Diagnosis and Therapies for Metastatic Cancer

A member of Cancer Support Basel recently attended a seminar at the Radio-Oncology Department of the University Hospital in Basel, one of a series of lectures on different aspects of cancer and its treatment. A number of diagnostic methods and treatments were discussed for metastases of liver, colon, lung and breast cancer, including MRI, PET/CT scans, surgery, radiotherapy, systemic therapy (monoclonal antibodies and chemotherapy). She’s kindly written a short report, which is printed below.

University Hospital Lectures

As part of a series of lectures sponsored by the Department of Radio-oncology at the University Hospital of Basel, the seminar on June 26 focused on diagnostics and treatment of metastases and whether they are primarily for alleviation of symptoms or for healing.

A number of diagnostic methods and treatments were discussed for metastases of liver, colon, lung and breast cancer, including MRI, PET/CT scans, surgery, radiotherapy, systemic therapy (monoclonal antibodies and chemotherapy).
Prof. Dr. Zimmerman, Chief of Staff of the University Hospital of Basel Department of radiotherapy and radio-oncology welcomed the participants and introduced the evening’s agenda.

Case studies were used to demonstrate how the different therapies can be useful in the treatment process:

  • In the case of metastases in the vertebrae, there is a danger of compression of the nerves and the spinal cord and spinal surgery can provide the necessary support to prevent such compression.  Particular note was made for patients who demonstrate new neck or back pain that doesn’t go away in one or two weeks (especially those with a known tumour or over 60 years of age), or who are too tired or weak to get out of bed, or have weakness in their arms or legs.  The best prognosis occurs when the operation occurs soon after diagnosis.    Prof. Dr. med B Jeanneret, Spinal Surgery
  • The use of radiotherapeutic techniques have advanced considerably in the past years.  Using the example of liver metastases, a review of recent methods was provided., such as chemo-ablative techniques, where the removal of tumour material is performed by chemotherapy.   This method has been overtaken by other better methods, such as thermoablation  (for example, RFA (radiofrequency ablation).  In the case of liver metastases, where surgery is the standard treatment, RFA and other techniques are used where surgery is not an option.  Such techniques include SIRT (selective internal radiation therapy), which is particularly suitable where tumours are scattered throughout the organ.  The diagnostic role of MRI (magnetic resonance imaging) and, more recently, PET/CT (positron emission tomography combined with x-ray computer tomography), was highlighted.  Dr. med. Ch. Zech, Interventional Radiology
  • In the case of marker-oriented cancers, the seminar demonstrated the systemic treatment of KRas positive colon cancer, and on the various markers for breast cancer (HER2, estrogen and progesterone).  Outlining the three steps of systemic treatment of neo-adjuvant (normally pre-surgery), adjuvant (post-surgery) and palliative (after diagnosis of metastases), several possible chemotherapy and monoclonal antibody treatments were reviewed.  Bone metastases are often treated in a similar manner to osteoporosis, with bisphosphonates or a RANK inhibitor (Denosumab), calcium and Vitamin D.  Non-systemic therapies such as radiotherapy are also possible.  Dr. med. A.Wicki, Medical Oncology
  • For lung and liver metastases, surgery is often the chosen option, with a success rate of 68% survival rate for 10 years.  Stereotactic radiotherapy can provide an alternative to surgery.  Good planning is necessary, with exact targeting for location and dose.  In general, it is well tolerated and provides excellent results.  Dr. med. J. Winkler, Radiotherapy and Radio-oncology

Despite the advances of recent years, many of these treatments are not able to cure the cancer treated.  For breast cancer, a cure is possible during the neo-adjuvant and adjuvant phases, but not once metastases are found. The diagnostic techniques outlined in the case studies not only allow for early detection but also may provide guidance for a treatment option.   Newer techniques such as stereotactic radiotherapy can provide a cure, where none was previously possible.

Disclaimer:  The writer is not medically educated nor a native German speaker [the lectures are all given in German], so any information provided here should be treated with some caution.  If the article raises any questions about your situation, please discuss it directly with your doctor.

http://www.radioonkologiebasel.ch/welcome.html

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