With 42 000 new cases per year, breast cancer is increasingly common. At the same time, the therapy is progressing and can maintain the anatomical women. Always a leader in this field for 60 years, the Institut Curie advance a new weapon to limit the uptake of the removal of the breast.
Breast cancer affects mostly young and active (half are under 61 years at diagnosis). For several years, advances in surgery have enabled the development of conservative treatment. Latest innovation, the taxanes used to limit the uptake of the removal of the breast.
Chemotherapy response to breast cancer
Faced with breast cancer, the treatment of choice is surgery. Based on early diagnosis, intervention may be limited to removal of the tumor while preserving the maximum mamma. This is referred to as lumpectomy. Today, advances in surgery can prevent most often use the complete removal of the breast (also called mammectomie). However, this operation is sometimes necessary to face large tumors, multiple tumors in one breast, scattered tumor cells or in case of recurrence after conservative treatment.
Allows radiation to destroy cancer cells remaining after surgery and reduce the risk of relapse. Chemotherapy may be used according to the same information (adjuvant chemotherapy). But they also placed before surgery to reduce the size of the tumor and allow a conservative (neo-adjuvant chemotherapy). Currently, the benchmark treatment in this indication is for breast cancer a combination of two molecules: doxorubicin / cyclophosphamide.
More breast conservation
Taxanes are molecules extracted from the yew, or bark (Taxol ®) or needle (Taxotere ®). These molecules are able to stop cell division, a property particularly attractive deal with cancer cells that have the particularity to grow in an anarchic way. Currently, they are used in advanced stages of breast cancer (metastatic breast carcinoma) and lung cancer. Taxol ® is also used to treat metastatic ovarian cancer.
But Dr Véronique Diéras, head of the Clinical Investigation Unit of the Institut Curie, wanted to study the effectiveness of Taxol ® (in combination with doxorubicin) compared to the combination of reference among 200 patients who can not receive conservative treatment. The results argue in favor of this new treatment. Paclitaxel administered before surgery (in combination with doxorubicin), reduces tumor size in 89% of patients against 70% with the combination of reference and allows a conservative treatment in 58% of patients against 45% . Finally, after an average follow-up of 31 months, the rate of disease-free survival was higher in the group treated with Taxol ® (91% against 70%)
To new indications for taxanes?
According to researchers, "this molecule, so far used in advanced stages of the disease, could in future be administered before surgery to reduce tumor size and increase the number of patients eligible for treatment Conservative. " Further studies will certainly confirm this benefit
How does Chemotherapy treatment chemo works?
Chemotherapy treatment (chemotherapy)
Chemotherapy treatment is a treatment for cancer patients that involve medication by mouth or injections. Treatment may provide better prospects of healing at some cancers than both surgery and radiation.
How does Chemotherapy works
Preparations referred to as Chemotherapy toxic effect that they interfere with normal cell functions. Some of the first forms of Chemotherapy which was adopted, and that still applied, are substances that damage DNA structure, including cyclofosfamid and melfalan. These are drugs that were originally developed in terms of biological warfare. Other preparations - which metotrexat, 5-Fluorouracil and doxorubicin works in that it blocks the normal metabolic paths in cancer cells.
Certain preparations containing the metal platinum, which in certain forms can get DNA to perish. There are also a number of preparations that contain plant extracts that have similar effects on DNA, or that gets the inner structure of the cells to break down. Examples which contains extracts from taxol extracted from the bark of the yew.
Cancers that are treated with Chemotherapy
The cancer types that respond best for cellegift are those caused by the fast-growing tumors. This is because the fast-growing cells take up the poison of the far greater extent than healthy cells, so that limits the side effects. Among the cancer types that are developing quickly find leukemia and Hodgkins disease, and different cancers that strike children.
Chemotherapy manager may also have an important effect on tumors that are not of the most rapidly growing battle, including breast tumors, ovary tumors, bladder tumors and tumors in the head and neck region.
