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Immunotherapy; A Cancer Breakthrough

One of the biggest scientific discoveries in recent years, produces ‘Extraordinary’ results in Cancer patients.
Efficacy rates normally considered to be “unprecedented in medicine.” the technique is considered a new era for cancer treatment.
T-cell therapy shows promise for treating advanced disease, making Immunotherapy a ‘pillar’ of cancer care.Immunotherapy is a treatment that uses the immune system to work harder or smarter to attack cancer cells thus preventing growth and spreading of the cells.
Immunotherapy is a new dimension of the treatment of cancer with drug. Every day, millions of cancer cells occur in our body. Cells are available in the human’s immune system to defeat the cancer cells. The immune system acts immediately and destroys the cancer cells when it knows them. T-cells (T-lymphocytes) in the immune system fight with them. The T-cells fight against the cancer cells and try to destroy them. However, cancer cells, using their receptors, connect to the T-cells’ receptors and prevent their fight against them. Immunotherapy drugs prevent the T-cells and cancer cells from connection to each other by means of the receptors and allow the T-cells to carry out their missions. The purpose of immunotherapy is to strengthen the immune system, and thus, to let the body itself to defeat cancer.
-What is the difference from chemotherapy?
•Until now, 3 types of drug treatment were applied in respect with cancer. The first of these is the “cytotoxic” chemotherapy that kills the cancer cells (stereotaxic in cancer). The second is the hormonotherapy methods used for breaking the hormone mechanisms in cancer types such as breast and prostate cancers which develop secondary to the hormones. The third is the targeted treatment that has been used for the last 15 years and increasing gradually; the purpose in this treatment method is to block the mechanisms that develop and spread the cancer. The aim of immunotherapy is to strengthen the target, i.e. The immune system, and thus, to let the body itself to defeat cancer.
•They are different from each other as mechanisms. Chemotherapy kills the cells and immunotherapy strengthens the immune system.
•They have different side effects. Side effects such as hair loss, low blood level, nausea, and vomiting observed in chemotherapy are not observed in immunotherapy. Side effects of immunotherapy are the side effects that occur by stimulation of the immune system mostly.
•In order to apply chemotherapy, the patient’s performance should be good and the body should be functioned. Problem secondary to both the disease and chemotherapy should not harm the patient. Immunotherapy is effective also in patients with low performance. It can be provided even to the very exhausted and sluggish patients. It can be effective in them too.
-How is it made?
Immunotherapy drugs are infused from vessels via serum as in chemotherapy. However, it is comfortable than chemotherapy. It does not create any significant problem while it is applied.
-Who is suitable?
Immunotherapy drugs are not used in the early illness periods for now; it is used in patients with spread and metastasis. It can be used in patients in Stage IV. After all, the patient should be in the early period of Stage IV for the good results.
-In which cancer types is it used?
It is in trial period for many cancer types and gives hope. It is the most important drug for malign melanoma cancers. Chemotherapy has almost no efficacy in malign melanoma, however, immunotherapy is very effective. It is used in progressed diseases after chemotherapy as the first choice for the non-small cell lung cancer. Namely, chemotherapy is applied first and then immunotherapy drugs are given as the second choice when the disease is progressed. Its third area of use is renal cancers. Immunotherapy is used as a second choice when the targeted drugs are fail. Fourthly, it is used for lymph cancers (Hodgkin’s Disease).
-In which other cancers is it intended to use?
It gives hope for intestinal, bladder, gastric and breast cancers. It is still in research phase and not used.
-What kinds of side effects does it have?
Immunotherapy causes to side effects in relation with the immune system. These may cause to some symptoms on skin and diarrhea. It can have effects of inflammation of lung (non-germ pneumonia) and on the hormone system. For example, it may have effect on the thyroid gland and cause to slow or fast functioning of it. It may cause to adrenal insufficiency. Insufficiency of the pituitary gland may be observed. It may cause to fatigue and anorexia. Its side effects should be known very well and the patients should be followed up closely. Therefore, the medical oncologists applying immunotherapy should know when the drug will be discontinued or continued and should take precautions against them when these side effects occur. Not only the medical oncologists, also physicians in other branches such as pulmonology, endocrinology, gastroenterology should know how they will response when any side effect is observed. For example, using cortisone can save life when side effects are observed. Thus, the physician should know when they use cortisone.
-Is it in use in Turkey?
No drug is available in Turkey. Drugs can be supplied by special permissions. Payment problems are experienced. Because drugs are expensive. If immunotherapy drugs are used with proper treatment in the right people, applied with awareness than very successful results can be obtained.
-It is used for cancers in Stage IV.
-It strengthens the immune system and allows the body to fight against the disease.
-It is a long-term treatment.
-The purpose is to keep the disease under control. It is used to prevent the progression of disease.
-Responsive patients live for a long time.

