treating cancer
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Principles of treating cancer and flaws in alternative therapiesTRANSCRIPT
Cancer ManagementCancer ManagementHow do we decide?How do we decide?
Alex J CrandonAlex J CrandonMB BS (Syd) PhD (Leeds) FRCOG (Lond) FRANZCOG (Melb) CGOMB BS (Syd) PhD (Leeds) FRCOG (Lond) FRANZCOG (Melb) CGO
Gynaecological OncologistGynaecological OncologistMater and Brisbane Private HospitalsMater and Brisbane Private HospitalsDirector Qld Centre for Gyn. CancerDirector Qld Centre for Gyn. Cancer
Principles of Cancer Principles of Cancer ManagementManagement
1.1. Make a diagnosisMake a diagnosis
2.2. Determine disease distributionDetermine disease distribution
3.3. Ask: “What is the aim of Ask: “What is the aim of treatment?” Cure or palliationtreatment?” Cure or palliation
4.4. What does the literature say is What does the literature say is the best way to achieve the the best way to achieve the identified aim of treatment.identified aim of treatment.
Current TreatmentsCurrent Treatments
These are in no specific order:These are in no specific order: Surgery,Surgery, Radiotherapy,Radiotherapy, Chemotherapy,Chemotherapy, Some combination of above, orSome combination of above, or Do nothing.Do nothing.
SurgerySurgery
This involves the This involves the treatment of a treatment of a specific region. specific region. Generally by Generally by removing the removing the offending tumour offending tumour +/- surrounding +/- surrounding tissue and draining tissue and draining lymph nodes.lymph nodes.
RadiotherapyRadiotherapy
Uses x-rays to Uses x-rays to treat cancer.treat cancer.
Some cells killed Some cells killed out-right.out-right.
Many more cells Many more cells damaged and damaged and die later trying die later trying to reproduceto reproduce
ChemotherapyChemotherapy
Uses chemicals Uses chemicals called cytotoxics called cytotoxics to damage cells to damage cells so they die out-so they die out-right or when they right or when they try to reproduce.try to reproduce.
Not all chemo Not all chemo makes you sick-makes you sick-there are over 80 there are over 80 different drugsdifferent drugs
Palliative CarePalliative Care
Doesn’t mean Doesn’t mean your about to your about to die.die.
Your treatment is Your treatment is no longer aimed no longer aimed at cure but at at cure but at quality of lifequality of life
You may be You may be undergoing undergoing palliative care for palliative care for years.years.
New TreatmentsNew Treatments
Identify the new treatmentIdentify the new treatment Test it for:Test it for:
Safety – how much to give or do?Safety – how much to give or do? What side-effects?What side-effects? Effectiveness?Effectiveness? Then compare with standard best Then compare with standard best
therapy, i.e., a prospective clinical therapy, i.e., a prospective clinical trialtrial
Phase 1 TrialsPhase 1 Trials
Phase 1 trials are done to find Phase 1 trials are done to find out out The safe dose range The safe dose range The side effects The side effects How the body copes with the drug How the body copes with the drug
People entering phase 1 trials People entering phase 1 trials often have advanced cancer often have advanced cancer and have usually had all the and have usually had all the treatments available to them. treatments available to them.
