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Hani Gabra
Co-Founder, Board Member and Chief Scientific Officer at Papyrus Therapeutics Inc; Consultant Medical Oncologist, Portsmouth Hospitals University NHS Trust; Professor Emeritus in Medical Oncology, Imperial College London
Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LY- www.imperial.ac.uk
13 years, 8 months ago
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Cancer treatment may be hazardous for pregnant women, but that hazard is principally related to the first trimester of pregnancy. It is not uncommon for patients in their second and third trimesters of pregnancy to safely receive chemotherapy and for the cancer and then go on and have a perfectly safe pregnancy.
Cancer treatment does not have to impair fertility. Indeed, for most women and men who receive chemotherapy there is no impact on fertility, especially if you are younger.
The future of cancer therapy is that no one should die or suffer from this disease. For some, this will be enhanced cure rates and for others, it will be the normalization of the word cancer to that simply of a chronic disease like diabetes and high blood pressure. You will not have to fear cancer, but file it in the background and get on with the rest of your lives.
Hair loss with chemotherapy is emotionally difficult for patients. However, most chemotherapy drugs may not cause hair loss. Even in those that do, one can use something called a cold cap to prevent hair loss from happening. The reason chemotherapy causes hair loss is because the chemotherapy drugs travelling in the bloodstream can affect hair roots and inhibit hair follicles from dividing; thereby causing hair loss. The cold cap uses the cold to switch off the blood vessels to the scalp. This diverts the chemotherapy agents away from the hair roots and therefore for many people there is no hair loss that follows from chemotherapy
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WHAT ARE THE THREE MOST IMPORTANT BREAKTHROUGHS IN CANCER THERAPY?
The three most important breakthroughs in cancer therapy are difficult to state because there have been so many advances over time. However, if I were to choose three, they would be for different reasons.
The first that I would choose is the transformation of the prognosis of breast cancer, which has been achieved not only through research, but through the political will of governments and lobby organizations to provide funding for research, almost in a space-program type way. This has demonstrated how you can really fix a problem if you throw enough money at it. We have seen dramatic improvements in breast cancer survival artes, despite rising incidence rates of the disease.
The second example I would choose is bowel cancer. Bowel cancer used to be an extremely poor prognosis and have a very poor outlook. For no other disease have we seen such incorporation of biological therapies into a disease, which has truly transformed bowel cancer’s outcome. In particular, it is an example of a very difficult thing called metastasis, which has been successfully dealt with and cured.
Metastasis means more than one cancerous tumour and describes when a tumour spreads to non adjacent tissue.
The third example I would choose is a rare and very bad outlook disease called GIST: gastrointestinal stromal tumors. These tumors use to have a very bad prognosis. The reason I choose GIST as a major advance is because of the fact that we have completely understood the biology of GISTs and this has transformed their prognosis. Using a single biotherapy drug called Gleevec has shown the way to the future and what research can achieve.
Gleevec represents a new class of cancer drugs and a new way of thinking about cancer. These molecularly targeted drugs are different because they target abnormal proteins that are fundamental to the cancer itself.
Each year, approximately 3,300 to 6,000 adults in the United States will be diagnosed with a GIST. GISTs belong to a group of cancers called soft tissue sarcoma. Soft tissue sarcomas are a group of cancers that develop in the tissues that support and connect the body, and the sarcoma cells resemble the cells that hold the body together, including fat cells, muscles, nerves, tendons, joints, blood vessels, or lymph vessels. The most common locations in the body are in the stomach. GIST is a type of tumor that occurs in the gastrointestinal or digestive tract, including the esophagus, stomach, gallbladder, liver, small intestine, colon, rectum, and lining of the gut. GISTs are different from other types of gastrointestinal tumors because of the type of tissue in which they start
Radiotherapy is an important treatment for cancer. It is one of the most common used and consists of giving high energy Xrays directly to a tumor. The Xray beams are shaped to hit the tumor and not the adjacent tissue. The Xrays kills the cancerous tissue by affecting the DNA of the cancer directly. Radiotherapy is an essential treatment for many cancers.
Many cancers are driven by hormones in the body. For instance, breast, prostate and uterine cancers. Over the years we have developed effective blockers of hormones that drive these cancers. These blockers have found a way into common usage, particularly in breast and prostate cancers.
Biological therapies are treatments that are gaining importance as we progress globally with the management of cancer. Understanding the biology of cancer has enabled us to understand the targets that go wrong in those cancers. We have successfully used many biological treatments that hit directly those targets in order to inhibit or switch-off the cancers. These biological therapies may be useful on their own or more commonly, combined with standard cancer treatment such as chemotherapy, surgery and radiotherapy.
Organ transplant is almost never associated with cancer. The reason for this is that, in the main, you cannot be sure that a cancer is completely cured until many years after diagnosis. In addition, organ transplantation carries many hazards including deliberate immonosuppression of the patient, which is associated with cancer risk.
Deliberately induced immunosuppression is generally done to prevent the body from rejecting and organ transplant.
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Usually cancers which are diagnosed early have excellent survival rates. Patients are often cured when an early cancer is diagnosed and a multimodality therapy is given. However, there are types of cancer, which have exquisite response rates and where cure is the rule. These include diseases such as testicular cancer, lymphoma, choriocarcinoma, early cancer of the bowel and gut and even early ovarian cancer. Often patients are cured of these diseases.
Testicular Cancer Men who have a type of testicular cancer called seminoma have a very good chance of being cured. Since the introduction of combination chemotherapy in the 1970s, survival crates for testicular cancer have risen every year to cure rates of over 95 percent. The percentage of men who recover from early-stage testicular cancer is getting close to 100 percent.
Non Hodgkin's Lymphoma (NHL) Fifty one out of every 100 people (51percent) diagnosed in England and Wales with all types of NHL will live for at least 10 years. However, outcome of non Hodgkin’s lymphoma depends partly on how advanced it is when it is diagnosed.
Bowel Cancer If diagnosed early, over 90 percent of bowel cancer cases can be treated successfully.