What is Personalized Chemotherapy?

Personalized Chemotherapy is the next generation of cancer treatment, because instead of administering the classical way of drugs; we investigate the cellular and behavioral structure of your cancer first. Once we identify which drugs work best against your type of cancer in your body, we choose the best combination of drugs that will exactly hit your cancer cells with minimum side effects.

Of course, this requires very deep experience in different types of cancer cell behavior. As LIV Hospital, we are proud of having the most experienced and talented doctors with different expertise, who have been handling high number of cancer cases through a real multidisciplinary approach. As one of the leading reference hospitals in Europe, we have been curing thousands of such patients from different countries every year.

How often will I receive chemotherapy?

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

  • Your type of cancer and how advanced it is
  • The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
  • The type of chemotherapy
  • How your body reacts to chemotherapyYou may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you may receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

Why do I need chemotherapy?

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:

  • Make a tumor smaller before surgery or radiation therapy.
  • Destroy cancer cells that may remain after surgery or radiation therapy.
  • Help radiation therapy and biological therapy work better.
  • Destroy cancer cells that have come back or spread to other parts of your body.

As LIV Hospital, we make chemotherapy during your hospital stay, or while you visit us as an outpatient (which means you do not have to stay at the hospital). No matter how we do it, our doctors and nurses will watch you carefully for side effects and make any needed drug changes, in order to make your treatment correctly and with comfort.

Which Operations Can Be Done with Robotic Surgery?

Although the increasingly widespread use of robotic surgery over the past decade has been concentrated on urologic surgery, it is now being ever more widely used in general, gynecological and heart surgery.

What are the benefits of Robotic Surgery compared with traditional methods of surgery?

Some of the major benefits experienced by surgeons using the daVinci Robotic Surgery System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. daVinci Robotic Surgery System offers many potential benefits to patients facing surgery.

In addition to the classic advantages of laparoscopic surgery, the most significant benefits of robotic surgery are as follows:

  • LESS PAIN: Minimal trauma to the skin and muscle means much less post-operation pain and discomfort.
  • LOWER RISK OF INFECTION: Minimum contact between the abdominal organs and the air in the operating theater leads to a significantly lower risk of infection compared to open surgery.
  • SAFER SURGERY: 3-D and magnified images provide better vision and protection of the blood vessels and nerves. For example, blood loss during surgery is greatly reduced.
  • LESS SCARRING: With 1 -1.5 cm incisions compared to 20-25 cm incisions in open surgery, scarring is minimized.
  • FAST RECOVERY: Earlier post-operation mobilization and oral nutrition leads to the patient’s speedier recovery.
  • REDUCTION OF HOSPITALIZATION PERIODS: Most patients are discharged 3 or 4 days after surgery.
  • A FAST RETURN TO WORK AND DAILY LIFE: Patients return to normal life more rapidly due to more rapid recovery and healing.

What is Minimally Invasive Surgery (MIS)?

Minimally Invasive Surgery (MIS) is surgery typically performed through small incisions, or operating ports, rather than large incisions, resulting in potentially shorter recovery times, fewer complications, reduced hospitalization costs and reduced trauma to the patient. While MIS has become standard-of-care for particular surgical procedures, it has not been widely adopted for more complex or delicate procedures – for example, prostatectomy and mitral valve repair.

Will I lose my hair because of chemotherapy?

Hair loss occurs with some, but not all, chemotherapy drugs. The amount of hair loss varies from a slight thinning to complete baldness, affecting the scalp, eyelashes and eyebrows, legs, armpits, and pubic area. The loss may be gradual or sudden. Sometimes, all body hair may be lost. Keep in mind that hair loss is always temporary. Many people find that their hair starts growing back while they are still receiving chemotherapy. If you wish to purchase a wig, your nurse can provide you with a list of local suppliers. It is recommended that this be done prior to complete hair loss so that your wig can be matched to your natural hair.