Today Chemotherapy forms of treatment have little effect on some cancers, including pancreatic cancer, lung cancer, bowel cancer and stomach.
Whether giveing some drugs will benefit Chemotherapy treatment depends to a large extent by how the cancer cells in tumors appears under a microscope, the patient's age and general, and whether the liver and kidneys of his / her is able to poison the cell separator.
How does Chemotherapy treatment takes place
Cell poison usually given intravenously. Ie. that it led directly into the veins, so that one avoids the patient throws up the medicine. A typical course consists of treatments every third or fourth week. The goal is that the tumors are destroyed as far as possible, simultaneously with the charges for the patient not be larger than necessary. It was discovered that cellegift treatment is most effective when several types of medicines are given simultaneously in a combination - this despite the fact that the mixing of medicines increases the risk of side effects. There are several standard combinations that each one is tailored to specific forms of cancer.
Side effects of chemotherapy
Treatment suggests that the patient must expect to have side effects, but in a far lesser extent than was the case for only a few decades ago. Nausea that often accompanies cellegift, can be treated with a pesticide that ondansetron. This means that cellegift treatment in our day pretty much done outpatient.
It is a known issue that many people lose their hair in connection with Chemotherapy treatment. However, there are some medication combinations that do not lead to Hair Loss, even if the side effect for many patients share is not to avoid. However, the hair grows out again after the treatment.
From a purely medical standpoint, is the most serious side effect associated with cellegift treatment at benmargen can suffer damage. This leads to the infection risk and the risk of anemia and bleeding. To deal with these problems are given the medication, which in turn can cause liver and kidney damage. Patients who receive cellegift treatment should be monitored closely with regular blood samples to check whether the treatment provides this type of side effects, if the dosage is appropriate, and whether the patient could benefit from a more intensive treatment in hospital.
Combination of cancer Treatments by using Chemotherapy
Chemotherapy Treatment often included in a package that consists of several forms of cancer. By example. both breast cancer and bowel cancer removed the observable tumors surgical, while using the radiation will deal with a disease that does not appear during the operation. Finally, you use Chemotherapy to squash metastases (spread).
The future of Chemotherapy
Experts believe that the future Chemotherapy treatment will be far more specific than it is today. This means that the cell poison much more will be directed against cancer cells, and to a lesser extent, be toxic for the rest of the body. Such an effect can be achieve by binding to the poison cell antibodies against cancer cells. Another option is the new forms of Chemotherapy that works directly on the cancer cell growth.
Chemotherapy treatment is a treatment for cancer patients that involve medication by mouth or injections. Treatment may provide better prospects of healing at some cancers than both surgery and radiation.
How does Chemotherapy works
Preparations referred to as Chemotherapy toxic effect that they interfere with normal cell functions. Some of the first forms of Chemotherapy which was adopted, and that still applied, are substances that damage DNA structure, including cyclofosfamid and melfalan. These are drugs that were originally developed in terms of biological warfare. Other preparations - which metotrexat, 5-Fluorouracil and doxorubicin works in that it blocks the normal metabolic paths in cancer cells.
Certain preparations containing the metal platinum, which in certain forms can get DNA to perish. There are also a number of preparations that contain plant extracts that have similar effects on DNA, or that gets the inner structure of the cells to break down. Examples which contains extracts from taxol extracted from the bark of the yew.
Cancers that are treated with Chemotherapy
The cancer types that respond best for cellegift are those caused by the fast-growing tumors. This is because the fast-growing cells take up the poison of the far greater extent than healthy cells, so that limits the side effects. Among the cancer types that are developing quickly find leukemia and Hodgkins disease, and different cancers that strike children.
Chemotherapy manager may also have an important effect on tumors that are not of the most rapidly growing battle, including breast tumors, ovary tumors, bladder tumors and tumors in the head and neck region.
