PRRT and the promise it holds for cancer treatment

As we continue our conversation on Precision Medicine for cancer, a popular therapy used to treat NET tumours or Neuro Endocrine Tumours is PRRT or Peptide Receptor Radionuclide therapy.
Neuroendocrine tumours are a rare form of cancer and originate from Neuro endocrine cells in the body and hence the name.They are different from adenocarcinoma’s and often do not do not respond well to chemotherapy, the 1st line of treatment for most cancers.

By administering radioactive protein lutetium octreotate, it is possible to treat NET tumours or neuro endocrine carcinoma with precision and offset progression of disease.

PRRT for neuroendocrine tumour
PRRT treatment for metastatic cancer cells spreading and growing. Tailor-made precision medicine based on genetic profile and molecular structure of the tumour.

In PRRT a peptide or a cell targeting protein is combined with a small amount of radio active nuclide creating what is called as a radio peptide. The radio peptide when injected into the patients blood stream travels and binds to a neuro endocrine tumour, delivering a high dose of radiation to the tumours. This also limits damage to the nearby healthy tissue and hence lesser and milder side effects than chemotherapy.

What kind of cancers can be treated by PRRT?

Along with Neuroendocrine tumours, carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung a form of lung cancer, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach cancer , intestine cancer and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radio iodine are often treated with PRRT.

Role of PRRT is also being explored for treatment of prostate cancer.

When is a patient a candidate for PRRT ?

Patients with following conditions are often proposed for PRRT

  • When neuro endocrine tumours are not responsive to other lines of cancer treatment
  • When surgical removal of tumours is not possible at current stage, PRRT may be used to reduce size of the tumours.
  • PRRT is also a treatment option for last stage inoperable cancers when metastasis has set in.
    The main aim of PRRT is then to slow down progression of disease, offer relief and prolong life.

However, not all neuroendocrine tumours respond to PRRT. First an OctreoScan is done. If the patient is found to have a positive OctreoScan and meets other requirements, PRRT is proposed.

What happens during PRRT ?

For patients having a positive octreoscan, to start with an amino acid solution is delivered to protect the kidneys.

As most net tumours have a lot of a specific type of surface receptor, a protein called somatostatin. Octreotide, is a lab version of somastostatin. During PRRT, a dose of radio nuclides such as Lutetium, Yttrium are often combined with octreotide and injected into the blood stream.

Molecular imaging and scans follow to see whether the radio peptide has latched on of the tumour sites correctly.

The entire session usually lasts for about 4 hrs and is often done as an out patient procedure.

The main goals of PRRT hence are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.

Advantages of PRRT ?

PRRT along with other molecular therapies or targeted therapies offer excellent results as they are tailor made keeping in mind molecular properties of the tumour and also biologic characteristics of the patient.

PRRT is offered in Germany , USA, UK and other developed countries at a significant cost, In India, a single session of PRRT costs approx USD 6300.

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Decoding CyberKnife, for cancer treatment and benign tumours

We often get queries on CyberKnife and what is CyberKnife used for ?

CyberKnife is an excellent treatment option for treating cancer’s such as prostate cancer, gliomas ,brain cancer, kidney cancer, lung cancer, spine cancer, cancer of the pancreas, head and neck cancer, liver cancer, early stage -localised breast cancer and several types of malignant tumours, benign tumours and several other medical conditions.
CyberKnife delivers stereostatic radiation( SBRT) with extreme precision and a tissue margin of 1-5mm

Non invasive, CybeKnife vaporises a brain tumour

Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated.
CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.

Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.

Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.

CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.

CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.

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Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.

The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on  use of CyberKnife as treatment option can be arrived.
To connect to the best hospitals in India, offering CyberKnife, and to know if CyberKnife is a treatment option for your medical condition, send us an email on info@ihealthkonnect.com or Consult Now.

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Stomach Cancer- Why does it catch us unawares ?

Stomach cancer is defined as the growth of cancerous cells in the stomach lining.
According to the National Cancer Institute (NCI), there will be approximately 24,590 new cases of stomach cancer every year.