Although hair loss (alopecia) is often difficult to deal with, it’s comforting to know that the hair will grow back, often thicker than before. Hair loss can occur on all parts of the body, not just the head. Usually hair loss will occur 2 to 3 weeks after chemotherapy or radiation therapy treatment begins. Once it starts, this loss will continue over a period of days to weeks. Re-growth can begin as soon as 6 to 8 weeks after treatments are completed.

What is Thrombocytopenia?

Thrombocytopenia means: Low platelet count.

Platelet (PLT) cells are the types of blood cells that help form blood clots. Platelet cells are made in the bone marrow and can be found in both the bone marrow and the circulating blood. Patients with certain types of cancer and those patients receiving chemotherapy or radiation may experience a reduction in the number of platelets in the circulating blood called thrombocytopenia. This condition may increase your risk of bruising and bleeding once your platelet count drops below 50,000 uL.

What is Anemia?

Anemia means: Low red blood cell count.

Red blood cells carry oxygen throughout your body. When there are too few red blood cells, you have anemia. Your body tissues don’t get enough oxygen to do their work, and you could feel very weak, tired or even experience dizziness, chills or shortness of breath. However, not fatigue is caused by anemia. The stress of chemotherapy or radiation therapy can also make you very tired and fatigued. If your counts are severely low, you may need a blood transfusion to boost your RBC count.

What can I do to prevent infections?

It is important to realize that there is nothing that YOU can do to prevent neutropenia / low white blood cell count that is caused by chemotherapy. There are medications that your doctor may prescribe to try to prevent this. However, there are several things that you can do to prevent infections when your white blood cells ale low and you are at high risk.

Know what to look for. The signs and symptoms of infection include the following:

  • fevers, chills of sweats
  • cough, mucous production, shortness of breath, or painful breathing
  • soreness or swelling in your mouth, ulcers or white patches in your mouth, or a change in the color of your gums
  • pain or burning with urination or an odor to your urine
  • change in the odor, character, or frequency of your stool, especially diarrhea
  • redness, pain or swelling in any area of your skin
  • redness, pain, or swelling in the area surrounding any in-dwelling catheter or port
  • pus or drainage from any open cut or sore or from any in-dwelling catheter or port

Maintain excellent personal hygiene

  • wash your hands frequently, especially before eating and after using the bathroom
  • use antiseptic mouthwashes (that contain no alcohol) daily
  • when menstruating, use sanitary napkins rather than tampons, which may promote infection in neutropenic patients
  • strictly follow the instructions given to you by your nurse about care for your in-dwelling catheter or port

Avoid situations that will increase your chance of getting an infection

  • stay away from people with colds or other infections and avoid crowds as much as possible
  • consider using an electric shaver rather than a razor when shaving to prevent cuts and breaks in the skin
  • use a soft toothbrush that won’t hurt your gums
  • do not take vaccinations unless they have been approved by your oncologist
  • wear sunscreen with a sun protection factor (SPF) of at least 15 and avoid getting sunburned
  • protect your hands from cuts and burns.
  • reschedule any dental work until your white blood cell counts improve
  • wash all fruits and vegetables thoroughly and eliminate uncooked foods from your diet, including:
    • cold soups, made from fresh fruits or vegetables
    • raw meats or fish salads
    • natural cheeses
    • uncooked eggs
    • sushi and sashimi

What is Neutropenia?

Neuropenia means: Low white blood cell count.

Because chemotherapy kills both cancerous cells and other normal cells that grow at a fast rate, white blood cells (WBC) we often destroyed along with the cancerous cells resulting in a condition of low WBC’s in the circulating blood called neutropenia.

Because white blood cells play an important role in preventing infection, any time your white blood cell count drops you are at higher risk of getting an infection. What’s more, as these cells also help to fight off infections once they are in the body, it is harder to get over an infection when your white counts are low, therefore, you must do everything that you can to decrease the chance that you will develop an infection while you are receiving chemotherapy.

Will my chemotherapy make me sick?

This too often depends on the specific chemotherapy you receive. It may not occur at all or may occur soon after treatment and may last 24-48 hours. A number of very effective medications called anti-emetics or anti-nausea drugs are now available to help lessen or prevent nausea and vomiting. These medications may be given to you intravenously during your chemotherapy, or you may be given a prescription medication to take at home. There are also several things that you can do to complement those treatment strategies.