Today Chemotherapy forms of treatment have little effect on some cancers, including pancreatic cancer, lung cancer, bowel cancer and stomach.
Whether giveing some drugs will benefit Chemotherapy treatment depends to a large extent by how the cancer cells in tumors appears under a microscope, the patient's age and general, and whether the liver and kidneys of his / her is able to poison the cell separator.
How does Chemotherapy treatment takes place
Cell poison usually given intravenously. Ie. that it led directly into the veins, so that one avoids the patient throws up the medicine. A typical course consists of treatments every third or fourth week. The goal is that the tumors are destroyed as far as possible, simultaneously with the charges for the patient not be larger than necessary. It was discovered that cellegift treatment is most effective when several types of medicines are given simultaneously in a combination - this despite the fact that the mixing of medicines increases the risk of side effects. There are several standard combinations that each one is tailored to specific forms of cancer.
Side effects of chemotherapy
Treatment suggests that the patient must expect to have side effects, but in a far lesser extent than was the case for only a few decades ago. Nausea that often accompanies cellegift, can be treated with a pesticide that ondansetron. This means that cellegift treatment in our day pretty much done outpatient.
It is a known issue that many people lose their hair in connection with Chemotherapy treatment. However, there are some medication combinations that do not lead to Hair Loss, even if the side effect for many patients share is not to avoid. However, the hair grows out again after the treatment.
From a purely medical standpoint, is the most serious side effect associated with cellegift treatment at benmargen can suffer damage. This leads to the infection risk and the risk of anemia and bleeding. To deal with these problems are given the medication, which in turn can cause liver and kidney damage. Patients who receive cellegift treatment should be monitored closely with regular blood samples to check whether the treatment provides this type of side effects, if the dosage is appropriate, and whether the patient could benefit from a more intensive treatment in hospital.
Combination of cancer Treatments by using Chemotherapy
Chemotherapy Treatment often included in a package that consists of several forms of cancer. By example. both breast cancer and bowel cancer removed the observable tumors surgical, while using the radiation will deal with a disease that does not appear during the operation. Finally, you use Chemotherapy to squash metastases (spread).
The future of Chemotherapy
Experts believe that the future Chemotherapy treatment will be far more specific than it is today. This means that the cell poison much more will be directed against cancer cells, and to a lesser extent, be toxic for the rest of the body. Such an effect can be achieve by binding to the poison cell antibodies against cancer cells. Another option is the new forms of Chemotherapy that works directly on the cancer cell growth.
Which patients may be indicated HIPEC?
colon cancer (large intestine cancer)
The doctor will carefully assess each patient if a HIPEC is indicated or not. This evaluation is done both before and during the operation.
1. before surgery
-age: the patient can not be too old. An age below 70 year is a criterion. Younger the patient is, the greater the tolerance for intervention. Patients who have a little more than 70 years with peritoneal cancer and a limited excellent condition can always be taken into account.
motivation: the patient must be prepared to 'fight' in order to support the intervention, which is heavy.
-chemotherapy options: it must persist opportunities to administer chemotherapy after surgery. If peritoneal cancer has become resistant to all forms of chemotherapy, a HIPEC is not a good choice.
-good general condition, absence of occlusion, absence of ascites. In patients who are not fit enough, which are or have occlusion of ascites, a HIPEC does not work and the risk of complications is significantly higher. Note that these criteria are valid for HIPEC in peritoneal cancer by colon cancer.
absence of seeding to the liver or lungs. In these cases, it is unlikely that HIPEC is better than conventional chemotherapy infusion.
2. during the operation
-extension (Sugarbaker score)
-remove any possibility of
-seeding to the liver
When the score to extend Sugarbaker is above 20, when all visible tumor can not be removed, or in case of seeding to the liver, there is very little chance of achieving a HIPEC offer a better survival the patient and the intervention will not be continued (see above).
ovarian cancer
The doctor will carefully assess each patient if a HIPEC is indicated or not. This evaluation is done both before and during the operation.
