How can a person not get confused, where to start in order to get the right treatment, how today genetics helps to destroy the protective mechanisms of a tumor, why surgery does not solve all the problems of oncology - about this and much more in the article.
To whom should a person with a suspected cancer diagnosis contact? Where to start?
It would be correct if a patient suspected of having cancer should immediately consult a clinical oncologist. This is a relatively new specialty for Ukraine, although it has existed in the world for a long time. A clinical oncologist is a doctor who knows all methods of diagnosis and treatment, all approaches to combating any oncological disease. Therefore, he can clearly define the tactics, the sequence of methods. Before prescribing treatment, the patient must undergo the necessary diagnostic procedures. And the results of the examinations give the clinical oncologist answers - whether the tumor is malignant or not; if the process is malignant, where it has spread to which organs - this must be understood in order to determine the stage of the disease. Precise knowledge of the stage makes it possible to develop treatment tactics.
What does treatment tactics mean? Isn't removing the tumor the first thing to do?
Tactics is a sequence of methods. There are main methods of treatment in oncology: surgery, chemotherapy and radiation therapy. It is the stage of the disease that determines their sequence. And removal of the tumor, which is always the first stage, which always. Yes, in the early stages, in many cases, we start with a surgical method. But if the process is widespread, that is, the tumor is not in one place, but has affected other organs, we cannot start with surgery, because we will condemn the patient to unsuccessful treatment. After all, each of the methods is aimed at blocking certain ways of development of the oncological process.
What is their difference?
The surgical method is local. The operation removes the center itself and the first way of spreading the process, i.e. the adjacent lymph nodes. It is carried out if there is an indication for it. Radiation therapy is a method, preferably also of local influence, aimed at preventing recurrence, which may occur in the same place or at a short distance from the tumor; also works against damage to regional lymph nodes. And chemotherapy is a systemic method aimed at destroying circulating cells or treating a widespread process when one or more organs are affected.
It still seems to many that the main thing is the operation, that it is important to "throw" the tumor out of the body.
It's just that people are used to thinking that surgery gets rid of problems and solves everything in oncology, but this is wrong. If we start to treat a patient in the second or third stage with a surgical method, not only will we not achieve success, but, on the contrary, we stimulate the growth of the tumor. Today, there is a lot of powerful chemotherapeutic drugs, targeted drugs that allow us to target the tumor and systematically affect the processes. Therefore, the place of surgery is far from prominent, as it was before.
Who makes the decision? How is the correct sequence of methods determined?
In our Center, this is an established process, the same as in the world's leading clinics. After the patient passes the two mandatory stages of diagnosis (imaging and histological confirmation), the clinical oncologist analyzes all the results and, together with a team of our specialists, determines the stage of the disease (the third stage, which we call staging) and decides on treatment tactics. And which method to use, which chemopreparations, their doses - everything is dictated by the type of tumor, because each education has its own structure, its own processes of protection both from the action of the immune system and from the action of drugs.
Can a tumor "know" how to defend itself?
The insidiousness of cancer lies in the fact that each formation has mechanisms that prevent the immune system from recognizing a malignant cell as foreign, which resist both chemotherapy and immunological drugs. That's why genetics comes to the rescue of oncologists today, and we use not only histological examination, but also genetic analysis to clearly know how to affect a particular tumor. It is genetics that allows us to make predictions and choose more aggressive or less aggressive treatment tactics.
That is, not everything depends only on the stage of the disease?
Not everything. The complete answer for determining the correct treatment tactics is provided by the results of both histology and immunohistochemistry, as well as genetic analysis. A vivid example is breast cancer. There are two roughly identical types: luminal A and luminal B. These are hormonally sensitive tumors, but in the first case, the so-called proliferation index is low, and in the second - high, which indicates a more malignant course of the disease, regardless of the stage.
That is, even if we detect the disease at stage 1, and the proliferation index is high, the situation dictates the use of more aggressive treatment tactics. Only standard immunohistochemical analysis will not give us a 100% answer, and then we use genetic research to clearly understand how the disease will proceed in the future and develop the only correct treatment plan.
In modern oncology, in addition to surgery and radiotherapy, there are many effective methods - both polychemotherapy, which involves the combination of several drugs, and targeted therapy, which acts on the tumor in a targeted manner. It is the targeted drugs that destroy the "defense" mechanisms of malignant formation, deal the first blow, breaking the defense. And the rest of the drugs, affecting the tumor, already "finish" it.
How to choose drugs?
How to use target therapy - as monotherapy or in combination with other drugs, which target to use - the question is answered by genetics, the study of mutations, "breakdowns" of genes that are present in tumors. We need to know what this mutation is in order to choose a drug for a specific tumor in a specific patient. This is the personalized approach necessary for effective treatment.
What is the role of a clinical oncologist?
Before the patient begins treatment, the clinical oncologist must summarize many factors — based on the results of research, make the correct diagnosis, determine the stage of the disease, as part of a multidisciplinary council, develop treatment tactics that will depend on the individual clinical picture in each case. That is, I return to the main point: the most correct decision for a patient with suspected cancer is to come to an experienced clinical oncologist. This will be a competent and correct step on the way to recovery.
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