The examinations for a proper diagnosis
Laboratory tests and anatomical pathology
Numerous laboratory parameters are used for diagnosis of diseases and monitoring treatment and follow-up. Anatomical pathology and cytology, a medical and biological speciality, allows the exact nature of the disease to be determined through microscopic examination of cells or tumor tissues (biopsies, surgical specimens). It is an essential examination that precedes any treatment measures.
Medical imaging is used:
- to detect a tumor lesion, to characterize the nature of the lesion so the best treatment may be chosen;
– to assess the size and reaction of the tumor during treatment;
– for post-treatment follow-up.
Medical imaging is also used for the preparation of treatment plans, particularly for ballistic accuracy in radiotherapy.
In oncology, imaging uses a set of techniques which are often combined to optimize performance ("multimodality imaging"). The images produced by ultrasound, MRI, or scanner, and also by functional methods such as PET scan, can be compared or merged further to refine the diagnosis.
Surgery is often the first diagnostic and/or therapeutic stage. It can be combined with other treatments such as radiotherapy or chemotherapy. In recent years, surgery has developed less invasive procedures that improve quality of life, whilst remaining therapeutically effective. The benefits are measured mainly in terms of a reduction of side effects, functional preservation, conservation and reconstruction. Along the same lines, outpatient surgery allows the patient to go home in the evening following the procedure.
Hematology and its treatment
Hematology treats diseases of the blood, bone marrow and lymphatic system. Most are cancerous diseases (abnormal cells), whilst others are of a dysimmune nature (disruption of the body's defenses).
The treatments (chemotherapy, immunotherapy, targeted therapies) are offered according to the most recent and validated international standards, and where possible as part of clinical trials providing access to advanced therapies once patients have been informed and have given their consent. These trials or "protocols" may in some cases be conducted in the IUCTO Clinical Trials dedicated Unit.
Treatments are preceded and/or accompanied by various measures to preserve patient safety and
quality of life: implantation of venous access lines ; preservation of fertility, psychological and social support, presence of volunteers and associations, etc.
Monitoring of patients in the active treatment stage may call on the AMA program (Outpatient Assistance), which is based on telephone monitoring by a specialized nurse of patients after patients have returned home under medical supervision (see page 34). After treatment, patients are followed up through appointments and/ or via the AMA Post-Cancer telephone monitoring program involving the patient's primary care physicians. The follow-up involves monitoring physical, psychological and social elements.
Treatment by transplant
Bone marrow or hematopoietic stem cell transplant is a specific type of therapy (cell therapy). The patient's own stem cells (autologous transplant) or hematopoietic stem cells from a healthy donor (allograft) may be used. The decision to perform a transplant is taken at a multidisciplinary team meeting during the course of the patient's care. The transplant is organized by the transplant coordination group.
For the transplant of hematopoietic stem cells (HSCs), patients are hospitalized in a highly protected area to protect them against the risks of infection associated with immunosuppression secondary to transplant. Compliance with a number of rules and procedures is essential (controlled air filtration, sterile food,etc.). The particulars of hospitalization in the sterile area are explained to patients during a specific medical and paramedical appointment.
Chemotherapy is based on the administration of drugs that act on cancer cells either by destroying them or by blocking their proliferation. Adapted for each cancer, chemotherapy uses one or more products. Management of product toxicity is improving constantly.
The indication and choice of drugs and how they need to be administered depends on several factors, starting with the type of tumor being treated. The physician selects a protocol that defines the frequency of administration and duration of treatment. Treatment cycles are alternated with rest cycles.
Targeted therapies, developed in recent years, are drug treatments designed to act on anomalies identified in cancer cells. By operating on these "targets", these drugs trigger mechanisms that delay or halt the growth of cancer cells by starving them, causing their destruction, directing the immune system against them or encouraging them to return to normal. Targeted therapies are administered orally or by infusion.
Radiotherapy, which has been used for a century, is an essential means of therapy. Used alone or in combination with other treatments, it is improving continuously due to continued progress in imaging techniques and information technology. Recent techniques such as tomotherapy and stereotaxis now make it possible to focus the treatment on the area of the tumor, preserving the healthy tissue around the tumor as far as possible. Accuracy is of the order of one millimeter. The choice of the technique used depends on the disease, its location and the shape of the tumor. Most treatments, spread over several sessions, are carried out without hospitalization.
Nuclear medicine treatments
Nuclear medicine, also called vectorized internal radiation therapy, involves the administration of a radiopharmaceutical intravenously or orally that binds to the lesions to be treated. Patients are hospitalized in special rooms for a few days.
Derived from external radiotherapy, brachytherapy involves placing a radioactive source in contact with the area to be treated. It is indicated for certain diseases such as cancers of the prostate or gynecological cancers. Where necessary, brachytherapy involves a hospital stay of several days in a protected area.