1. before surgery
-age: the patient can not be too old. An age below 70 years is a criterion. Younger the patient is, the greater the tolerance for intervention. Patients who have a little more than 70 years with peritoneal cancer and a limited excellent condition can always be taken into account.
-good condition
motivation: the patient must be prepared to 'fight' in order to support the intervention, which is heavy.
-chemotherapy options: it must persist opportunities to administer chemotherapy after surgery. If peritoneal cancer has become resistant to all forms of chemotherapy, a HIPEC is not a good choice.
absence of seeding to the liver or lungs. In these cases, it is unlikely that HIPEC is better than conventional chemotherapy infusion.
2. during the operation
-possibility to remove most of the tumor after surgery, it can not remain as homes below 1 cm
-seeding to the liver
When all visible tumor larger than 1 cm can not be removed, or in case of seeding to the liver, there is very little chance of achieving a HIPEC offers better patient survival, and response will not be continued (see above).
Other tumors
For other rare forms of peritoneal cancer, there are similar criteria.
Final consideration
All information on this page is intended to provide basic information to patients with cancer of the peritoneum. In this way, the patient can prepare questions he wants to ask the surgeon, or read the text at home after the consultation. However, the disease of each patient is unique and the medical and surgical treatment of peritoneal cancer is evolving rapidly. That is why the explanation that your doctor gives you or treatments they are offering may be slightly different from this introduction. Do not be mislead. The explanations from your doctor always prevail on the explanations contained in this document.
The doctor will carefully assess each patient if a HIPEC is indicated or not. This evaluation is done both before and during the operation.
1. before surgery
-age: the patient can not be too old. An age below 70 year is a criterion. Younger the patient is, the greater the tolerance for intervention. Patients who have a little more than 70 years with peritoneal cancer and a limited excellent condition can always be taken into account.
motivation: the patient must be prepared to 'fight' in order to support the intervention, which is heavy.
-chemotherapy options: it must persist opportunities to administer chemotherapy after surgery. If peritoneal cancer has become resistant to all forms of chemotherapy, a HIPEC is not a good choice.
-good general condition, absence of occlusion, absence of ascites. In patients who are not fit enough, which are or have occlusion of ascites, a HIPEC does not work and the risk of complications is significantly higher. Note that these criteria are valid for HIPEC in peritoneal cancer by colon cancer.
absence of seeding to the liver or lungs. In these cases, it is unlikely that HIPEC is better than conventional chemotherapy infusion.
2. during the operation
-extension (Sugarbaker score)
-remove any possibility of
-seeding to the liver
When the score to extend Sugarbaker is above 20, when all visible tumor can not be removed, or in case of seeding to the liver, there is very little chance of achieving a HIPEC offer a better survival the patient and the intervention will not be continued (see above).
ovarian cancer
The doctor will carefully assess each patient if a HIPEC is indicated or not. This evaluation is done both before and during the operation.
1. before surgery
-age: the patient can not be too old. An age below 70 years is a criterion. Younger the patient is, the greater the tolerance for intervention. Patients who have a little more than 70 years with peritoneal cancer and a limited excellent condition can always be taken into account.
-good condition
motivation: the patient must be prepared to 'fight' in order to support the intervention, which is heavy.
-chemotherapy options: it must persist opportunities to administer chemotherapy after surgery. If peritoneal cancer has become resistant to all forms of chemotherapy, a HIPEC is not a good choice.
absence of seeding to the liver or lungs. In these cases, it is unlikely that HIPEC is better than conventional chemotherapy infusion.
2. during the operation
-possibility to remove most of the tumor after surgery, it can not remain as homes below 1 cm
-seeding to the liver
When all visible tumor larger than 1 cm can not be removed, or in case of seeding to the liver, there is very little chance of achieving a HIPEC offers better patient survival, and response will not be continued (see above).
