Medical Oncology

Chemotherapy

The role of Chemotherapy is to cure or control cancer, and can also be given as palliative chemotherapy. Chemotherapy is usually administered over a set period of time in order for it to be effective. Your attending oncologist will plan a chemotherapy protocol and outline when and for how long you will receive your chemotherapy. Chemotherapy protocols are varied, depending on the type and stages of cancer. Before your chemotherapy starts, you will need to have a blood test and physical assessment to ensure you are fit and will be able to cope with any side effects.

Chemotherapy is usually delivered intravenously. It can also be delivered directly into various cavities in the body (e.g. Intra-peritoneally, intraventricularly). Some chemotherapy can also be given topically and orally.

Sometimes chemotherapy is the only treatment you need. More often, chemo is used with surgery or radiation therapy or both. Here’s why:

• Nipple tenderness or a lump or thickening in or near the breast or underarm area
• Chemo may be used to shrink a tumour before surgery or radiation therapy. Chemo used in this way is called neoadjuvant therapy.
• It may be used after surgery or radiation therapy to help kill any remaining cancer cells. Chemo used in this way is called adjuvant therapy.
• It may be used with other treatments if your cancer comes back.

At Sunway Medical Centre, we have a dedicated CDR laboratory, staffed with trained pharmacy technicians to prepare chemotherapy drugs for our patients.

Targeted Therapy

Recent advances in the understanding of how cancer cells grow and metastasis has led to the development of new drugs that specifically target the cancer cells without causing undue damage to the normal cells in the body. This new drug can be used on its own or combined with conventional chemotherapy.

Target therapy drugs specifically block certain receptors or proteins that control the growth or proliferation of cancer cells. Example includes drugs that block the EGFR (Epidermal Growth Factor Receptor) like gefitinib, cetuximab and others, which are rapidly being developed and used by oncologists.

Targeted therapy is a special type of chemotherapy that takes advantage of differences between normal cells and cancer cells. It’s sometimes used alone, but most often other cancer treatments are used with targeted therapy.

Targeted drugs can be used as the main treatment for some cancers, but in most cases they’re used with other treatments such as chemo, surgery, and/or radiation therapy.

Targeted drugs can work to:

• Block or turn off chemical signals that help cancer cells to grow and divide
• Change proteins within the cancer cells so the cells die
• Stop making new blood vessels to feed the cancer cells
• Trigger immune system to kill the cancer cells
• Carry toxins to the cancer cells to kill them, but not normal cells

Hormone Therapy

Hormones are substances produced to help regulate and coordinate growth, metabolism and reproduction of our body. Prostate and breast cancer depend on hormones to grow. To slow down or stop the growth and spread of cancer cells, Hormone Therapy is used to block or remove hormones they need.

The treatment may consist of taking medication to suppress the production of certain hormones. Examples of hormone therapy include drugs like Tamoxifen, Anastrozloe, Letrozole and others. In other cases, surgery may be required to remove the gland that produces hormones. Hormone Therapy is often used in combination with other treatments such as chemotherapy, radiation therapy or after surgery.

Hormone therapy is a form of systemic therapy, meaning it reaches cancer cells almost anywhere in the body and not just in the breast. It's recommended for women with hormone receptor-positive (ER-positive and/or PR-positive) breast cancers, and it does not help women whose tumours are hormone receptor-negative (both ER- and PR-negative).

Hormone therapy is often used after surgery (as adjuvant therapy) to help reduce the risk of the cancer coming back. Sometimes it is started before surgery (as neoadjuvant therapy) as well. It is usually taken for at least 5 years.

Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.