Advances in Cancer Care
February 23, 2015 A1
According to the National Cancer Institute (NCI), cancer is a A3 “term used for diseases in which abnormal cells divide without control and are able to invade other tissues” (NCI, 2014). This definition is an important one because many people are accustomed to thinking about cancer as a single disease. However, cancer actually refers to a wide variety of diseases and is most accurately used to describe the cellular growth characterizing the disease. This unchecked abnormal cell growth is what makes cancer so difficult to control and is what provides the commonality for different types of cancer. However, depending on the organ of origin and other factors, cancer can actually act very differently in the body, so it is critical to know the type of cancer when determining the course of treatment.
A4 Although there are actually more than 100 different types of cancers, cancer is generally grouped into one of several broader categories: carcinoma, sarcoma, leukemia, lymphoma and myeloma, and central nervous system cancers. Carcinomas are cancers that begin in the skin or tissues that line or cover internal organs. Sarcomas are cancer that begin in connective or supportive tissue like bone, cartilage, fat, muscle, or blood vessels. Leukemia is cancer that begins in blood-forming tissue such as the bone marrow and is characterized by abnormal cells in the blood. Lymphomas and myelomas are cancers of the immune system. Finally, central nervous system cancers are those cancers beginning in the brain or spinal cord (NCI, 2014). It is important to realize that, because cancer spreads or metastasizes, the location where a cancer is found may not be the location of origin. Cancer is described by the organ where the cancer originated. Therefore, a person with breast cancer that has metastasized to the lungs does not have breast and lung cancer; she has metastatic breast cancer. This differentiation is critical when examining treatment protocols as the different types of cancer cells respond differently to various interventions.
One of the most promising fields in cancer research is the area of immunotherapy. While traditional cancer treatment has been focused on chemotherapy, which is the introduction of foreign substances to kill cancer cells, those treatments have usually been associated with very harsh side effects, largely due to the fact that the chemotherapy is unable to distinguish between healthy cells and cancer cells. Immunotherapies target cancer in a very different way; instead of introducing toxins into the body, they use a patient’s own immune system to kill the cancer cells. “In 2012, T cell-based treatments demonstrated promising early results, with researchers at the University of Pennsylvania using neutered HIV to infect a patient’s own immune system to produce new anti-cancer T-cells” (Le, 2012). Furthermore, central memory T-cells can be used along with autologous bone marrow transplants with the goal of establishing lifelong immunity and help prevent the recurrence of lymphoma after such a transplant (Le, 2012).
Immunotherapy also involves vaccinations and researchers are investigating the cancer vaccine. It may be overly simplistic to think of any vaccine as preventing cancer. However, vaccines can prevent other diseases that can lead to cellular changes that eventually become cancer. Several types of cancer are highly linked to underlying infections: cervical, anal, throat, and liver cancer. Some strains of the human papilloma virus (HPV) and long-term hepatitis B (HBV) infections increase those risks. Vaccines exist to guard against infection with HBV and some strains of HPV, lowering the overall risk of developing certain cancers. They are not vaccinations that target the cancer, but they are vaccines that can help reduce cancer risk.
Other vaccines may actually work to directly to impact the cancer, itself. Instead of trying to prevent disease, these vaccines work by trying to stimulate the immune system into attacking the cancer. So far, the only vaccine approved by the US Food and Drug Administration (FDA) to treat cancer is Sipuleucel-T (Provenge). It is specifically approved for the treatment of advanced prostate cancer when hormone therapy is no longer helpful:
For this vaccine, immune system cells are removed from the patient’s blood and sent to a lab. There they are exposed to chemicals that turn them into special immune cells called dendritic cells. They are also exposed to a protein called prostatic acid phosphatase (PAP), which should produce an immune response against prostate cancer.
The dendritic cells are then given back to the patient by infusion into a vein (IV). This process is repeated twice more, 2 weeks apart, so that the patient gets 3 doses of cells. Back in the body, the dendritic cells help other immune system cells attack the prostate cancer (American Cancer Society, 2014).
