 25 to 35 percent of patients have an HLA-matched sibling. The chances
of obtaining HLA-matched stem cells from an unrelated donor are slightly better, approximately
50 percent. Among unrelated donors, HLA-matching is greatly improved when the donor and
recipient have the same ethnic and racial background. Although the number of donors isincreasing overall, individuals from certain ethnic and racial groups still have a lower chance of
finding a matching donor. Large volunteer donor registries can assist in finding an appropriate
unrelated donor.
Because identical twins have the same genes, they have the same set of HLA antigens. As a
result, the patients body will accept a transplant from an identical twin. However, identical
twins represent a small number of all births, so syngeneic transplantation is rare.
6. How is bone marrow obtained for transplantation?The stem cells used in BMT come from the liquid center of the bone, called the marrow. Ingeneral, the procedure for obtaining bone marrow, which is called harvesting, is similar for all
three types of BMTs (autologous, syngeneic, and allogeneic). The donor is given either general
anesthesia, which puts the person to sleep during the procedure, or regional anesthesia, which
causes loss of feeling below the waist. Needles are inserted through the skin over the pelvic
(hip) bone or, in rare cases, the sternum (breastbone), and into the bone marrow to draw the
marrow out of the bone. Harvesting the marrow takes about an hour.
The harvested bone marrow is then processed to remove blood and bone fragments. Harvested
bone marrow can be combined with a preservative and frozen to keep the stem cells alive until
they are needed. This technique is known as cryopreservation. Stem cells can be cryopreserved
for many years.
7. How are PBSCs obtained for transplantation?The stem cells used in PBSCT come from the bloodstream. A process called apheresis or
leukapheresis is used to obtain PBSCs for transplantation. For 4 or 5 days before apheresis, the
donor may be given a medication to increase the number of stem cells released into the
bloodstream. In apheresis, blood is removed through a large vein in the arm or a central venous
catheter (a flexible tube that is placed in a large vein in the neck, chest, or groin area). The blood
goes through a machine that removes the stem cells. The blood is then returned to the donor
and the collected cells are stored. Apheresis typically takes 4 to 6 hours. The stem cells are then
frozen until they are given to the recipient.
8. How are umbilical cord stem cells obtained for transplantation? Stem cells also may be retrieved from umbilical cord blood. For this to occur, the mother must
contact a cord blood bank before the babys birth. The cord blood bank may request that she
complete a questionnaire and give a small blood sample.
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Cord blood banks may be public or commercial. Public cord blood banks accept donations of
cord blood and may provide the donated stem cells to another matched individual in their
network. In contrast, commercial cord blood banks will store the cord blood for the family, in
case it is needed later for the child or another family member.
After the baby is born and the umbilical cord has been cut, blood is retrieved from the umbilical
cord and placenta. This process poses minimal health risk to the mother or the child. If the
mother agrees, the umbilical cord blood is processed and frozen for storage by the cord blood
bank. Only a small amount of blood can be retrieved from the umbilical cord and placenta, so
the collected stem cells are typically used for children or small adults.
9. Are any risks associated with donating bone marrow?Because only a small amount of bone marrow is removed, donating usually does not pose any
significant problems for the donor. The most serious risk associated with donating bone marrow
involves the use ofanesthesia during the procedure.
The area where the bone marrow was taken out may feel stiff or sore for a few days, and the
donor may feel tired. Within a few weeks, the donors body replaces the donated marrow;
however, the time required for a donor to recover varies. Some people are back to their usual
routine within 2 or 3 days, while others may take up to 3 to 4 weeks to fully recover their
strength.
10.Are any risks associated with donating PBSCs?Apheresis usually causes minimal discomfort. During apheresis, the person may feel
lightheadedness, chills, numbness around the lips, and cramping in the hands. Unlike bonemarrow donation, PBSC donation does not require anesthesia. The medication that is given to
stimulate the mobilization (release) of stem cells from the marrow into the bloodstream may
cause bone and muscle aches, headaches, fatigue, nausea, vomiting, and/or difficulty sleeping.
These side effects generally stop within 2 to 3 days of the last dose of the medication.
