Effective Radiation Therapy for the Treatment of Breast Cancer

Most women who have been diagnosed with breast cancer will undergo some form of treatment for the disease. The most favorable course of treatment will depend on a number of factors, including the size and location of the breast tumor, the stage of the cancer, and results of other laboratory tests. This section provides information on the treatment options for breast cancer, discusses how to cope with the side effects of treatment, and addresses important aspects to consider before and after breast cancer treatment.

Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. Radiation therapy is often used to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm) area after surgery. Occasionally, radiation therapy is used before surgery to shrink the size of a tumor. A common treatment for early stage breast cancer is breast-conserving therapy. Breast-conserving therapy (BCT) is the surgical removal of a breast lump (lumpectomy) and a surrounding margin of normal breast tissue. BCT is typically followed by at least six to seven weeks of radiation therapy. 

Treatment with radiation usually begins one month after surgery, allowing the breast tissue adequate time to heal. Radiation therapy may occasionally be recommended for women to destroy remaining cancer cells after mastectomy (surgical removal of the affected breast) or to shrink tumors in patients with advanced breast cancer.

External Beam Radiation

The most common type of radiation therapy used on women with breast cancer is called external beam radiation. External beam radiation is delivered from a source outside the body on the specific area of the body that has been affected by the cancer. Experts compare the experience of external beam radiation to having a diagnostic x-ray, except that radiation is usually administered for a longer period of time and at a higher dose.

Before radiation therapy begins, the physician will measure the correct angles for aiming the radiation beam at the specific area of the body and make ink marks on the patient’s skin. As part of treatment after breast surgery, patients are typically treated with radiation five times per week for at least six weeks in an outpatient clinical setting. Each treatment generally lasts a few minutes; the entire radiation session after machine set-up typically lasts 15 to 30 minutes. The procedure itself is pain-free. While the radiation is being administered, the technologist will leave the room and monitor the patient on a closed-circuit television. However, patients should be able to communicate with the technologist at any time over an intercom system.

Side effects of external beam therapy vary among patients. The most common side effect is fatigue. Fatigue (extreme tiredness) can be especially bothersome in the later weeks of treatment. Patients who experience fatigue after radiation sessions should get plenty of rest and try to maintain an active lifestyle. While many patients can still work and participate in normal activities during radiation therapy, some patients find it necessary to limit their work or activities until treatment has been completed.

Other common side effects of radiation therapy are neutropenia (sharp decrease in white blood cell count) swelling of the breast, a feeling of heaviness in the breast, a sunburn-type appearance of the breast skin, and loss of appetite. These side effects usually disappear after six to 12 months. Near the end of treatment with radiation, the breast skin may become moist. Patients should try to wearing loose fitting clothing and expose the skin to air as much as possible to help the skin heal quickly.

Temporary Side Effects of Radiation Therapy

• Fatigue
• Neutropenia (reduction in white blood cells)
• Breast swelling or tenderness
• Feeling of heaviness in the breast
• Sunburn-like appearance of the breast skin
• Loss of appetite

In most cases, the breast will look and feel the same after radiation therapy is completed, though it may be more firm. In rare cases, radiation therapy may cause changes in the breast size. Breasts may become larger due to fluid build-up (seroma) or smaller due to tissue changes. Some women may find that the breast skin is more sensitive after radiation, while others may find that it is less sensitive. Radiation therapy of the axillary (underarm) lymph nodes may cause lymphedema (chronic swelling of the arm) in some women. Women who have radiation to the lymph nodes will usually be instructed on arm exercises and other activities to help prevent lymphedema.

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Breast Cancer Treatment at World Best Cancer Hospitals in India : Surgery, Chemotherapy, Radiation Therapy and Hormonal Therapy

Breast Cancer - World Class Treatment in India

Breast cancer is not one single disease. There are several types of breast cancer. It can be diagnosed at different stages of development and can grow at different rates. . You may need help to get the facts straight and to ask the questions that are important to you.If you have any questions, please remember that we offer a range of services for people affected by breast cancer. 