Some of the most interesting advances in cancer treatment have come in the arena of female cancers, such as HER2-positive breast cancer, cervical cancer, endometrial cancer, and ovarian cancer. The FDA has approved the use of pertuzumab as a neoadjuvant therapy to treat HER2-positive breast cancers with local metastasis, alongside the chemotherapy drugs used to treat the cancer. Furthermore, research advances are questioning the efficacy of surgery as a first line treatment for metastatic breast cancer, suggesting that surgery can actually hasten the spread of the disease, which could completely alter the therapeutic approach to breast cancer. Researchers have found that adding bevacizumab to existing cervical cancer treatments slows the growth of new blood vessels and increases the efficacy of existing treatments, increasing survival times for late-stage cervical cancer patients. Furthermore, while the Pap smear has become routine for cervical cancer early detection, in many countries it remains unaffordable; however, research is demonstrating that vinegar applied to the cervix may actually be an effective tool. Advances in the molecular analysis of certain uterine cancers have not yet led to changes in treatment regimes, but may promise a pathway to better understanding and treatment of the disease in the future. Finally, ovarian cancer has long been considered one of the deadliest diagnoses, in part because it is often not diagnosed in a timely manner. There is a new drug, salumetinib, which may offer hope against resistant ovarian tumors. Moreover, drugs targeting the genetic mutations that often lead to breast and ovarian cancer have traditionally had high toxicity, but researchers are close to finding replacement preventative therapies that are just as effective, but without the same side effects.
Targeted Cancer Therapies
Another promising development in cancer treatment is the advent of targeted cancer therapies that focus on new gene-specific uses for existing drugs. The goal is to find targeted uses for existing drugs by examining certain types of tumors and determining their responsiveness to those drugs (Le, 2012). While these drugs may not be sufficient, on their own, to kill the tumors, they may be sufficient to weaken the tumors, thereby enhancing the therapeutic value of any other therapy used in the treatment process (Le, 2012). Combining targeted therapies may provide an even better way to enhance the efficacy of existing treatments.
Changing the Goal of Cancer Treatment
Perhaps one of the most significant advances in cancer treatment has come in how people approach cancer. For a significant period of time, the single goal of cancer treatment was to find a cure for the cancer. While a cure is still a noteworthy goal, many cancer researchers are also looking at the goal of increasing survival times. Many therapies, especially combined, have the ability to not only significantly extend a person’s life but also to greatly improve quality of life. It is not just looking at these incremental increases that is considered an advance, but looking at how to combine the incremental increases that has such promise, because the combination can mean years of extra life and great improvements in quality of life.
Legal Changes with a Big Impact
Perhaps one of the most significant changes in cancer care over the last few years has nothing to do with scientific innovation and everything to do with the changing modern legal landscape. The Affordable Care Act (ACA) has changed the landscape of care for cancer patients and cancer survivors. Healthcare providers can no longer deny coverage for people because of preexisting conditions, which means that many people who were once ineligible for affordable healthcare policies are once again eligible for healthcare coverage. This can be significant, not only in treating cancer, but in ensuring that current and former cancer patients have access to the healthcare that they need.
Another major change is that the ACA established preventative care screening guidelines for insurance companies. In the past, many insurance policies covered screening, but they were not required to do so and they might have offered it at different stages and ages than those recommended by medical professionals. Combined with the mandatory coverage guidelines, this means that all people should have access to the type of preventative care and screening that has proven effective at increasing early detection and, therefore, increasing survival rates. This includes colorectal screening coverage for adults aged 50 and over; cervical cancer screening for sexually active women; mammograms; breast cancer chemoprevention for women at high risk for breast cancer; and HPV DNA testing for high risk women. This change means that many people who once would not have been able got get a diagnosis, and therefore, no treatment, before presenting, usually with the serious and painful symptoms associated with late-stage disease, may be able to access treatment in early stages of cancer, which greatly improves the likelihood of recovery.
There have been a number of advances in cancer care in the last few years, and not all of them have occurred in the scientific arena or involve scientific breakthroughs. Instead, many of these advances are actually combinations in existing treatments or changes in social policies that offer significant hope for cancer patients. The cure for cancer will not be found tomorrow and will not be a single cure, but the steady advances and progresses made in the fight against cancer make it clear that cancer will, eventually, be a manageable disease.
American Cancer Society. (2014, September 5). Cancer vaccines. Retrieved February 12, 2015
from Cancer.org website: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/immunotherapy/immunotherapy-cancer-vaccines
Le, S. (2012, December 31). Cancer: 5 research areas to watch in 2013. Retrieved February
12, 2105 from City of Hope website: http://breakthroughs.cityofhope.org/cancer-
National Cancer Institute. (2014, March 7). What is cancer? Retrieved February 12, 2015 from
National Institutes of Health website: http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer