Treatments & Therapy for Cancer: Dr. Ullas Batra

Treatments & Therapy for Cancer: Dr. Ullas Batra. Famhealth asked Dr. Ullas Batra, Senior Consultant, Medical Oncologist, Rajiv Gandhi Cancer Institute (Delhi) some frequently asked questions on cancer.

According to Dr Batra cancer treatment and therapy has to be specific to the patient, the placement and the stage of cancer, so consulting your oncologist is the best way forward.

Q: Do Targeted and Immunotherapy work on Stomach Cancer?
A: Both targeted and immunotherapy work on stomach cancer, although the magnitude of their effect is lesser than Lung Cancer. The advancement in drugs makes selection of targets more specific in cancer of the lung when using targeted therapy.

Q: Which medicine is better for Lung Cancer ? Alectinib or Crizotinib?
A: These are medicines for Stage 4 of ALK-Rearranged Lung Cancer. Alectinib has shown superior results – A study showed that 63% of patients treated with Alectinib lived beyond 5 years. Also, lung cancer crosses into the brain where the ‘blood-brain barrier’ inhibits most medicines from being effective in the brain. Although more expensive, Alectinib, has the ability to cross this barrier and hence is better.

Q: Is there a problem if there is a break in Radiation Therapy? Will it be as effective once you resume?
A: No. Every treatment has a protocol of time and course of dosage. In case of a break in treatment, patient needs to get a PET-CT Scan to evaluate the condition and the next course of action.

Q: If one has a high CA-125, does it confirm cancer in your body?
A: Not necessarily. While CA-125 is a marker for testing ovarian cancer in women, an elevated CA-125 score could also mean Peritonitis or an ovarian cyst. No single marker can determine ovarian cancer; only a biopsy can diagnose this.
Patients are requested to get blood tests only in consultation with a doctor as a variance in scores in the absence of a larger context can cause panic.

Q: “I have been suffering from breast cancer for 2 years. 1 year ago I got diagnosed with liver cancer, 1 month back I got diagnosed with cancer of the spine (T3&T5). Why is this happening ?”
A: Unfortunately, the breast cancer has spread and it may be because the body is becoming resistant to treatment or that the cancer cells are finding a way to circumvent it. As next steps, the Oncologist will evaluate the current ER (Estrogen) PR (Progesterone) Hertonial status and determine the next course of action.

Q: Treatment advice on Lower Soft Part Sarcoma
A: Sarcoma is not chemotherapy sensitive and one needs to go in for surgery depending on MRI, CT-Scan reports and if the cancer is not spread in the body.

Q: 68 year old woman ovarian cancer patient is undergoing chemotherapy for 6 years and has had a recurrence of cancer. She is also diabetic. How can one manage side effects of chemo like mouth ulcers, cramps, pain in legs etc ?
A: To deal with the side effects of chemotherapy, oncologists can decrease the dose of the drug. A mouth ulcer classified as Grade 1 & 2 is usually managed through other medicines. A Grade 3 ulcer would need a dose reduction whereas the drug itself may need to be replaced in a Grade 4 ulcer. The attending doctor is best suited to evaluate the risk-benefit ratio and choose the right solution to control the cancer.

Q: An elderly diabetic woman with stents underwent radiation for breast cancer. Was suggested Tac Zoldria 4 mg Injections but was unable to go due to lockdown. Can she do so now?
A: All adjuvant chemotherapy has to be taken within 6 months of surgery. One needs to follow all protocols else the therapy does not provide the intended efficacy. At this stage the doctor will ask for fresh imaging scans; ER PR Hertonial status and possibly hormone tests and therapy.

Q: Patient is weak after surgery, can chemotherapy commence after 4-5 months once they are strong?
A: No. All treatments have to start immediately after surgery to curtail the spread of cancer. It gallops and spreads rapidly and the best chance is to control it before it does.

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