11.How does the patient receive the stem cells during the transplant? After being treated with high-dose anticancer drugs and/or radiation, the patient receives the
stem cells through an intravenous (IV) line just like a blood transfusion. This part of the
transplant takes 1 to 5 hours.
12.Are any special measures taken when the cancer patient is also the donor (autologoustransplant)?
The stem cells used for autologous transplantation must be relatively free of cancer cells. The
harvested cells can sometimes be treated before transplantation in a process known as
purging to get rid of cancer cells. This process can remove some cancer cells from the
harvested cells and minimize the chance that cancer will come back. Because purging may
damage some healthy stem cells, more cells are obtained from the patient before the transplant
so that enough healthy stem cells will remain after purging.
13.What happens after the stem cells have been transplanted to the patient? After entering the bloodstream, the stem cells travel to the bone marrow, where they begin to
produce new white blood cells, red blood cells, and platelets in a process known as
engraftment. Engraftment usually occurs within about 2 to 4 weeks after transplantation.
Doctors monitor it by checking blood counts on a frequent basis. Complete recovery ofimmune
functiontakes much longer, howeverup to several months for autologous transplant recipients
and 1 to 2 years for patients receiving allogeneic or syngeneic transplants. Doctors evaluate the
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results of various blood tests to confirm that new blood cells are being produced and that the
cancer has not returned. Bone marrow aspiration (the removal of a small sample of bone
marrow through a needle for examination under a microscope) can also help doctors determine
how well the new marrow is working.
14.What are the possible side effects of BMT and PBSCT?The major risk of both treatments is an increased susceptibility to infection and bleeding as a
result of the high-dose cancer treatment. Doctors may give the patient antibiotics to prevent or
treat infection. They may also give the patient transfusions of platelets to prevent bleeding and
red blood cells to treat anemia. Patients who undergo BMT and PBSCT may experience short-
term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and
skin reactions.
Potential long-term risks include complications of the pretransplant chemotherapy and radiation
therapy, such as infertility (the inability to produce children); cataracts (clouding of the lens ofthe eye, which causes loss of vision); secondary (new) cancers; and damage to
the liver, kidneys,lungs, and/or heart.
With allogeneic transplants, GVHD sometimes develops when white blood cells from the donor
(the graft) identify cells in the patients body (the host) as foreign and attack them. The most
commonly damaged organs are the skin, liver, and intestines. This complication can develop
within a few weeks of the transplant (acute GVHD) or much later (chronic GVHD). To prevent
this complication, the patient may receive medications that suppress the immune system.
Additionally, the donated stem cells can be treated to remove the white blood cells that cause
GVHD in a process called T-cell depletion. If GVHD develops, it can be very serious and is
treated with steroids or other immunosuppressive agents. GVHD can be difficult to treat, but
some studies suggest that patients with leukemia who develop GVHD are less likely to have the
cancer come back. Clinical trials are being conducted to find ways to prevent and treat GVHD.
The likelihood and severity of complications are specific to the patients treatment and should
be discussed with the patients doctor.
HYPERTHERMIA IN CANCER TREATMENT
Key Points
Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures (up to113F) to damage and kill cancer cells
Hyperthermia is almost always used with other forms of cancer therapy, such as radiationtherapy and chemotherapy
Several methods of hyperthermia are currently under study, including local, regional, and whole-bodyhyperthermia
Many clinical trials (research studies) are being conducted to evaluate the effectiveness ofhyperthermia
1. What is hyperthermia?Hyperthermia (also called thermal therapy or thermotherapy) is a type of cancer treatment in
which body tissue is exposed to high temperatures (up to 113F). Research has shown that high
temperatures can damage and kill cancer cells, usually with minimal injury to normal tissues. By
killing cancer cells and damaging proteins and structures within cells, hyperthermia may
shrink tumors.
Hyperthermia is under study in clinical trials (research studies with people) and is not widely
available.
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2. How is hyperthermia used to treat cancer?Hyperthermia is almost always used with other forms of cancer therapy, such as radiation
therapy and chemotherapy. Hyperthermia may make some cancer cells more sensitive to
radiation or harm other cancer cells that radiation cannot damage. When hyperthermia andradiation therapy are combined, they are often given within an hour of each other.
Hyperthermia can also enhance the effects of certain anticancer drugs.
