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DEPARTMENT OF
HEMATO-MEDICAL
ONCOLOGY |
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| Medical oncology is the
youngest of the three modalities used in cancer
care. Previously, radiation oncologists and
surgeons used to carry out administration of
chemotherapy. However, with rapid progress in the
field, the specialty has carved out an important
place and demands that dedicated qualified medical
oncology consultants perform administration of
chemotherapy to achieve the best results in terms
of cancer cure while minimizing the toxicity of
treatment. |
| Department of Hemato-medical
Oncology at DCHRC provides state-of-the-art
services in the management of cancer patients
through the use of chemotherapy and allied drugs.
The Department is serviced by full time highly
trained and dedicated medical oncologists who
focus solely on cancer management. |
| The Department has expertise
in the management of hematological malignancies
such as acute and chronic leukemias, lymphomas,
multiple myelomas and all solid
cancers. |
| With rapid advances taking
place in the field, the consultants in the
Department have been regularly participating in
National and International cancer conferences and are also
involved in multicentric global clinical trials to
give the benefit of latest advances to their
patients. The medical oncologists in the
Department have been pioneering the use of newer
molecules, new drug combinations, and, newer
methods of administration of chemotherapy in the
country. |
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MEDICAL ONCOLOGY INFRASTRUCTURE AT
DCHRC |
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 Day care center |
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| DCHRC has been using the day
care concept for administration of single and
multi-drug infusional chemotherapy from the
inception. Day care chemotherapy has the advantage
of avoiding disruption in the day to day life of
cancer patients and their families while
minimizing treatment costs. Two separate types of
day care beds (single room and shared) are
available at DCHRC for catering to the differing
needs of patients. |
| Dedicated Leukemia / Neutropenia
Wing |
| Dedicated leukemia /
neutropenia wing caters to the special needs of
these patients who are at a high risk of
developing infections. Separation from other
patients, double barrier nursing, HEPA filters,
microwaved food and other precautions to minimize
the chances of infection in these patients lead to
a faster recovery and improved outcome while
containing treatment costs. |
| Super Deluxe, deluxe, single, double and
semi paying beds. |
| All types of in-patient
accommodation are available that provide
comfortable and pleasing stay to the patients and
relatives. In combination with efficient and
courteous nursing and other staff, the objective
is to make the patient "feel at
home". |
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Intensive care unit |
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Fully equipped intensive care
unit with latest monitoring and therapeutic
facilities to cater to critically ill patients. |
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Blood Bank equipped with Blood Cell Separator
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In house blood bank is a
necessity for any medical oncology service. In
addition, a blood cell separator is very useful. It
provides facilities for single donor platelet
transfusions (donor donates only platelets and not
whole blood) and stem cell harvesting from
peripheral blood. |
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| Electronic and elastomeric pumps for
continuous infusion of chemotherapy
drugs. |
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PATIENT INFORMATION |
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| What is medical
oncology? |
| Medial oncology is the
youngest branch of oncology and it deals with
treatment of cancer using medicines and is also
the most rapidly developing branch with new
breakthroughs coming almost every
day. |
| The specialty primarily
originated from the identification of cytotoxic
chemicals developed as part of chemical warfare.
The "mustard" gases developed around World War II
were found to be strongly cytotoxic to human
beings with very strong effects on the
hematopoietic system. It was this observation that
led to attempts to use these agents and their
derivatives in hematological malignancies first
and solid cancers later. |
| With intensive drug discovery
programs undertaken by many government agencies in
USA and multinational pharmaceutical corporations,
the super specialty first grew in USA. Medical
Oncology has taken a major leap and now forms a
very important part of multimodality management of
almost all cancers and specially hematological
malignancies. |
| Initially developed for the
administration of cytotoxic agents, the specialty
has expanded its scope remarkably with newer
agents that use many different mechanisms to treat
cancer. |
| What is the role of medical oncology in
treatment of cancer? |
| 1. Haematologic malignancies
such as leukemias (blood cancers), lymphoma and
multiple myeloma are treated primarily with
medicines. |
| 2. Some of the solid cancers
are potentially curable with chemotherapy.
Examples of this include germ cell tumors and
gestational trophoblastic disease. In such cases,
chemotherapy has become the prime modality of
treatment and may be complemented by limited
surgery. |
| 3. Adjuvant chemotherapy has
become an important modality in the treatment of
many solid cancers such as breast cancer,
colorectal cancer, etc. Adjuvant use of
chemotherapy is based on the concept of
micrometastases that can not be identified with
any current imaging modalities but are responsible
for the majority of recurrences after potentially
curative local therapy. |
| 4. Neoadjuvant chemotherapy
is chemotherapy administered up front to achieve
downstaging of tumor, before use of a local
modality such as surgery or radiation. Neoadjuvant
chemotherapy can be used to make the disease
operable if it was inoperable before or permit the
use of limited local therapy. In breast cancer,
neoadjuvant chemotherapy can be used in locally
advanced breast cancer to make the tumors
operable. In early disease, it is used to increase
the chances of breast conservation
surgery. Recently Organ preservation surgery
is the target. This can be achieved by
Neo-adjuvant chemotherapy |
| 5. In a number of situations,
chemotherapy and radiotherapy are being used at
the same time (not one after another) to treat
malignancies. Chemotherapy here serves to enhance
the efficacy of radiation and thus lead to
improved loco-regional control rates. In some
cases, this approach permits the use of organ
conservation strategies. This has been used
adequately at DCHRC for cancer sites like head and
neck cancers, cervix, lung and oesophagd.
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| 6. Palliative chemotherapy is
a very important modality to improve the quality
of life of a large proportion of cancer patients
who present with advanced disease that is not
amenable to curative treatment with surgery and/or
radiotherapy. Here, chemotherapy can improve
distressing symptoms and also lead to some
prolongation of survival with good quality of
life. |
| What are the medicines used in medical
oncology? |
 Cytotoxic
chemotherapy |
| Conventional chemotherapy
drugs that kill dividing (Replicating) cells in the body. Since
cancer cells are almost always rapidly dividing,
they are preferentially killed. |
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Hormones and hormone
antagonists |
| Hormonal
antagonists and agonists have been very useful in
the management of breast cancer in women and
prostate cancer in men. A number of exciting new
agents are becoming available that are enhancing
the role of such
interventions. |
| High
dose chemotherapy |
| High dose
chemotherapy is the use of more than the standard
doses of chemotherapy and it is used in the
management of more aggressive, relapsed, or
advanced cancers that are often non-responsive to
standard dose of chemotherapy. |
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Biological agents e.g. interferons, interleukins,
etc |
| A number
of biological agents such as interferons and
interleukins have been found to have activity
against some cancers. These agents have been
particularly useful in the management of chronic
myeloid leukemia, cancer of the kidney,
superficial bladder cancers (follicular),
non-Hodgkin lymphoma (follicular), Hairy cell
leukemia, etc. |
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Immunotherapy: monoclonal
antibodies. |
| A
promising new field where exciting advances are
taking place. Two monoclonal antibodies are
currently available in the country (Trastuzumab or
Herceptin for breast cancer, and rituximab or
Mabthera for hematological
maligancies). Radio labeled monoclonal
antibodies for Acurate Leukemias, Lymphomas etc. |
| Gene
therapy |
| Gene
mutations are at the root of all cancers.
Interventions at the genetic level are thus very
attractive. Lot of research work has been going on
and some products are expected to come into
clinical practice soon. |
| Signal
transduction inhibitors (Target Therapy) |
| Drugs
such as tyrosine kinase inhibitors, anti
angiogenesis drugs, farnesyl transferase
inhibitors, etc are very tempting because they
have the promise of being effective with oral
administration and have negligible systemic
toxicity. One of the top success stories is a new
drug Gleevac (Imatinib) that has shown very high
efficacy in chronic myeloid leukemia in all phases
of disease. Newer products are expected to be
available soon for a variety of
cancers. e.g. Gleevac, Isserra, Terceva |
| Vascular access devices (ports /
central lines). |
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Arterial and Venous Pumps (elastomeric and / or
electronic pumps). |
| Growth
factors to take care of low blood counts (febrile
neutropenia). |
| Blood
component therapy including single donor
platelets. |
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Chemo-protectors |
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