Medical oncology is one of the major cancer treatment modalities, and it uses systemic treatment approaches, such as Chemotherapy, Immunotherapy, Targeted Therapy and Hormonal Therapy to manage cancer effectively. These systemic therapies help destroy cancer cells present throughout the body. They are often administered in combination with other treatment modalities like surgery and radiation therapy for best clinical outcomes among the patients.

The experts from our medical oncology department at HCG work towards the prevention, screening, diagnosis and treatment for a wide range of cancers through cutting-edge technology and personalised multimodal treatment protocols.

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Apart from inpatient chemotherapy facilities, the department has also made outpatient and ambulatory chemotherapy facilities available for patients via specialised chemoports. Our medical oncologists are skilled and experienced to manage both solid tumours and haematological disorders whilst preserving the quality of life among both adult and paediatric patients.

Chemotherapy

Chemotherapy is a cancer treatment approach under medical oncology and it uses powerful drugs to find and destroy cancer cells throughout the body. Chemotherapy works by stopping or slowing the growth of body cells that divide and grow rapidly, which include cancer cells as well.

However, chemotherapy can also damage rapidly dividing healthy cells, such as those in the lining of the mouth and intestine and hair follicles. This may cause a few mild to moderate side effects among patients during and for a short period after the treatment. Usually, these side effects wear off with time. However, in a few cases where the side effects are severe, oncologists recommend medications to manage them.

Chemotherapy is categorised into two types based on the time it is administered:

• Neoadjuvant chemotherapy and adjuvant chemotherapy. Neoadjuvant chemotherapy is administered before the radiation therapy or surgery. Neoadjuvant chemotherapy may help in downstaging the disease, enhancing the patient’s tolerance and response to the surgery or radiation therapy, reducing the recurrence rates and improving the overall survival rates.
• Adjuvant chemotherapy, on the other hand, is administered after surgery or radiation therapy. Adjuvant chemotherapy helps reduce the risk of recurrence and improve the chances of a positive clinical outcome.

Apart from preventing recurrence, chemotherapy is also helpful in preventing cancer from spreading to other organs (metastasis). Initially, there were few chemotherapy drugs only; however, there are several 1st, 2nd and 3rd line drugs today that are not only showing excellent results but also come with less severe side effects.

In recent times, oncologists are also adopting innovative chemotherapy approaches such as metronomic chemotherapy, wherein chemo drugs are administered in low doses over a long period; this approach is being used for patients who cannot tolerate high dose chemotherapy sessions.

Immunotherapy

Immunotherapy, which is also known as biological therapy, is a personalised treatment approach, wherein the body’s immune cells are stimulated to launch an attack against cancer cells. In other words, immunotherapy stimulates the body’s natural defence system to combat and destroy cancer cells. Immunotherapy either employs the body’s immune cells or modified immune cells synthesised in the laboratory to boost the immune response against cancer.

Immunotherapy works against cancer through multiple mechanisms:

• Stimulating the immune system to recognise and attack cancer cells
• Triggering immune cells to kill cancer cells through complex immunological mechanisms
• Administering specialised components that enhance the immune response against cancer cells

Various personalised approaches are used to reprogram the immune system among cancer patients:

1. Monoclonal Antibody Therapy: Monoclonal antibodies are lab-generated antibodies that could work by blocking the division of cancer cells or triggering the immune system to attack and kill cancer cells.

Checkpoint inhibitors are a special class of monoclonal antibodies that work by blocking the proteins, which stop the immune system from acting against cancer cells.

2. Dendritic Cell Therapy: During this procedure, the dendritic cells are extracted from the patient’s body and are reengineered in the laboratory. Later, these modified dendritic cells are injected back into the patient’s body. Upon entering the immune system, these modified cells launch an attack on cancer cells and kill them.

3. T-cell Therapy: T-cell therapy involves modified T-cell, which is one of the immune cell types. The T-cells are extracted, modified and injected back to the patient’s body where they target and destroy cancer cells.

4. Oncolytic Virus Therapy: Oncolytic virus therapy is another form of immunotherapy wherein a special type of virus is injected into the body of the cancer patient. These viruses kill cancer cells without harming the healthy cells.

5. Cytokine Therapy/ Immune System Modulators: Cytokines are a group of special proteins that can stimulate the immune system against cancer by regulating the growth and division of cancer cells or triggering immune cells to attack the cancer cells. Cytokines also trigger the cancer cells to produce chemicals that attract the immune cells to find and attack them.

