2021 Oncology Treatment Plan：With the rapid development of modern medical treatment, most diseases can be controlled. However, there is still one disease that is regarded as a beast by patients, which is “cancer”. When most people hear this name, they associate it with “terminal disease” and “incurable”. The contradiction between the high cost of treatment and the disproportionate reward is the reason why most patients and their families have formed such a view.
Mankind’s battle against cancer has spanned thousands of years of history, and the war continues to this day.
As early as 3,500 years ago in the Yin and Zhou dynasties, the name “tumor” already appeared on the oracle bones left behind by the ancients. During the pre-Qin period, the Rites of Zhou recorded a specialist physician, “ulcerologist”, who was associated with the treatment of tumors. 4,000 years ago, an Egyptian physician recorded all the known diseases and treatments in the ancient world on a piece of sedge paper, in which 45 cases were recorded. The corresponding treatment was written in the column of “swelling, enlargement and hardening of the breast”: none.
But is cancer really as overwhelming as the public believes? Today, let’s find out how many cancer treatments have been mastered by human beings in this war without smoke and mirrors.
Before we start, let’s learn about the concept of “five-year survival rate”.
Five-year survival rate refers to the percentage of a tumor that survives for more than five years after a combination of treatments. There is some scientific validity in expressing the effectiveness of a treatment by five-year survival rate. After the treatment of a certain tumor, some patients may develop metastasis and recurrence, and some of them may die because the tumor is in advanced stage. Most of such metastasis and recurrence occur within three years after radical surgery, accounting for about 80%, and a small proportion occurs within five years after radical surgery, accounting for about 10%. Therefore, the chances of not recurring within five years after radical surgery for various tumors and recurring again are rare.
For a long time, people were just helpless to treat cancer until the 1890s, when, with the awareness of tumors, William Halstead completed a breast cancer surgery, which was the first cancer surgery protocol to be performed in human history. Radical mastectomy has since become the mainstay of cancer treatment as well.
The removal of the entire tumor and surrounding normal tissue, including the removal of lymphatic gland tissue, to ensure eradication, was a landmark in the history of cancer treatment. Today, more than 100 years later, the global five-year survival rate after breast cancer surgery is 83.2%. For most patients and their families, breast cancer is no longer an incurable disease and we can fight for the hope of life through surgery.
Surgical treatment of cancer is vastly different from surgical removal of ordinary benign lesions. Cancer is like a large tree whose roots grow in the soil, and surgery requires uprooting and removing all the body tissues involved in the cancer cells. A thorough examination is required before surgery, and those found to be localized lesions with no metastatic conditions in other organs are suitable for radical surgical treatment. However, most cancers are not pure, and when there are metastases to lymph nodes and organs, other treatment methods are needed to assist.
Radiotherapy is a treatment that uses highly penetrating radiation to irradiate the local tumor site, causing the tumor tissue to absorb high energy in a short period of time, resulting in the destruction of the tumor tissue. Radiotherapy includes a variety of technical means, such as X-ray, Gamma Knife, etc.
Radiotherapy originated in the winter of 1896 when Emil Grubb, a 21-year-old medical student in Chicago, experimented with a newly discovered radiation, X-rays, and discovered that this mysterious ray could pass through the skin. Grubb felt that if the rays were concentrated and powerful enough, they could burn away tumors that were beyond the reach of surgery.
Emil targeted a breast cancer patient’s chest with a homemade X-ray machine, and after 18 nights of treatment, his tumor miraculously began to shrink. Radiation therapy was soon heralded as a miracle cure, and one Chicago doctor even argued that “this is the cure for absolutely all cancers. But along the way, many early investigators paid the price with their lives, often dying of leukemia, bone cancer, and other cancers caused by radiation.
Thanks to the efforts of generations of predecessors, radiation therapy has become an essential treatment for many types of cancer. Tumors that are highly sensitive to radiation, such as those of the lymphatic and hematopoietic systems, can be treated with radiation therapy alone.
The efficacy of radiotherapy alone in treating nasopharyngeal carcinoma is also very good. Some studies have shown that patients with stage I nasopharyngeal carcinoma who receive radiotherapy can have a local control rate of 90%, and 50% and 60% of stage IV patients can also be controlled by chemotherapy. With radiotherapy, a significant proportion of patients can survive for a long time or even be completely cured. In most cases, radiotherapy and surgical treatment go hand in hand.
Preoperative radiotherapy can kill the subclinical foci beyond the surgical resection margins and margins, which can shrink the tumor and facilitate surgery, as well as prevent local implantation caused by inadvertent surgical operation, and also reduce the incidence of distant metastasis. Postoperative radiotherapy can significantly reduce the rate of local recurrence or delay the time of local recurrence. For metastases in brain and bone, palliative radiotherapy can significantly reduce the symptoms and prolong the survival period.
Don’t think it is over after radiotherapy, the treatment will bring some adverse reactions, such as no appetite, general weakness, even some nausea, vomiting and weakness, postoperative care is also important, meanwhile, patients should pay attention to the hospital for relevant review regularly to see if there are cancer cells remaining, especially in the first one or two years after treatment.
