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Local therapy, aimed at the destruction of metastatic breast cancer
Local therapy, aimed at the destruction of metastatic breast cancer
Treatment of metastatic disease can be divided into three types: System therapy, which aims to kill cancer cells outside of the metastases. Local therapy, aimed at the destruction of metastases. Analgesics.
You can only know one place where there is metastasis. However, if the metastases developed in one place, it may well appear somewhere else. In this case the tumor is so small that the patient does not even feel it. X-rays also can not detect such small metastases.
The operation in this case is not the best method of treatment, since it does not allow to remove all the cancer cells completely. So if you have marked one or more metastases, it is likely that your doctor may prescribe systemic treatment that affects all the cancer cells.
Systemic therapy includes: hormonal therapy, chemotherapy and target therapy drug Herceptin, new experimental therapies - for example, the drug Avastin, which prevents the formation of new blood vessels, additional methods of treatment.
But the effect of systemic therapy does not appear immediately, but in your case maybe you want a quick effect, to prevent adverse effects on bone metastases, brain or spinal cord. In this situation, more importantly, application of local therapy such as radiation therapy. Therefore, commonly used combination of these methods.
Treatment, acting on specific metastases may consist of various methods, including: cteroidnye drugs, radiation therapy, surgical treatment to eliminate compression of the tissue or restore the integrity of the bone.
While systemic therapy will begin to act, appointed by the painkillers. When bone lesions are appointed agents for its restoration.
The use of local therapy for metastases
In some cases, the metastases may have a direct effect on specific organs. In this case, apply a topical treatment to relieve these symptoms.
Spinal cord compression
At the same metastatic tumor begins to compress the spinal cord or nerve roots coming out of the spinal canal. Usually occurs in the tissue metastases of vertebrae, and the tumor starts growing pressure. This leads to pain in the spine, weakness and even paralysis of the extremities, as well as dysfunction of the bladder and intestines. Sometimes it does not grow in the metastatic vertebra, and around the nerve.
In this situation it is necessary to begin treatment immediately, while the nerve is not completely destroyed the tumor. In order to reduce swelling in the area of lesions initially appointed by the steroids - they may be in tablets and injections. The most commonly used dexamethasone. After application of steroids is assigned radiotherapy. Sometimes compression is applied to eliminate surgery.
Metastases in the brain
If the metastases in the brain manifest themselves in any form, is also required to immediately begin treatment, as is the case with the spinal cord, first used steroids, and thereafter surgery, chemotherapy or radiation therapy.
In case of metastases in an easily accessible area of the brain, then perhaps its surgical removal. Surgical treatment of solitary metastasis as in, have a marked compression, if other treatments are ineffective. However, if there are multiple brain metastases, or in other areas, surgery is usually not applicable. Occasionally, when the circulation of intracranial metastases violates the liquid and there is a risk of increased intracranial pressure and the development of hydrocephalus surgically installed a small tube, through which the outflow of the fluid - the so-called shunt.
In case of contact with cancer cells in the cranial-spinal fluid (CSF) that bathes the brain and spinal cord, cancer can affect individual nerves. This leads to a violation of the sensitivity of the limbs or their paralysis. The use of steroids can improve this problem. However, a more efficient use of chemotherapy, and chemotherapy drugs injected directly into the spinal canal. This is called intrathecal drug. This leads to reduction of cancer cells in the cerebrospinal fluid. As a result, significantly reduces the risk of nerve damage, but this has no effect on the changes already caused by the nerves. Radiation therapy is used in the ratio of the whole brain or specific nerves. Rarely the irradiation of the spinal cord. This is due to the fact that exposure to very large areas leads to a decrease in immunity.
Bleeding
Usually bleeding is applied radiotherapy. Sometimes the bleeding may be from the skin of the breast or adjacent to, or from metastasis in the lungs (while noting coughing up blood). With such a bleeding radiation exposure is very effective.
Metastases in the bones
Metastasis of cancer in the bones of legs, hips or hands can cause weakening of the bone and lead to the so-called "pathological" fractures, which do not even need much effort. If detected significant bone loss or violation of its structure, for the prevention of bone fractures in the metal spokes installed. This helps reduce the risk of fracture.
In the case of fracture of important bones like the femur or leg bone is held to surgical repositioning with special orthopedic devices. After this, the fracture is applied radiotherapy. Radiation kills cancer cells, and bone can heal. It is very important, as the bone itself, struck with cancer healed.
In addition, the lesion of bone metastases used medications that strengthen bone structure and reduce pain. These include drugs like Areda (pamidronate disodium) and Zometa . They are usually administered intravenously.
These products allow you to: reduce bone pain, strengthen the bone structure, to reduce the risk of fracture due to metastasis, reduce the risk of new bone metastases and reduce high levels of calcium in the blood.
Very rare side effect of these drugs is necrosis of the lower jawbone, which can cause some problems in patients visiting the dentist. If while taking these drugs you are visiting the dentist, you should tell him about these drugs. Sometimes the use of Zometa Areda and leads to renal dysfunction, although this effect is reversible. During the reception of these agents is carried out regular monitoring of renal function.
Now apply a new drug in this group - bonefos (clodronate), which is as effective as the above-mentioned drugs. In one study shows. bonefosa that the application for two years significantly improves the mineral content of the femur and vertebrae.
Metastases in some patients may have different painful metastases in the bone tissue, which do not respond to chemotherapy. These tumors can also irradiate the radiation exposure since the area is too large. It uses a different type of radiation - strontium-89. This radioactive drug is injected intravenously. It is known that strontium is absorbed by cells of bone tissue, while its cells absorb and metastasis. However, as with chemotherapy, strontium has side effects such as reduced immunity, anemia and bleeding.
Hypercalcemia
This condition is when the blood was elevated levels of calcium. This may be the tumor itself, and its effects on bone. Hypercalcemia may also be a side effect of cancer treatment. Elevated levels of calcium in the blood can cause serious problems. This condition requires immediate treatment.
To do this, use: increase fluid intake, other drugs that lower blood calcium levels, Areda or Zometa to stop leaching of calcium from bone.
Pleural effusion
Sometimes the patient is confused with the fluid in the lungs pleural effusion. When pleural effusion fluid accumulates in the pleural cavity surrounding the lungs. In the very same light liquid appears usually in violation of the heart. Pleural effusion disturb normal lung function, shortness of breath that is shown. In this case, you want to remove this fluid.
To do this in the pleural cavity is entered, or a thin tube is just a pumped syringe. This procedure is called thoracentesis. It is performed under local anesthesia. The needle is introduced at the same time not in the lungs and the pleural cavity.
To prevent accumulation of fluid in the future, is introduced into the pleural cavity is usually sterile talc for any antibiotic. This leads to irritation and the formation of scar tissue (adhesions), resulting in pleural cavity of the "overgrown" and the fluid will not accumulate. This procedure is called "pleurodesis" and the patient should spend some time in the hospital. In this case for some time felt the pain when breathing. In this case, are appointed by painkillers. In the case of a successful procedure, breathing is improved, so wait a little pain is worth the result.
Pain in the liver
This is usually caused by a growing metastasis in the liver, which leads to an increase in its size and stretch the capsule. It is this tension and provides a pain. Most effective in this case, the use of chemotherapy and anesthetics. However, if no improvement is noted, apply radiation therapy.