From diagnosis, through treatment and beyond, our services are here every step of the way. The most common sign of breast cancer is a new lump or a mass. A lump that is painless hard and has uneven edges is likely to be cancer. But some cancer are soft, tender and rounded. All Breast lump are not cancerous, in fact most are benign. However each has to be analyzed and tested as some benign lumps can increase your risk. So its important to have anything unusual checked by your doctor.

Other Signs of Breast Cancer:

• A Swelling of a part of a breast
• Skin irritation or dimpling in the breast area
• Unusual Nipple pain or the nipple turning inward
• Redness or scaliness of the nipples or breast skin
• A Nipple discharge other than breast milk

There are several modalities of the treatment-these include Surgery, Chemotherapy, Radiation Therapy and Hormonal Therapy. These are usually used in a combination.

1) Surgery

A) Breast Conservation Surgery: Wide excision of only the Breast Lump (saving the normal breast) with removal of axillary nodes. At the end of the procedure ,you have a near normal breast.

B) Modified Radical Mastectomy (MRM): This surgery involves the removal of entire breast and axillary lymph nodes. This surgery is recommended in the following circumstances:-

• Cancer is found in more than one part of the breast
• Breast is so small that wide excision of the lump can severely deform the breast

Following the surgery a drain is placed in the axilla and another drain is placed under the flaps after the Mastectomy. This will be removed in another 7-14 days depending on the amount of the fluid that is draining out. Stitches are removed two weeks after the surgery.

C) Modified Radical Mastectomy with Reconstruction: For those women who are unhappy with the idea of losing their breast and are suitable for immediate breast reconstruction can choose this option. A plastic surgeon is involved in this surgery and utilizes patient's own tissues to create a breast which closely matches the opposite breast, if required an artificial implant may also be use.

2) Chemotherapy
Many Patients may require Chemotherapy after the Breast Cancer Surgery. In Chemotherapy a combination of the drugs is used to kill the cancer cells. The medical oncologist will plan the therapy according to the individual case. Chemotherapy may be administered as Neoadjuvant,Adjuvant and Palliative chemotherapy.

3) Radiation Therapy
Breast Conservation Surgery is always followed by Radiation Therapy. It may also be used after Mastectomy surgery if required. The radiation therapy uses very high energy X-rays to destroy the cancer cells that still may be present in the affected breast or nearby lymph node. This procedure is painless and the patient does not feel anything when the treatment is going on.

4) Hormonal Therapy
Hormonal therapy medicines are whole-body (systemic) treatment for hormone-receptor-positive breast cancers. Hormone receptors are like ears on breast cells that listen to signals from hormones. These signals "turn on" growth in cells that have receptors. Hormonal therapy medicines can be used to lower the risk of early-stage hormone-receptor-positive breast cancer coming back, lower the risk of hormone-receptor-positive breast cancer in women who are at high risk but haven't been diagnosed with breast cancer and help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers

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Difference between hodgkin's and non-hodgkin's lymphoma : Lymphoma Cancer Treatment in India

What is Lymphoma Cancer?

Lymphoma Division comprises a specialized team of professionals who are dedicated to preventing, diagnosing, treating, and managing cancers of the lymphatic system, including Hodgkin's and non-Hodgkin's lymphoma. 

The lymphoma team brings together experts in Hematology / Medical oncology, Immunology, Infectious Diseases, Pathology, Radiation Oncology, Transfusion Medicine and Nursing. This specialized approach to treating lymphoma provides patients with the exact type of services they need to battle the disease and its physical, emotional, and social side effects. 

Types of Lymphoma

Hodgkin's Lymphoma Cancer - This is the most common type of lymphoma is. It has special characteristics that distinguish it from the others. Often it is identified by the presence of a unique cell, called the Reed-Sternberg cell, in lymphatic tissue that has been surgically removed for biopsy.

Hodgkin's disease tends to follow a more predictable pattern of spread, and its spread is generally more limited than that of the non-Hodgkin's lymphomas. By contrast, the non-Hodgkin's lymphomas are more likely to begin in extranodal sites (organs other than the lymph nodes, like the liver and bones).

Non-Hodgkin's Lymphoma Cancer - In this case the cells in the lymphatic system grow abnormally. They divide too rapidly and grow without any order. Too much tissue is formed, and tumors begin to grow. The cancer cells also can spread to other organs.