  • Eat several small meals throughout the day rather than a few large ones.
  • Stay away from fatty, sweet or fried foods.
  • Eat foods cold or at room temperature.
  • Eat dry foods like cereal toast or crackers in the morning.
  • Wear loose fitting, comfortable clothing.
  • Always be sure to tell your doctor or nurse if you are experiencing nausea and or vomiting.

Is it true that I will feel tired after chemotherapy?

Most people who receive chemotherapy experience fatigue. Your daily activities should be planned according to how you feel. We suggest that you take rest periods throughout the day; as often as you feel necessary. Your nurse can suggest other rips to combat fatigue. There are several things that you can do to help yourself recover from this condition.

  • Take naps during the day and sleep more at night
  • Maintain your usual lifestyle activities, as much as possible, but pace activities according to your energy level. Plan on doing your most important activities first or when you feel your best .
  • Mild exercise such as walking, playing golf, swimming or stretching may actually increase your feelings of energy. Heavy exercise, however, generally should be avoided.
  • Eat a well balanced diet. Good nutrition will help with your energy level.
  • Additional protein will help normal cells to repair themselves.
  • Ask family member and friends to pitch in with daily duties and obligations.

How is my chemotherapy scheduled?

Your schedule is determined by the specific treatment ordered by our doctors at LIV Cancer Center. Depending on how available your medical condition is, you may have to be seen weekly or perhaps even daily for a period if your blood counts are low.

Is it true radiation is always used with chemotherapy and/or surgery?

Although some types of cancer respond best to combination treatment approaches, which may include radiation plus surgery, chemotherapy, or immunotherapy, radiation therapy alone is often an effective treatment for some types of cancer.

Should a person having radiation therapy avoid physical contact with friends and family because of possible radioactivity?

External-beam radiation therapy does not make a person radioactive at any time. The radiation is delivered to the body from a machine located in the treatment room so there is no radiation left behind once the treatment machine is turned off. However, with internal radiation therapy (also called brachytherapy), the implants placed in the patient’s body deliver most of the radiation to the cancer, but some radiation can be emitted (released). Therefore, people who receive internal radiation therapy need to take specific precautions for a period of time to reduce others’ exposure to the radiation.

Does radiation treatment make a person lose his or her hair?

Radiation therapy is a local treatment, meaning it only affects the area of the body where the tumor is located. People do not lose their hair from having radiation therapy unless it is aimed at a part of the body that grows hair, such as the scalp.

Does radiation therapy cause infertility?

Radiation therapy to the pelvic area can affect the reproductive system. For some women, permanent infertility (the inability to conceive a child or maintain a pregnancy) can occur, but usually only if both ovaries receive radiation. Men receiving radiation therapy to the testes or to nearby organs, such as the prostate, will have lowered sperm counts and reduced sperm activity, which affects fertility (the ability to father a child).

Do all patients experience the same side effects of radiation therapy?

For some people, radiation therapy causes few or no side effects. For others, the side effects are more severe. No two cancers and no two patients are exactly alike; therefore, each radiation treatment is individually customized by the radiation oncologist. If a side effect occurs, it is often during the second or third week of treatment and may last for several weeks after the final radiation treatment. Your radiation treatment team will work with you to ease or prevent many of these side effects.

Is radiation therapy painful?

Most people cannot feel radiation from the machine, even during daily treatments, so there is no need to worry that a treatment session will be painful. A few people have reported a slight warming or tingling sensation in the area being treated.

What is the goal of radiation therapy?

Most people receive radiation therapy in an effort to eliminate all cancer cells as part of a curative treatment approach. In addition to destroying cancer cells and slowing tumor growth, radiation therapy can also be used to shrink tumors and reduce pressure, pain, and other symptoms of cancer in cases when it is not possible to completely eliminate the disease. This is called palliative radiation therapy, in which the goal is to improve a person’s quality of life.

Will radiation therapy cause another cancer?

Having radiation therapy slightly increases the risk of developing a second cancer. However, it is important to remember that, for many people, radiation therapy can eliminate the current, existing cancer. This benefit far outweighs the small risk that the treatment could cause a new cancer later in life.