In recent years, oncology as a branch of medicine has been developing rapidly, thanks in part to the emergence of new techniques that can successfully fight some types of cancer. These methods are described oncologist-surgeon of the highest category “SM-Clinic”, Ph.D. Dmitry Zinatulin.
— Dmitry Ravilevich, has the number of cancer patients requiring tumor removal changed in recent years? Today they often talk about the success of drug therapy, perhaps because of this, the need for oncosurgery is gradually decreasing?
“Unfortunately, in recent years there has been a steady increase in the number of cancer patients. For example, in 10 years the incidence of liver cancer has increased by 50%. This is a high figure. Despite the fact that the number of cases when cancer is detected at stages I-II remains quite low. That is, the number of patients requiring surgery is increasing. Indeed, the use of new types of drug therapy (for example, targeted, when the drug acts on the tumor “targeted”, or immunotherapy, when the patient’s immune system is “activated”) has made it possible to make cancer treatment more effective. But they did not replace surgery. Most often, we combine surgery with drug or radiation therapy.
— Have there been any new “breakthrough” technologies in oncosurgery, say, in two or three decades?
– Low-traumatic surgical techniques that do not require complex operations have begun to be actively used – for example, radiofrequency and microwave ablation of a tumor (exposure to a tumor with a high-frequency current). In a few minutes, the tumor is destroyed with a special electrode, which is inserted through a small puncture. This is an acceptable option for those patients whose body is weakened by the disease and for whom general anesthesia is contraindicated.
Or chemoembolization of the tumor. What it is? It is very important for any tumor to “eat”, receiving oxygen from the blood. If we block the blood flow in the vessel with special particles, the tumor begins to decrease in size. Such operations are performed using an angiograph – an X-ray machine, thanks to which the doctor can practically “see” the vessels on the screen.
Finally, the combination of surgery with hyperthermochemotherapy, which allows you to remove metastases scattered throughout the abdominal cavity.
– Please tell us more about the last method.
— The technique of hyperthermochemotherapy (the English abbreviation HIPEC) appeared in the 1980s. in the USA. Later, it began to be used in China, Japan, Israel, South Korea. In USA, it is still performed only in a few specialized clinics, in particular, in our Oncology Center, but the data that we receive after performing this type of therapy and that our foreign colleagues share in scientific publications, allow us to talk about the prospects of the method.
What is the principle of action of hyperthermochemotherapy? The fact is that with some types of cancer – I will not use complex terms, I will name ovarian cancer, stomach cancer, intestinal cancer known to everyone – metastases (secondary tumor foci) intensively spread throughout the abdominal cavity, resembling a kind of “nodules”, “grains”. There are usually a lot of them, and most of them do not exceed a few millimeters in size. Even a very experienced surgeon will not be able to remove them all in a few hours – he simply will not “catch” them with a scalpel. But if the metastases from the peritoneum are not removed, they will “sprout” in some vital organ – for example, in the lung or liver. And it will happen soon enough, in 5-6 months.
And then one day, oncologists discovered that if, after removing the tumor, the patient’s abdominal cavity was washed with a solution of chemotherapy drugs, this would also help to cope with metastases. But the breakthrough also consisted in the fact that they decided to heat the medicine to a temperature of + 42-43 ° C, at which malignant cells die. This enhanced the effect of HIPEC.
– What results can be achieved by the method?
– If earlier patients with metastases in the abdominal cavity lived for six months or a year, now it is 45 months or more. Some foreign scientists, for example, Israeli ones, even say that patients after surgery and HIPEC can live for ten years or more.
– How is this and other types of treatment prescribed?
– Treatment for an oncological patient is always prescribed by a council of doctors (oncologist, chemotherapist, surgeon). The patient undergoes an initial appointment, passes the necessary tests, and then “represents himself” to the oncoconsilium. At the SM-Clinic Oncology Center, the council is attended not only by doctors directly related to oncology, but also by specialists in other fields of medicine – for example, a general practitioner, a cardiologist, who can prescribe additional examinations to the patient in order to make sure that the heart can withstand anesthesia ( this matters, since some operations, in particular the operation to remove the tumor + HIPEC, can last 7, 8 even 10 hours, and metastases in the abdominal cavity appear at stage IV of the cancer, when the body is clearly weakened by the disease).
So during the examination, we evaluate the individual physiological characteristics of the patient’s body, weigh the risks and prescribe the best treatment option. This can be either traditional chemotherapy or a combination of surgery with chemotherapy (including HIPEC), a combination of surgery and radiation therapy, etc.
What happens after the patient leaves the clinic?
– It is very important that any patient does not stop in treatment, continues to fight the disease: regularly come to see an oncologist, be examined, take tests, and monitor their physical condition. All this greatly increases the chances of recovery. We aim for success in every patient. It is clear that not all types of cancer, especially those detected in the late stages, can be cured, but today we have the opportunity to prolong the life of the patient and significantly improve its quality. Together with our patients, we strive for this.
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License: LO 77-01-018779 dated 09/19/2019 (SM-Clinic LLC)