Chemotherapy is the abbreviation of chemotherapy, that is, to inhibit the growth of cancer cells by infusing chemical drugs into the body. Simply put, chemotherapy is the treatment of cancer with drugs that can kill cancer cells. Chemotherapy originated in World War I. In the battle between Germany and Britain in July 1917, shells carrying mustard gas caused 8,000 casualties. The immediate consequences of chemical weapons were horrific, burns, blisters, death, and not only that, it had a long-term effect.
In the few survivors, doctors found that the patients’ white blood cells disappeared. Later, during World War II, two Yale researchers, Louis Goodman and Alfred Gilman, rediscovered the strange inhibitory effect of mustard gas on white blood cells and used it on a lymphoma patient. This became the beginning of human treatment of cancer with chemicals.
In 1993, 38-year-old physician Brian Drucker’s experiments on chronic granulocytic leukemia were an unexpected success, as the tumors in the experimental mice regressed within days, while normal blood cells remained unharmed.
The drug used in this experiment was the drug that would later be invented as Gleevec, the original form of the drug in the “I Am Not a Druggist” movie.
Chronic granulocytic leukemia, which was a terminal disease 20 years ago, has become chronic because of the introduction of Gleevec in 2001. Statistics show that patients with this leukemia are well treated and can usually live out their lives as long as they take Gleevec for life.
Since the biggest difference between cancer cells and normal cells is the rapid cell division and growth, the principle of action of anti-cancer drugs is usually to inhibit the growth of cancer cells by interfering with the mechanism of cell division. Most chemotherapeutic drugs are not specific and thus can harm some healthy cells that need to divide rapidly to maintain normal function, resulting in side effects such as vomiting, mouth ulcers, hair loss, numbness, etc.
Faced with the side effects, people cannot help but think, is it possible to invent a drug that can kill cancer cells while minimizing the harm to normal cells? The answer is: targeted therapy.
With the deepening of people’s understanding of cancer, the current consensus is that cancer is essentially a genetic disease, and all cancers originate from genetic mutations. Although it is still difficult to turn mutated genes into normal ones, it is possible to stop the growth of tumors by blocking the signals that allow cancer cells to divide indefinitely through drugs.
The drug can be aimed at the target of action like a bullet, and precisely binds to and locks the target, therefore, this treatment is imaginatively called targeted therapy.
Targeted therapy is a treatment that targets an identified cancer-causing site (the site can be a protein molecule inside a tumor cell or a gene fragment) at the cellular molecular level. The drug enters the body and binds specifically to the oncogenic site, acting to cause the specific death of the tumor cells without affecting the normal tissue cells surrounding the tumor.
After the 1980s, the accumulation and advancement of basic research offered the possibility of finding an anti-cancer drug with specificity for humans. in 1988, Slamon, an oncologist at the University of California, and his companions, together developed an antibody against the Her2 gene, which was able to kill breast cancer cells with Her2 mutation.
In 1990, a 48-year-old American woman with breast cancer had her breast removed and underwent chemotherapy for seven months, but after a few months, her breast cancer metastasized extensively. Two years later, she enrolled in a clinical trial of the Her2 antibody and after completing 18 weeks of treatment, she is alive to this day. The drug, which treats Her2-mutated breast cancer, is Herceptin, which is a big name in the anti-cancer field today.
Herceptin, also known as trastuzumab for injection, is indicated for metastatic breast cancer, but also for adjuvant treatment of breast cancer and metastatic gastric cancer.
Herceptin specifically binds to HER2 receptors on the surface of tumor cells, causing a variety of intracellular biological effects, including induction of apoptosis, reduction of HER2 expression on the cell surface, reduction of tumor cell proliferation, reduction of other tumor-causing growth factors, and enhancement of chemotherapy effects.
Scientists have also developed second- and even third-generation targeted drugs for cancer patients who have developed resistance to first-generation targeted drugs.
The treatment with gene-targeted drugs can destroy cancer cells in a targeted manner with low side effects. Until today, it is one of the hottest directions in cancer research, promising to replace traditional chemotherapy methods and reduce the damage to normal tissues caused by chemotherapy.
However, it is only applicable to cancer patients with very clear location of cancer cells and immunohistochemical nature. Since the types of targeted therapies developed so far are not sufficient to cover all types of cancer, there are still few clinical applications.
In the future, when we have a clearer understanding of the causes of cancer development, more new drugs will definitely be introduced to cover more oncological diseases.
In addition to the above more common treatments, our weapons against cancer include new approaches such as antibody-coupled drugs, tumor vaccines, immune checkpoint monoclonal antibodies, pericyte immunotherapy, and hormone therapy.
Through the above introduction, we understand that the treatment of tumor is no longer only surgical resection and radiotherapy in the traditional sense, but also new treatment methods such as targeted drugs, immunotherapy, vaccines, etc. are becoming hot spots for research.
The road of cancer treatment is no longer the thorny and muddy one in the past, but is being widened and extended by us step by step. With the deepening of human understanding of cancer, more drugs with better efficacy will be invented. We believe that the future is bright and sooner or later, the day will come when cancer will be completely defeated!