Numerous clinical trials have studied hyperthermia in combination with radiation therapy
and/or chemotherapy. These studies have focused on the treatment of many types of cancer,
includingsarcoma, melanoma, and cancers of the head and neck,
brain, lung, esophagus, breast, bladder,rectum, liver, appendix, cervix, and peritoneal lining
(mesothelioma). Many of these studies, but not all, have shown a significant reduction in tumor
size when hyperthermia is combined with other treatments. However, not all of these studies
have shown increased survival in patients receiving the combined treatments.
3. What are the different methods of hyperthermia?Several methods of hyperthermia are currently under study, including local, regional, and
whole-body hyperthermia.
o In local hyperthermia, heat is applied to a small area, such as a tumor, using various techniquesthat deliver energy to heat the tumor. Different types of energy may be used to apply heat,
including microwave, radiofrequency, and ultrasound. Depending on the tumor location, there
are several approaches to local hyperthermia:
o External approaches are used to treat tumors that are in or just below the skin. Externalapplicators are positioned around or near the appropriate region, and energy is focused on the
tumor to raise its temperature.
o Intraluminal or endocavitary methods may be used to treat tumors within or near bodycavities, such as the esophagus or rectum. Probes are placed inside the cavity and inserted
into the tumor to deliver energy and heat the area directly.
o Interstitial techniques are used to treat tumors deep within the body, such as brain tumors.This technique allows the tumor to be heated to higher temperatures than external
techniques. Under anesthesia, probes or needles are inserted into the
tumor. Imaging techniques, such as ultrasound, may be used to make sure the probe is
properly positioned within the tumor. The heat source is then inserted into theprobe. Radiofrequency ablation (RFA) is a type of interstitial hyperthermia that uses radio
waves to heat and kill cancer cells.
o In regional hyperthermia, various approaches may be used to heat large areas of tissue, suchas a body cavity, organ, or limb.
o Deep tissue approaches may be used to treat cancers within the body, such ascervical orbladder cancer. External applicators are positioned around the body cavity or organ to be
treated, and microwave or radiofrequency energy is focused on the area to raise its
temperature.
o Regional perfusiontechniques can be used to treat cancers in the arms and legs, such asmelanoma, or cancer in some organs, such as the liver or lung. In this procedure, some of the
patients blood is removed, heated, and then pumped (perfused) back into the limb or organ.
Anticancer drugs are commonly given during this treatment.
o Continuous hyperthermic peritoneal perfusion (CHPP) is a technique used to treat cancerswithin the peritoneal cavity (the space within the abdomen that contains
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hhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=sarcoma&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=drug&version=Patient&language=English 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theintestines, stomach, and liver), including primary peritoneal mesothelioma and stomach
cancer. During surgery, heated anticancer drugs flow from a warming device through the
peritoneal cavity. The peritoneal cavity temperature reaches 106108F.
o Whole-body hyperthermia is used to treat metastatic cancer that has spread throughout thebody. This can be accomplished by several techniques that raise the body temperature to 107
108F, including the use of thermal chambers (similar to large incubators) or hot water
blankets.
The effectiveness of hyperthermia treatment is related to the temperature achieved during the
treatment, as well as the length of treatment and cell and tissue characteristics. To ensure that
the desired temperature is reached, but not exceeded, the temperature of the tumor and
surrounding tissue is monitored throughout hyperthermia treatment. Using local anesthesia, the
doctor inserts small needles or tubes with tiny thermometers into the treatment area to
monitor the temperature. Imaging techniques, such as CT (computed tomography), may be used
to make sure the probes are properly positioned.
4. Does hyperthermia have any complications or side effects?Most normal tissues are not damaged during hyperthermia if the temperature remains under
111F. However, due to regional differences in tissue characteristics, higher temperatures may
occur in various spots. This can result in burns, blisters, discomfort, or pain. Perfusion
techniques can cause tissue swelling, blood clots, bleeding, and other damage to the normal
tissues in the perfused area; however, most of these side effects are temporary. Whole-body
hyperthermia can cause more serious side effects, including cardiac and vascular disorders, but
these effects are uncommon. Diarrhea, nausea, and vomiting are commonly observed after
whole-body hyperthermia.
