Systematic preoperative therapy in the treatment of cancer
It is in the early stages, the best treatment, if the patient’s condition allows it, is surgical treatment.
Surgical removal of the cancer is the goal because it saves lives.
For this reason, early diagnosis is also recommended with various tests such as mammography, colonoscopy, PSA testing, etc. However, even when the cancerous lesion is surgically removed, in many cases the cancer returns in the form of metastases.
What is the reason for this? Because even before the operation, a small number of cancer cells have already entered the bloodstream and may have settled in various organs of the body. At the time of surgery, these malignant cells are not detectable with any imaging technique (CT scans, MRI scans, PET scans, etc.). Over time, these cells will develop tumors in the organs where they are located, known as metastases.
In recent years, clinical studies have increasingly shown that if we administer some treatment, usually chemotherapy, before surgery, it is possible to reduce the likelihood of recurrence and therefore increase the success of the surgery, in terms of the patient’s final cure.
What are the benefits of preoperative systemic therapy?
In addition to the probability of reducing recurrences mentioned above, administering chemotherapy before surgery can reduce the size of the tumor and thus the surgery can be done more easily and perhaps more radically. This avoids leaving even the smallest residue in the tumor area. It is one thing for the surgeon to deal with a tumor of, for example, 7 centimeters and another if it has been reduced to 3 centimeters with treatment.
Another benefit is the control of the cancer’s sensitivity to drugs. So we see whether with the specific treatment administered, the cancer is reduced a lot, a little, completely or not at all. This is important for the need for possible future treatment that will improve the results even more. For example, in cases of breast cancer, if preoperative treatment is administered and a residue remains at the time of surgery, it is proven that specific treatments after surgery will increase the cure even more.
Preoperative immunotherapy
It is true that for many decades, the only drugs available in the fight against cancer were chemotherapeutics. Thus, the idea of preoperative treatment necessarily involved the administration of chemotherapy. In recent years, we have witnessed an impressive development of anticancer drugs, with the introduction of biological agents, antibodies, targeted therapies, etc. The last major step was the therapeutic application of immunotherapy. Consequently, preoperative treatment in many cases includes combinations of chemotherapy with immunotherapy or other biological drugs with truly impressive results.
Oncology now requires the cooperation of many specialties, it is, as we say, an interdisciplinary process. The cooperation of oncological surgeons, oncologists and radiation oncologists is indispensable. These specialties are supported by pathologists, radiologists, interventional radiologists, and doctors from many other specialties.
For this reason, and to disseminate new knowledge, a two-day conference was organized at the Inter-Balkan Medical Center of Thessaloniki, on February 23-24, with the participation of all the specialties involved, where preoperative systemic treatment for a variety of tumors was extensively discussed, as another therapeutic approach that helps in the definitive fight against cancer.