6. Cancer Vaccine: Cancer vaccines are used for both the prevention and treatment of cancer. These vaccines may contain dead cancer cells or protein components from cancer cells. Cancer vaccines work by triggering the immune system to produce antibodies against cancer cells.

Targeted Therapy

Targeted therapy is a form of precision cancer treatment under medical oncology. Before administering the targeted therapy, a thorough assessment of the tumour microenvironment is performed. Studying the tumour microenvironment helps oncologists understand the tumour behaviour and accordingly plan the treatment. As the name says, targeted therapy targets specific proteins that are responsible for the growth, development and spreading of cancer cells and regulate their growth.

Targeted therapy attacks cancer cells via multiple mechanisms:

• It may block the chemical signals that are responsible for the growth and multiplication of cancer cells
• It may change the proteins in cancer cells and lead to their death
• It may also block the production of new blood vessels and thereby stop feeding the cancer cells
• Targeted therapy may stimulate the immune system to launch an attack against cancer cells
• It may deliver toxins to cancer cells to destroy them while sparing the healthy cells.

Hormone Therapy

A few cancers need hormones to grow or multiply – these cancers are either called hormone-dependent or hormone-sensitive cancers.

Hormone therapy uses specific drugs to block certain hormones or reduce their levels in the body to stop the growth of cancer cells or delay the disease progression. Just like other systemic therapies, hormone therapy is combined with other treatment modalities like surgery or radiation therapy. This helps in enhancing the overall effectiveness of the treatment given.

Following are the cancers that can be treated with hormone therapy:

• Breast Cancer
• Prostate Cancer
• Ovarian Cancer
• Uterine Cancer (also called Endometrial Cancer)

Frequently Asked Questions

1. How will I know if the chemo is working?

When you are undergoing chemotherapy or any other cancer treatment, it is normal for your treating doctor to monitor how your body is responding to the treatment. There are several tests that oncologists use to study the treatment response and the main ones include blood tests, physical examination and imaging methods like X-rays, MRI, PET CT, etc.

These tests will help both the doctors and patients know whether or not the treatment is working. Based on the observations, your treating doctor may modify your treatment plan for better results.

2. How long after chemo does my body get back to normal?

It takes from 9 – 12 months for a patient to completely recover from the after-effects of chemotherapy. For improved treatment response and faster recovery, oncologists often recommend rehabilitation programmes for cancer patients. These rehabilitation programmes comprise yoga therapy, physiotherapy, diet counselling, psychological counselling, etc., all of which holistically heal the ill effects of the treatment and help you bounce back to normal life as early as possible.

3. Will I be able to work during chemotherapy, immunotherapy, targeted therapy, etc?

Medical oncology is a lot more advanced than it was before. Today, treatments like chemotherapy, immunotherapy and targeted therapy cause minimal disruption to routine activities of the patients, be it domestic chores or a desk job. However, a few patients may experience treatment-related after-effects, such as tiredness, loss of appetite, nausea, etc., and this might make it difficult for them to take part in day-to-day activities.

In these cases, patients can opt for alternate options, such as work-from-home, hiring assistance, taking it slow, etc. It is important for the patients to know that, in most cases, this is a temporary phase and the patients will be able to perform their routine activities without much help as time passes.

4. Which is better – chemotherapy or targeted therapy?

This entirely depends on the type, stage, location of your cancer and your overall health condition. For a few cancers, chemotherapy works the best and for a few, it is targeted therapy.

Most importantly, each patient and his/her response to the treatment is as unique as type of cancer itself. Therefore, before recommending chemotherapy, immunotherapy or any other treatment, your treating doctor will carefully assess multiple parameters and then recommend the best suitable treatment plan for you.

5. Can I drive while I am undergoing immunotherapy?

Unless your doctor asks you not to, you can drive yourself back and forth to the hospital. However, we recommend you to have your caregiver accompany you, who will be able to assist you with the formalities and stay beside you as you undergo your treatments.

6. What to do when treatment-related side effects are severe?

Patients usually experience mild to moderate side effects while undergoing their cancer treatments. These side effects can be managed with nutritious food, ample rest and gentle exercises. However, in rare cases, patients might find it hard to manage these side effects without medical attention. In such cases, patients should get in touch with their treating doctors or the expert team, who will prescribe medication to manage these symptoms.