Phase 2 TrialsPhase 2 Trials
Phase 2 trials are done to find out Phase 2 trials are done to find out
If the new treatment works well If the new treatment works well enough to test in a larger phase 3 enough to test in a larger phase 3 trial trial
Which types of cancer the treatment Which types of cancer the treatment works for works for
More about side effects and how to More about side effects and how to manage them manage them
More about the best dose to use More about the best dose to use
Phase 3 TrialsPhase 3 Trials
These trials compare new treatments These trials compare new treatments with the best currently available with the best currently available treatment (the standard treatment). treatment (the standard treatment). They may compareThey may compare
A completely new treatment with the A completely new treatment with the standard treatment standard treatment
Different doses or ways of giving a Different doses or ways of giving a standard treatment standard treatment
A new radiotherapy schedule with the A new radiotherapy schedule with the standard onestandard one
Example of ProblemsExample of Problems
A new drug was developed for A new drug was developed for ovarian cancerovarian cancer
Phase 3 trial: Phase 3 trial: multimillion dollar international trial multimillion dollar international trial given after surgery compared with given after surgery compared with
the then standard therapy showed the then standard therapy showed it worked better than standard it worked better than standard therapytherapy
Example of Problems 2Example of Problems 2
New studies about the same time New studies about the same time showed that survival after showed that survival after ovarian cancer treatment was ovarian cancer treatment was much better for patients who had much better for patients who had been optimally debulked at been optimally debulked at surgerysurgery
Example of Problems 3Example of Problems 3
Questions were asked about the Questions were asked about the debulking success in the new debulking success in the new chemotherapy trialchemotherapy trial
When looked at it was found that When looked at it was found that by chance alone most of the by chance alone most of the optimally debulked patients had optimally debulked patients had ended up in the group that got the ended up in the group that got the new drugnew drug Are we seeing the effect of the new Are we seeing the effect of the new
drug or the optimal debulking?drug or the optimal debulking?
Example of Problems 4Example of Problems 4
Back to the drawing boardsBack to the drawing boards A new multimillion dollar A new multimillion dollar
international trial to allow for the international trial to allow for the effects of the debulkingeffects of the debulking
It turned out that in both It turned out that in both optimally and non-optimally optimally and non-optimally debulked groups the new debulked groups the new chemotherapy did betterchemotherapy did better
Complementary or Complementary or Alternative TreatmentAlternative Treatment
Most medicos have little problem Most medicos have little problem with complementary treatmentwith complementary treatment
They recognise that many of our They recognise that many of our current drugs started as plant or current drugs started as plant or animal extractsanimal extracts
We know what we are giving the We know what we are giving the naturopath does not.naturopath does not.
St Anthony’s FireSt Anthony’s Fire
Ergotism – a painful disease with Ergotism – a painful disease with seizures, spasms, diarrhoea, seizures, spasms, diarrhoea, vomiting, paresthesia, headaches, vomiting, paresthesia, headaches, burning in limbs sometimes burning in limbs sometimes leading to gangrene and deathleading to gangrene and death
Eating bread made from rye Eating bread made from rye infected with a fungus infected with a fungus claviceps claviceps purpureapurpurea
Ergot & MidwivesErgot & Midwives
Midwives knew that women having Midwives knew that women having post partum haemorrhage could be post partum haemorrhage could be stopped from bleeding by giving stopped from bleeding by giving them some ergot infected breadthem some ergot infected bread
Problem: sometimes they killed Problem: sometimes they killed women with ergotismwomen with ergotism
We have discovered that the active We have discovered that the active ingredient is ingredient is ergometrineergometrine and now and now we give that or its synthetic cousin we give that or its synthetic cousin syntocinon.syntocinon.
Legislative requirementsLegislative requirements
Only a licensed Vet can operate Only a licensed Vet can operate on an animalon an animal
Only a licensed gas fitter or Only a licensed gas fitter or plumber can install a gas stove plumber can install a gas stove or water heateror water heater
Only a qualified electrician can Only a qualified electrician can rewire your houserewire your house
Legislative EnigmaLegislative Enigma
Anyone can hang up a piece of Anyone can hang up a piece of wood saying “Naturopath”, wood saying “Naturopath”, “Herbalist”, “Iridologist” or “Rake “Herbalist”, “Iridologist” or “Rake Healer” etc and provide treatment Healer” etc and provide treatment in isolation to people with cancerin isolation to people with cancer
These people have never provided These people have never provided a single phase 3 study to backup a single phase 3 study to backup their treatment(s)their treatment(s)