There are about ten different types of Non-Hodgkin's lymphoma. Some types spread more quickly than others. The type is determined by how the cells look under a microscope (histology). The histologies are grouped together, based on how quickly they spread, into low-grade, intermediate-grade, or high-grade lymphomas.

Symptoms of Lymphoma Cancer

The most common symptom of non-Hodgkin's lymphomas is a painless swelling in the lymph nodes of the neck, underarm, or groin. Other symptoms may include fevers, night sweats, tiredness, weight loss, itching, and reddened patches on the skin. Sometimes there is nausea, vomiting, or abdominal pain.

As lymphomas progress, the body is less able to fight infection. These symptoms are not sure signs of cancer, however. They also may be caused by many common illnesses, such as the flu or other infections. But it is important to see a doctor if any of these symptoms lasts longer than 2 weeks.

Diagnosis Of Lymphoma Cancer

Following tests are usually required

• Blood tests, including complete blood count (CBC), liver and kidney function test
• Bone marrow biopsy or Fine Needle Cytology Aspiration
• Lumbar puncture (spinal tap) to check for Cancer spread to the central nervous system (brain and spinal cord)
• Ultrasound
• Bone scan or gallium scan (when a radioactive material is injected into the bloodstream to look for evidence of inflammation or bone tumors)
• PET Scan - Positron emission tomography scan

Lymphoma Cancer Treatment

Treatment of Hodgkin Lymphoma

The specific treatment for Hodgkin lymphoma largely depends on the stage, overall health and type of disease. The aim is to kill all the present cancer cells. Some of the treatment options include –

Stem Cell Transplant : In this treatment, a diseased bone marrow is replaced with healthy stem cells in order to grow new bone marrow. This treatment can be the only option if Hodgkin lymphoma occurs again despite being treated. The removal of a patient’s blood stem cells is done that are then stored and frozen for later use. A patient then receives high-dose of radiation and chemotherapy for destroying cancerous cells in the body. The stem cells are then softened and injected into the body by the means of veins and they then helps in building new healthy bone marrow.

Chemotherapy : This therapy makes use of chemicals for destroying lymphoma cells. These drugs travel to the bloodstream and finally reach to all parts of the body. Radiation therapy is often combined with chemotherapy for treating those people who are suffering from early-stage classical type of Hodgkin’s lymphoma.

Radiation Therapy : High-energy beams that include x-rays are used in this therapy for destroying cancer cells. Radiation therapy is usually used after the chemotherapy for treating classical Hodgkin’s lymphoma. Radiation therapy is used alone for treating those people who are suffering from early stage lymphocyte-predominant of Hodgkin’s lymphoma.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma, also referred to as NHL or non-Hodgkin’s lymphoma, is a type of cancer that begins in lymphocytes (a part of the immune system of the body). NHL can be categorized into 40 different types. There are no known causes of Non-Hodgkin lymphoma. People who have weak immune systems that also include those people, who are suffering from HIV infection or had an organ transplant, can develop Non-Hodgkin lymphoma.

Types of Non-Hodgkin Lymphoma

T-cell or B-cell lymphomas are categorized under lymphomas that depends on whether these lymphomas have began from T-cell lymphocytes or B-cell lymphocytes. B-cell lymphomas are considered as the most common that include –

• Follicular lymphoma
• Diffuse large B-cell lymphoma

Some of the not so common types are –

• Lymphoplasmacytic lymphoma
• Extranodal marginal zone lymphoma of mucosa-associated tissue
• Small lymphocytic lymphoma (SLL)
• Mediastinal large B-cell lymphoma
• Mantle cell lymphoma
• Nodal marginal zone lymphoma
• Burkitt lymphoma

T-cell lymphoma types include –

• Lymphoblastic lymphoma
• Peripheral T-cell lymphoma
• Anaplastic large cell lymphoma
• Skin (cutaneous) lymphoma

Symptoms of Non-Hodgkin Lymphoma

• Concentration problem, seizures, headache or personality changes can occur if the brain is affected by the cancer
• Night sweats
• Weight loss
• Abdominal swelling or pain results in vomiting, loss of appetite, nausea and constipation
• Fever and chills that come and go
• Swollen lymph nodes in the groin, neck and underarms areas
• Shortness of breath or coughing can occur when the cancer affects lymph nodes or thymus gland in the chest that puts pressure on other airways or on the windpipe
• Itching