Stomach cancer
Clinical stages of stomach cancer. How stomach cancer spreads?

Stomach cancer is often left undiagnosed because it doesn’t have many early symptoms – it is diagnosed when cancer spreads to other parts of the human body.

A few early signs are:
Nausea and Vomiting: Nausea is defined as a feeling of queasiness at the back of your throat or stomach. Vomiting, on the other hand, is defined as the contraction of your stomach muscles that push the digested food back through your oesophagus. Both nausea and vomiting may be early symptoms of stomach cancer especially if one’s blood shows in the vomit.
Bloating: If one faces bloating, which doesn’t ease up and persistent, it calls for a visit to the doctor and an ultrasound at least to start with.

H. Pylori Infection: If one suffers from frequent indigestion, bloating,one must get tested for bacterial Infection with H pylori, as it is the most prominent indication of people developing stomach cancer later.

Research has shown that people suffering from H.Pylori infections have a much incidence of stomach cancers.

Weight loss: Stomach tumours cause blockages, preventing food from passing into the stomach or into the intestines causing loss of appetite. Similarly, stomach cancer causes energy from food to be burned at a faster rate which combined with nutritional loss causes weight loss.

Stomach Pain: Unexplained stomach pain , the kind which persists is also a warning sign that something may be wrong.

Frequent HeartBurns:  Frequent heartburns could be because of ulcers and may also indicate that everything is not ok.

Inability to eat: As the tumour progresses, it blocks various parts of the digestive system. Coupled with body’s inability to digest food,  there is a reduced appetite, which at a later stage is often total inability to eat and digest food.

As the symptoms are so generic, they are often missed leading to diagnosis at a much later stage when the cancer has spread or metastatised to other parts of the body.

Is there a co-relation between our habits and stomach cancer?
Food: Food and stomach cancer have a direct relationship. The right dietary intake can lower the risk of stomach cancer. Storage of food through refrigeration instead of by smoking, salting and pickling also reduces the risk because the nitrates and nitrites in smoked food increase the risk of stomach cancer.
Smoking: The use of tobacco increases the risk of stomach cancer. It is said that the rate of risk of stomach cancer is doubled in smokers as compared to non-smokers. This is because smoking reduces the production of natural substances that protect the stomach and duodenum from tissue damage. Additionally, smoking promotes the duodenum reflux and increases the acidity of the duodenum making it vulnerable to H. Pylori bacteria. Smoking also constricts the blood vessels in the stomach reducing the blood flow in the stomach. All these mechanisms strengthen the link between stomach cancer and smoking.

Treatment of stomach cancer involves, surgery if detected at an early stage, followed by chemotherapy as the 1st line of treatment.

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Anaemic ! Could it be You ?

sickle cell anemia
anemia

Anaemia is very common medical condition, where the body does not produce enough healthy red blood cells or excessively destructs blood cells.
Most people have anaemia due to poor dietary habits and inadequate nutrition while certain forms of anaemia are hereditary.
Some of the early warning signs , which are common across all 400 types of anaemia are:

anemia symptoms
Early warning sign and symptoms that may appear in anemia

Fatigue : The most common warning sign of anaemia is fatigue. It occurs because the body doesn’t have enough Red Blood Cells to carry haemoglobin which contains oxygen to the cells leading to exhaustion.

Pale Skin : Paleness of the skin is usually dependent on the thickness and density of blood vessels below the skin. A lack of red blood cells due to anaemia

A very pale pallor can also be due to sickle cell anaemia ( a medical condition where abnormally shaped red blood cells block the flow of blood).

Swollen or Sore tongue : A big warning sign of anaemia is an anaemia tongue wherein ones tongue gets inflamed due to low iron levels in the body. The surface of the tongue can often smoothen out or your tongue can morph into different shades.

Swollen Hands and feet : Swollen hands and feet are a symptom of sickle cell anaemia. In sickle cell anaemia, the sickle shaped red blood cells clump together and block the flow of blood in the body – leading to the blood flow being cut off from the tissues and organs.