Other tumors
For other rare forms of peritoneal cancer, there are similar criteria.
Final consideration
All information on this page is intended to provide basic information to patients with cancer of the peritoneum. In this way, the patient can prepare questions he wants to ask the surgeon, or read the text at home after the consultation. However, the disease of each patient is unique and the medical and surgical treatment of peritoneal cancer is evolving rapidly. That is why the explanation that your doctor gives you or treatments they are offering may be slightly different from this introduction. Do not be mislead. The explanations from your doctor always prevail on the explanations contained in this document.
What are the complications? after HIPEC?
After a HIPEC treatment for peritoneal cancer, there may be complications in about 30% of interventions.
And after each surgery, complications such as infection or bleeding may occur.
Some complications are more specific to the HIPEC, including:
-a higher risk of dropping the sutures between the intestines because of the heated chemotherapy. In case of high risk, the doctor may consider it more secure to create a stoma (out part of the intestine) temporarily.
-liquid in the thoracic cavity (the space between the lungs and chest cavity), especially in cases of tumor resection on the diaphragm. In these cases, the surgeon will place a preventive pipes in the chest cavity to suck any liquid for a few days.
-delayed evacuation of the stomach for about two weeks (see above).
Complications of chemotherapy are very rare.
And after each surgery, complications such as infection or bleeding may occur.
Some complications are more specific to the HIPEC, including:
-a higher risk of dropping the sutures between the intestines because of the heated chemotherapy. In case of high risk, the doctor may consider it more secure to create a stoma (out part of the intestine) temporarily.
-liquid in the thoracic cavity (the space between the lungs and chest cavity), especially in cases of tumor resection on the diaphragm. In these cases, the surgeon will place a preventive pipes in the chest cavity to suck any liquid for a few days.
-delayed evacuation of the stomach for about two weeks (see above).
Complications of chemotherapy are very rare.
What are the side effects of HIPEC Treatment?
A HIPEC is a rather cumbersome task requiring considerable energy to the body and mind. Many patients feel tired enough for three months. The appetite may be low for some time and there may occur episodes of low morale. A good motivation beforehand, correct information and good support from family, the surgeon, general practitioner, the dietitian and physiotherapist are of great importance. After three months, the quality of life is at the level before the operation.
How long must I stay on hospital after HIPEC treatment?
During hospitalization and after returning home, the patient receives for a few weeks of physiotherapy which will have a positive effect on the general rehabilitation after heavy intervention on peritoneal cancer treatment.
The patient is reviewed regularly in consultation with the surgeon after convalescence, which adapt progressively the system, which will provide the best possible answers to many questions, and to support the patient psychologically.
Once the patient has recovered sufficiently in the physical and psychological, as a rule complementary chemotherapy by intravenous infusion is given for 6 months.
Have regular check (taking blood, scanner) are programmed.
The patient is reviewed regularly in consultation with the surgeon after convalescence, which adapt progressively the system, which will provide the best possible answers to many questions, and to support the patient psychologically.
Once the patient has recovered sufficiently in the physical and psychological, as a rule complementary chemotherapy by intravenous infusion is given for 6 months.
Have regular check (taking blood, scanner) are programmed.
Why rinse the belly cavity with heated chemotherapy?
Rinsing of the belly cavity with heated chemotherapy is designed to kill peritoneal cancer tumor homes that are invisible to the naked eye and are left behind after resection of the tumor. Chemotherapy poured into the cavity of the stomach, enters very little in the rest of the body and causes far fewer side effects than the same amount of chemotherapy given via intravenous infusion. In this way, we can deliver much larger quantities and thus exposing the tumor cells at concentrations that are up to 100 times higher than via an infusion.
If in addition the drug is heated, it increases the destructive effect on tumor cells and the depth of penetration in the remaining homes.
If in addition the drug is heated, it increases the destructive effect on tumor cells and the depth of penetration in the remaining homes.
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