Treatment of Non-Hodgkin Lymphoma

The treatment of Non-Hodgkin lymphoma depends on its stage, symptoms and the type. The aim of the treatment is to eliminate the lymphoma without causing any damage to the surrounding cells. The common treatment options for Non-Hodgkin lymphoma include –

• Monoclonal Antibodies: This treatment is used for destroying lymphoma cells. Monoclonal antibodies can also be combined with chemotherapy drugs for delivering high concentration of the drugs to the tumor cells.
• Chemotherapy: Anti-cancer drugs are used for destroying lymphoma cells that are injected through the vein or can also be taken by mouth. This treatment has proved very beneficial for lymphoma as anti-cancer drugs enter into the bloodstream that also reaches to every part of the body.
• Radioimmunotherapy: This treatment uses a monoclonal antibody that also combines a radioactive particle to it. This helps in destroying the lymphoma cells and simultaneously it also destroys many more cells that are in the radiation path.
• Radiation Therapy: High dose x-rays are used for treating cancer cells that are still there after surgery. This therapy is usually used for treating Non-Hodgkin lymphoma cancer. External radiation is a method by which radiation is given directly to the cancer from a machine that is outside of the body.
  
  
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Signs of Endometrial Cancer (Uterine Cancer) : Most Advanced Technology for Cancer Treatment at World Best Hospitals in India

Endometrial Cancer (Uterine Cancer)

Uterine (Endometrial) cancer originates in the female reproductive system and genrally affects postmenopausal women between ages 50 and 60;. It develops in the body of the uterus or womb whose wall has an inner lining (called the endometrium) and an outer layer of muscle tissue (called the myometrium)..

Endometrial cancer (Uterine Cancer) is often detected at an early stage because it frequently produces vaginal bleeding between menstrual periods or after menopause. If discovered early, this slow-growing cancer is likely to be confined to the uterus. Removing the uterus surgically (Hysterectomy) successfully eliminates Endometrial cancer if detected and carried out in the initial stages.

Diagnosis of Endometrial Cancer (Uterine Cancer)

A pelvic exam is performed by the doctors checking the vagina, uterus, ovaries, bladder, and rectum for Endometrial Cancer (Uterine Cancer). An instrument called a speculum is used to widen the vagina so the doctor can see the upper portion of the vagina and the cervix. 

The Pap Smear test is often performed during a pelvic exam Endometrial Cancer (Uterine Cancer). The doctor uses a wooden scraper (spatula) or small brush to collect a sample of cells from the cervix and upper vagina. The cells are then sent to a medical laboratory to be checked for abnormal changes. Because uterine cancer begins inside the uterus, it may not show up on a Pap test, which examines cells from the cervix.

A biopsy may be needed for a definitive diagnosis where the doctor removes a sample of tissue from the uterine lining. In some cases, a woman may require a dilation and curettage (D&C), which is usually a day care procedure. During a D&C, the opening of the cervix is widened and the doctor scrapes tissue from the lining of the uterus. A pathologist examines the tissue to check for cancer cells, hyperplasia, or other conditions.

Common Endometrial Cancer (Uterine Cancer) Symptoms

 Abnormal bleeding- heavy bleeding between periods, or heavy bleeding  during irregular periods

   Pain during intercourse, pelvic pain or pain in the legs or back

   Difficulty urinating or pain during urination

   Enlarged uterus , Vaginal discharge and or unexplained weight loss

Surgical Treatment of Endometrial Cancer (Uterine Cancer)