Shortness of breath : This occurs because the red blood cells carrying oxygen have less haemoglobin and less capacity to bind oxygen causing shortness of breath.

Brittle nails : Nails have a protective hard layer called keratin that protects the soft tissue in your nails. Lack of red blood cell production due to anaemia prohibits the growth of nails. Ridges and banding in the nails are often indicators of anaemia.

Appetite for inedible items : Pica is defined as a craving to chew or eat substances of no nutritional value such as ice, paper, chalk, pencils, wall putty etc. These unusual cravings in order to satiate the body’s appetite for iron must not be ignored as it is the first sign of anaemia.

Sickle cell anaemia is a very severe form of anaemia and is often inherited. Although those suffering from anaemia and sickle cell disease suffer from fatigue, pale pallor, shortness of breath, people suffering from just anemia rarely suffer from frequent chest infections or have painful crisis

Sicklers or people suffering from sickle cell anaemia, often have painful crisis situations, when the haemoglobin can even drop to between 1 and 3 leading to even death within few hours.

Sickles often suffer from organ damage and  may need a hip replacement . a shoulder replacement or rarely even a knee replacement.

Although Sickle cell anaemia can be managed with hydroxy urea, if the patients has reached a point where he or she suffers from chest infections, frequent painful crisis, or needs a hip replacement or shoulder replacement, a bone marrow transplant should be considered.

A bone marrow transplant, with matching donors has more than an 85% success rate and is the only possible cure and treatment for sickle cell anaemia.

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Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Although chemotherapy is useful for treating most types of cancer, kidney cancer is often resistant to chemotherapy. However, researchers continue to study new drugs and new combinations of drugs. For some patients, the combination of gemcitabine (Gemzar) and capecitabine (Xeloda) or fluorouracil (5-FU, Adrucil) will temporarily shrink a tumor.

It is important to remember that transitional cell carcinoma, also called urothelial carcinoma, and Wilms tumor are much more likely to be successfully treated with chemotherapy.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

Radiation therapy is not effective as a primary treatment for kidney cancer. It is very rarely used alone to treat kidney cancer because of the damage it causes to the healthy kidney. Radiation therapy is used only if a patient cannot have surgery and, even then, usually only on areas where the cancer has spread and not the primary kidney tumor. Most often, radiation therapy is used when the cancer has spread to help ease symptoms, such as bone pain or swelling in the brain.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. For kidney cancer, internal radiation therapy is given using a hollow needle to insert radioactive seeds directly into a tumor.

Another type of radiation therapy is stereotactic radiosurgery, which is designed to direct the radiation therapy to a specific area without damaging nearby tissue. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Internal radiation therapy may cause some bleeding, infection, and risk of injury to nearby tissue. Most side effects go away soon after treatment is finished.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Interleukin-2 (IL-2) is a drug that has been used to treat later-stage kidney cancer. It is a cellular hormone called a cytokine that is produced by white blood cells and is important in immune system function, including the destruction of tumor cells.

High-dose IL-2 can cause severe side effects, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attack, bleeding, chills, and fever, so patients may need to stay in the hospital for up to 10 days during treatment. However, some symptoms may be reversible. Only centers with expertise in high-dose IL-2 for kidney cancer should recommend IL-2. Some centers use low-dose IL-2 because it has fewer side effects, although it is not as effective.

Alpha-interferon is another type of immunotherapy used to treat kidney cancer that has spread. Interferon appears to change the proteins on the surface of cancer cells and slow their growth. Although it has not proven to be as beneficial as IL-2, alpha-interferon has been shown to increase survival when compared with an older treatment called megestrol acetate.

Researchers have tested many combinations of IL-2 and alpha-interferon for patients with advanced kidney cancer, and these treatments have also been combined with chemotherapy. It has not been shown in research studies that these combinations are better than IL-2 or interferon alone.

Researchers are working to learn more about how IL-2 and interferon destroy kidney cancer cells and which patients can benefit the most from these treatments. Newer forms of immunotherapy called checkpoint inhibitors are also being tested in clinical trials .