It used to be that the cancer doctor’s toolbox contained three essential tools — a scalpel to cut out the disease, chemo to poison it and radiation to zap it.
But today that toolbox is bulging with new and better weapons.
"We're living in an era in which we are able to look at cancer in ways we've never been able to look at it before," said Dr. Peter Rosen, research director at the Disney Family Cancer Center at Providence Saint Joseph Medical Center in Burbank. "In some cases, the results have been almost miraculous."
Radiation can be completed faster than ever — sometimes before a patient awakens from surgery. Intraoperative radiotherapy, or IORT, can deliver a single high dose of radiation to the site of a woman's breast tumor while she is still under anesthesia.
The results are just as good as with radiotherapy that lasts several weeks, said Dr. Dennis Holmes, medical director of the new Los Angeles Center for Women's Health at California Hospital Medical Center in downtown Los Angeles.
Ideal candidates for IORT are women with tumors no bigger than a nickel, with no lymph node involvement.
At Providence Saint Joseph Medical Center in Burbank, women with early-stage breast cancer can complete a course of radiation in just five days, thanks to a treatment known as SAVI. This therapy uses multiple catheters — an improvement over single-catheter systems that are difficult to tailor to a woman’s individual anatomy.
And there's good news on the prostate cancer front. Men with localized disease can now complete radiation in just two weeks, with no surgery. Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to targeted areas in just five sessions on alternate days.
"The beauty of SBRT is that it's pretty much an entirely noninvasive approach to prostate cancer," said Dr. Christopher King, a radiation oncologist at Ronald Reagan UCLA Medical Center.
Meanwhile, a new hormone therapy called Zytiga is extending the lives of men with advanced prostate cancer. Genotyping, also known as "molecular fingerprinting," is giving rise to targeted biologic therapies that offer new hope.
"Historically, cancer was treated — and still is treated — with surgical removal, radiation and chemotherapy. While they remain important, new drugs exemplify the emerging molecular approach to treating cancer," Rosen said.
An oral agent called Zelboraf extends the lives of people with inoperable or late-stage melanoma who test positive for a specific genetic mutation. For lung cancer patients with particular mutations, the drugs Tarceva and Crizotnib "can produce quite astounding benefits," Rosen said.
In the battle against glioblastoma, the most common and deadly type of brain tumor, "we have made some important advances in the last 10 years," said Dr. Rose Lai of the Brain and Spine Tumor Center at USC Norris Cancer Hospital.
Among the newest therapies are a vaccine called CDX-110 and a biologic agent called Avastin. But one of the most exciting developments for people with this aggressive form of cancer is a portable battery-operated device worn as a tight-fitting helmet on the head. Developed by an Israeli firm, the NovoTTF delivers alternating electric fields to cancer cells by means of insulated electrodes worn on the scalp, under a white cap. The helmet stunts the growth of tumor cells in patients with reoccurring or progressive brain cancers, without nasty side effects, Lai said.
“It sounds like science fiction, but it’s approved — it’s here,” she said.
The Power of Positive Thinking
Particularly for women with breast cancer, there's a growing awareness among oncologists of the importance of self-image in the recovery process. A rapidly growing field called oncoplastic surgery seeks not only to preserve the appearance of a woman's breasts but to "even improve them sometimes," Holmes said. For women with breasts that are asymmetrical, saggy or too large, a properly trained oncoplastic surgeon can perform cosmetic work in conjunction with cancer removal, Holmes said.
"The goal is not just to get the cancer out, but to help a woman feel physically whole and remain physically desirable," Holmes said.
A Nurturing Environment
Cancer centers such as those at Providence Saint Joseph and California Hospital Medical Center are no longer sterile and white-walled dens of sadness and despair. At the Disney Family Cancer Center, patients can mellow out with mood lighting and their choice of music and images projected on curved walls. At the Los Angeles Center for Women’s Health, a “patient navigator” helps take care of little tasks that can bedevil a woman’s life after surgery, like making sure that the fridge is stocked with fresh food and the bedroom closet has plenty of clean clothes that are easy to put on and take off. These innovations demonstrate that cancer centers are increasingly aware of the importance of environment in treating cancer.