• Surgery :During exploratory surgery, oncopathologist, who specialize in tissue study examine the cancer tissue so that gynaeoncologist can determine how much tissue to remove. In most cases, gynaeoncologist will recommend a hysterectomy (removal of the uterus) or a complete hysterectomy (removal of the uterus, fallopian tubes and ovaries). To find out whether the cancer has spread, gynaeoncologist also removes tissue from the lymph nodes near the uterus and other abdominal sites.
• Chemotherapy : Certain types of chemicals are used for killing the cancer cells. One or more chemotherapy drugs may also be combined. The injection of these drugs can be done either through the mouth or into the veins. Women who are suffering from recurrent or advanced stage of uterine cancer that has spread beyond the uterus are treated with the help of chemotherapy. The drugs then enter into the bloodstream that moves in the entire body for destroying the cancer cells.
• Radiation therapy : High-energy radiation beams are used in this therapy for killing the cancer cells. Radiation therapy is also recommended for reducing the risk of recurrence after surgery. Also this therapy is also beneficial after surgery for shrinking the tumor so that can be easily removed. This therapy may involve –
• Radiation given within the body : This involves the placement of a radiation-filled device like a cylinder, small seeds or wires within the vagina for a short duration. This process is known as internal radiation or Brachytherapy.
• Radiation given through a machine outside the body : This process makes use of machine that is placed outside the body. The radiation is then directed at a specific point in the body and this process is known as external beam radiation.
• Hormone therapy Gynaeoncologist may recommend progestin (synthetic progesterone) to help stop the cancer from spreading. Patient may take progestin with other medications.
  
  
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Robotic Surgery for Prostate Cancer : Advantages over Both Open and Laparoscopic Prostate Cancer Surgery

The technology offers a number of other advantages over both open and laparoscopic surgery. It is a much less invasive form of surgery than open surgery, resulting in a shorter hospital stay and quicker recovery time, while patients experience reduced blood loss during surgery and reduced post-operative pain as smaller incisions are required. In addition there is much less need for blood transfusion and there is a lower risk of wound infection.

 It provides the specialist with far superior three-dimensional, high definition visualisation of the prostate, surrounding tissue and neurovascular bundles than is possible with open or laparoscopic surgery. It allows the surgeon improved dexterity and a steadier ‘hand’ when performing the procedure.

The technology translates the surgeon’s hand movements on the instruments on the console into corresponding movements of the robotic arm instruments inside the patient, which gives the surgeon excellent control in performing a wide range of motions.The robotic technology is a much-needed addition to the armoury in the fight against prostate cancer as it offers patients who require a radical prostatectomy a treatment option that delivers better outcomes.

Worldwide increase in robotic surgery

Worldwide, the da Vinci system is being used in an ever increasing number of different procedures. To date it has mainly been used in the field of urology to perform prostatectomies to treat prostate cancer, a procedure that requires great surgical precision.

Some 80% of prostatectomies in US are now being performed robotically, and the number of procedures completed with such technology is increasing significantly year-on-year throughout the world.

World’sMost Advanced Robotic Surgery for Prostate Cancer

A boon for Prostate Cancer patients – Advanced Robotic Prostate Surgery is now preferred choice for Prostate Cancer patients due to following unmatched advantages

• Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Lower blood transfusion rates
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and
• fecal discharge) and causing Impotency

What is Da Vinci master slave Robotic System?

The surgical application of robotic systems is one of the most exciting and significant technological developments of this century; its future implications are incalculable.Huge strides have been made in the field of closed operations in the past 10 years and the use of robotic systems has emerged as the principle solution to technical limitations|

The use of robotic surgical systems has numerous advantages. Whereas modern laparoscopic systems give only a two-dimensional vision, robotic systems give the surgeon a three-dimensional field of vision and depth, provide arms that, unlike the human hand, never tire and permit an unprecedented continuityin operations. Since robotic systemsexceed even the human hand’s freedom and facility of movement, far greater delicacy and dexterity is achieved. Modern robotic systems fall into three categories; active, semi-active and master-slave.But the most commonly used are master-slave systems distinguished by the surgeon’s absolute control of the robot via a remote control console.

The Da Vinci is a sophisticated master-slave robot that incorporates 3-D high definition visualization, scaling of movement, and wristed instrumentation. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is working a few feet away from the operating table, while seated at a computer console with a three-dimensional view of the operating field.

UnbeatableAdvantages of Robotic Prostate Surgery over the Conventional Prostate CancerSurgery

1) Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

2) Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

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Best and Advanced Lung Cancer Treatment Options in India

A Lung Cancer is when out-of-control cell growth occurs in one or both lungs. The cancer can arise in any part of the lung, but majority of it arises in the epithelial cells, which are the lining of the Bronchi and bronchioles i.e. the larger and the smaller airways of the lungs. Lung cancer is predominantly a disease of the elderly almost 70% of people diagnosed with lung cancer are over 65 years of age.