LASER THERAPY
Key Points
Laser light is a light of such high intensity and narrow beam that it can be used to do precisesurgery toremove cancer or precancerous growths or to relieve symptoms of cancer. It is used most often to treat
cancers on the surface of the body or the lining of internal organs
Laser therapy is often given through a thin tube called an endoscope. An endoscope can be inserted inopenings in the body to treat cancer or precancerous growths inside
the trachea(windpipe), esophagus, stomach, or colon
Laser therapy causes less bleeding and damage to normal tissue than standard surgical tools, and thereis a lower risk ofinfection
However, laser therapy is extremely expensive and the effects of the surgery may not be permanent, sothe surgery may have to be repeated
1. What is laser light?The term laser stands for light amplification by stimulated emission ofradiation. Ordinary
light, such as that from a light bulb, has many wavelengths and spreads in all directions. Laser
light, on the other hand, has a specific wavelength. It is focused in a narrow beam and creates a
very high-intensity light. This powerful beam of light may be used to cut through steel or to
shape diamonds. Because lasers can focus very accurately on tiny areas, they can also be used
for very precise surgical work or for cutting through tissue (in place of a scalpel).
2. What is laser therapy, and how is it used in cancer treatment? Laser therapy uses high-intensity light to treat cancer and other illnesses. Lasers can be used to
shrink or destroy tumors. Lasers are most commonly used to treat superficial cancers (cancers
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=intestine&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=stomach&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=metastatic&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=local%20anesthesia&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tomography&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=side%20effect&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cardiac&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=diarrhea&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=laser&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=precancerous&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=symptom&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=organ&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=laser%20therapy&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=endoscope&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=trachea&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=windpipe&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=esophagus&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=stomach&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=colon&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tissue&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=infection&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=scalpel&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tumor&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=superficial&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=superficial&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tumor&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=scalpel&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=infection&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tissue&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=colon&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=stomach&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=esophagus&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=windpipe&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=trachea&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=endoscope&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=laser%20therapy&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=organ&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=symptom&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=precancerous&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=laser&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=diarrhea&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cardiac&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=side%20effect&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=tomography&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=local%20anesthesia&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=metastatic&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=stomach&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=intestine&version=Patient&language=English 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on the surface of the body or the lining of internal organs) such as basal cell skin cancer and the
very early stages of some cancers, such as cervical, penile, vaginal, vulvar, and non-small cell
lung cancer.
Lasers also may be used to relieve certain symptoms of cancer, such as bleeding or obstruction.For example, lasers can be used to shrink or destroy a tumor that is blocking a patients trachea
(windpipe) or esophagus. Lasers also can be used to remove colon polyps or tumors that are
blocking the colon or stomach.
Laser therapy can be used alone, but most often it is combined with other treatments, such as
surgery, chemotherapy, or radiation therapy. In addition, lasers can seal nerve endings to
reduce pain after surgery and seal lymph vessels to reduce swelling and limit the spread of
tumor cells.
3. How is laser therapy given to the patient? Laser therapy is often given through a flexible endoscope (a thin, lighted tube used to look at
tissues inside the body). The endoscope is fitted with optical fibers (thin fibers that transmit
light). It is inserted through an opening in the body, such as the mouth, nose, anus, or vagina.
Laser light is then precisely aimed to cut or destroy a tumor.
Laser-induced interstitial thermotherapy (LITT) (or interstitial laser photocoagulation) also uses
lasers to treat some cancers. LITT is similar to a cancer treatment called hyperthermia, which
uses heat to shrink tumors by damaging or killing cancer cells. (More information about
hyperthermia is available in the National Cancer Institute (NCI) fact sheetHyperthermia in
Cancer Treatment.) During LITT, an optical fiber is inserted into a tumor. Laser light at the tip of
the fiber raises the temperature of the tumor cells and damages or destroys them. LITT issometimes used to shrink tumors in the liver.
Photodynamic therapy (PDT) is another type of cancer treatment that uses lasers. In PDT, a
certain drug, called a photosensitizer or photosensitizing agent, is injected into a patient and
absorbed by cells all over the patients body. After a couple of days, the agent is found mostly in
cancer cells. Laser light is then used to activate the agent and destroy cancer cells. Because the
photosensitizer makes the skin and eyes sensitive to light for approximately 6 weeks, patients
are advised to avoid direct sunlight and bright indoor light during that time. (More information
about PDT is available in the NCI fact sheetPhotodynamic Therapy for Cancer.)