Lung Cancer is largely classified into two main types based on the cancer's appearance under a microscope viz. Small Cell Carcinoma which accounts for only 20% of the total lung cancers and Non small Cell Lung Cancer (NSCLC) which accounts for 80% of lung cancers.

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 Small cell carcinoma : It generally starts in one of the larger breathing tubes, grows fairly rapidly, and is likely to be large by the time of diagnosis.

·         Non-small cell lung cancer (NSCLC) :It is further classified into the following:

o       Epidermoid carcinoma or Squamous cell carcinoma: It forms in the lining of the bronchial tubes and it usually starts from one of the larger breathing tubes and grows relatively slowly.

o    Adenocarcinoma: It starts forming in the mucus-producing glands of the lungs. It is most common type of lung cancer that occurs in Women’s and Non-smokers.

o    Large cell caracinoma: This kind of NSCLC initiates near the surface of the lung and it grows rapidly.

There are usually no signs or symptoms in lung cancer. 

The main symptoms of lung cancer are listed below:

• ·         A cough that doesn’t go away after two or three weeks
• ·         A long-standing cough that gets worse
• ·         Persistent chest infections
• ·         Coughing up blood
• ·         Persistent breathlessness
• ·         Loss of appetite or unexplained weight loss

Surgery, radiotherapy and chemotherapy are all used to treat lung cancer. They can each be used alone or together. Your doctor will plan the best treatment for you. Some people with advanced non small cell lung cancer may have biological therapy.

Treatment and type of lung cancer

The treatment for non small cell lung cancer is different from the treatment for small cell lung cancer.

Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands) and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer. 

Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. Some people with advanced lung cancer may have biological therapy. 

Treatmentby stage for small cell lung cancer

If you have early stage small cell lung cancer you are most likely to have chemotherapy and then radiotherapyto the lung. People who are fairly fit may have chemotherapy and radiotherapy at the same time (chemoradiation). It is quite common for this type of cancer to spread to the brain. So doctors often recommend radiotherapy to the brain for people whose lung cancer shrinks with chemotherapy treatment. You usually have radiotherapy to the brain at the end of the chemotherapy treatment. It aims to try to kill any cancer cells that may have already spread to the brain but are too small to show up on scans. Doctors call this prophylactic cranial irradiation or PCI.

For very early stage small cell lung cancer that has not spread to the lymph nodes in the centre of the chest (the mediastinal lymph nodes), you may have surgery to remove the part of the lung containing the tumour . The surgery is followed by chemotherapy and sometimes radiotherapy. But usually the cancer has already spread at the time of diagnosis and surgery is not then possible.

If you have small cell cancer that has spread to lymph nodes or other areas of the body you may have chemotherapy, radiotherapy or treatment to relieve symptoms. If chemotherapy works well to shrink the lung tumour down and you are fairly fit you may also have radiotherapy to the brain to kill any cancer cells that may have already spread there.

• Chemoembolization:Strong chemicals are used in chemotherapy that interferes with cell division process and damages DNA or proteins. The aim of these treatments is to rapidly divide the cells. The normal cells can be recovered from any chemical-induced damage whereas cancer cells cannot be recovered. The medicines in chemotherapy travel in a systematic way by passing from the complete body and destroying the original tumor cells that have spread in the whole body. Usually many therapies are combined that also includes many types of chemotherapy.

• Radiation Therapy :Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative therapy), or as adjuvant therapy in combination with surgery or chemotherapy. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10%-15% of people it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further prolong survival when chemotherapy is administered. External radiation therapy can generally be carried out on an outpatient basis, while internal radiation therapy requires a brief hospitalization.

• Targeted Therapy :Targeted therapy drugs more specifically target cancer cells, resulting in less damage to normal cells than general chemotherapeutic agents. Erlotinib and gefitinib target a protein called the epidermal growth factor receptor (EGFR) that is important in promoting the division of cells. This protein is found at abnormally high levels on the surface of some types of cancer cells, including many cases of non-small cell lung cancer.

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