4. What types of lasers are used in cancer treatment?Three types of lasers are used to treat cancer: carbon dioxide (CO2) lasers, argon lasers, and
neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers. Each of these can shrink or destroy
tumors and can be used with endoscopes. CO2 and argon lasers can cut the skins surface
without going into deeper layers. Thus, they can be used to remove superficial cancers, such as
skin cancer. In contrast, the Nd:YAG laser is more commonly applied through an endoscope to
treat internal organs, such as the uterus, esophagus, and colon. Nd:YAG laser light can also
travel through optical fibers into specific areas of the body during LITT. Argon lasers are often
used to activate the drugs used in PDT.
5. What are the advantages of laser therapy?Lasers are more precise than standard surgical tools (scalpels), so they do less damage to normal
tissues. As a result, patients usually have less pain, bleeding, swelling, and scarring. With laser
therapy, operations are usually shorter. In fact, laser therapy can often be done on
anoutpatient basis. It takes less time for patients to heal after laser surgery, and they are less
likely to get infections. Patients should consult with their health care provider about whether
laser therapy is appropriate for them.
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er&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=non-small%20cell%20lung%20cancer&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=vaginal&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cervical&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=stage&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cell&version=Patient&language=English 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6. What are the disadvantages of laser therapy? Laser therapy also has several limitations. Surgeons must have specialized training before they
can do laser therapy, and strict safety precautions must be followed. Also, laser therapy is
expensive and requires bulky equipment. In addition, the effects of laser therapy may not lastlong, so doctors may have to repeat the treatment for a patient to get the full benefit.
PHOTODYNAMIC THERAPY
Key Points
Photodynamic therapy (PDT) combines a drug (called a photosensitizer or photosensitizing agent) witha specific type of light to kill cancer cells
The U.S. Food and Drug Administration has approved the photosensitizing agent calledporfimersodium, or Photofrin, for use in PDT to treat or relieve the symptoms of certain cancers
Patients treated with porfimer sodium should avoid direct sunlight and bright indoor light for at least 6weeks after treatment
Researchers continue to study ways to improve the effectiveness of PDT and expand its use to othercancers
1. What is photodynamic therapy?Photodynamic therapy (PDT) is a treatment that uses a drug, called a photosensitizer or
photosensitizing agent, and a particular type of light. When photosensitizers are exposed to a
specific wavelength of light, they produce a form of oxygen that kills nearby cells.
Each photosensitizer is activated by light of a specific wavelength. This wavelength determineshow far the light can travel into the body. Thus, doctors use specific photosensitizers and
wavelengths of light to treat different areas of the body with PDT.
2. How is PDT used to treat cancer?In the first step of PDT for cancer treatment, a photosensitizing agent is injected into the
bloodstream. The agent is absorbed by cells all over the body but stays in cancer cells longer
than it does in normal cells. Approximately 24 to 72 hours after injection, when most of the
agent has left normal cells but remains in cancer cells, the tumor is exposed to light. The
photosensitizer in the tumor absorbs the light and produces an active form of oxygen that
destroys nearby cancer cells.
In addition to directly killing cancer cells, PDT appears to shrink or destroy tumors in two other
ways. The photosensitizer can damage blood vessels in the tumor, thereby preventing the
cancer from receiving necessary nutrients. In addition, PDT may activate the immune systemto
attack the tumor cells.
The light used for PDT can come from a laser or other sources of light. Laser light can be directed
through fiber optic cables (thin fibers that transmit light) to deliver light to areas inside the body
(2). For example, a fiber optic cable can be inserted through an endoscope (a thin, lighted tube
used to look at tissues inside the body) into the lungs or esophagus to treat cancer in
theseorgans. Other light sources include light-emitting diodes (LEDs), which may be used for
surface tumors, such as skin cancer.
PDT is usually performed as an outpatient procedure. PDT may also be repeated and may be
used with other therapies, such as surgery, radiation, or chemotherapy.
3. What types of cancer are currently treated with PDT?
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