Assoc.Prof.Dr. Ekapop Sirachainan is a renowned oncologist in Phyathai 2 Hospital, Bangkok, Thailand and assistant professor at the Faculty of Medicine Ramathibodi Hospital. He has 20+ years of experience in the field of medical science. He specializes in chemotherapy and he has pursued his MD from Mahidol University. He has a diploma in the Thai Board of International Medicine, Diploma of Thai Board of Oncology and also Post Doctoral Fellowship of Hematology and Oncology at the University of Michigan, USA.
Dr. Sirachainan is a prominent personality. He is a medical lecturer at Ramathibodi Hospital, Thailand. He is one of the authors of The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire: translation and reliability study of Thai Version. He is amongst the best doctors and surgeons in Thailand for chemotherapy.
Stem cell transplant is one modern technology that is undergoing rapid improvements. It is said these days that instead of investing in various life insurance policies that are making the rounds in the market, to secure the future and precious life of your child go for stem cell technologies. This can later cure him or her from any life threatening terminal disease like cancer. Stem cell transplant has been used in recent times as a cure for cancer, but the technique is different from the stem cell bank that is maintained these days for new born.
The bone marrow which is part of the bones is responsible for making blood cells. It is soft and spongy tissue lodged inside the bone having hematopoietic stem cells. These cells either turn into bone marrow cells or can turn into any other kinds of cells or the blood cells. But there are certain forms of cancers that can keep these cells from developing normally.
A patient is recommended to get a blood as well as bone marrow stem cell transplant if they are in a condition which prevents the body from producing new healthy blood cells. Some of the conditions and diseases that prevent the bone marrow from doing so are given below:
The oncologist or hematologist shall decide for a stem cell transplant for a patient depending upon overall age and health, severity of the diseases and other treatment possibilities.
So the stem cell transplant is a kind of treatment to treat blood disorders or any types of cancer. Even blood diseases are also treated with transplants. Previously patients had to undergo a bone marrow transplant due to the fact that stem cells are collected from the bone marrow. But today stem cells get collected from the blood. And for this particular reason they are now called stem cell transplants. Nowadays stem cell therapies are used to combat hair loss and many other aesthetic related issues.
Some of the different types of stem cell treatments available are discussed below
Autologous transplant: These kinds of transplants are known as auto transplant. This kind of transplant has the scope of very high dose chemotherapy paired with autologous stem cell rescue. In this process usually the doctors treat the cancel and then make use of the stem cells from the patient itself. From the blood, stem cells are collected and the health care team then freezes it. These cells are usually placed back in the blood after thawing them in the frozen state post the chemotherapy. The cells take almost 24 hours to reach the bone marrow and start multiplying to give rise to healthy blood cells.
Allogenic transplantation: This is better known as an allo transplant medically. In this case stem cells are obtained from another individual. But this individual needs to be someone with whom the bone marrow of the patient matches. Due to presence of proteins in white blood cells called the human leukocyte antigens (HLA) it is important that bone marrow matching takes place. The most compatible stem cell donor will have the HLA matching with that of the patient.
But the process of matching can also give rise to a very severe condition named graft versus host disease or GVHD but then it is not very likely. In this kind of a disease the healthy cells obtained from transplantation will start attacking the cells of the patients. In such cases siblings are considered to be the best match. And if they are not available then some other close family member can also work. Once the donor is fixed then the patient starts receiving chemotherapy session with or without radiotherapy. The other person’s stem is then placed in a vein via a tube. These cells unlike the previous ones are not frozen so they can be given immediately after the completion of chemotherapy.
There can be two types of Allo transplantation depending upon the age, condition and the disease that is being addressed:
The first kind is ablative where high dose of chemotherapy is used and in the second kind milder doses of chemotherapy is employed.
When the assigned health care team is unable to find a matched adult donor then are other options that must be considered like the Umbilical cord blood transplant and these days cancer centers all around the globe make use of cord blood.
Parent child transplant and haplotype mismatched transplant: In these kinds of transplants which are commonly employed the match found is 50% instead of 100% and the donor can be a parent, child or brother and sister.
Chemotherapy is a category of standardized drug administration of various types for the treatment of cancer. With a curative intent, some combinations of drugs are administered to a patient to prolong their life and also to bring about a reduction in the symptoms shown by the patient. Chemotherapy treatment is considered to be one of the major categories of medical oncology. Many people around the world are prescribed to undergo chemotherapy treatment instead of undergoing a surgical procedure. But many are frightened with the side effects of this treatment as it is believed to reduce the quality of life of the patients.
Chemotherapy is a procedure where non-specific intracellular poisons are used, which are specifically related to preventing the process of mitosis or the natural cell division of the cancerous cells. This technique rather excludes those agents that are responsible for selective extracellular growth signal blockade (signal transduction blockers). If spoken about these agents used in chemotherapy, it has been found that most of them are cytotoxic in nature due to their property of interfering with natural mitosis. However, the cells of cancer can differ widely in terms of showing susceptibility to these administered agents.
Chemotherapy can be defined as a way of mass destruction of stress cells, which would eventually lead to the death of the cells when apoptosis is initiated. The commonly known side effects of chemotherapy can be traced back to the process of damaging normal non-cancerous cells, which are in the process of rapid division. They are sensitive to anti-mitotic drugs that are being administered to the patient and such cells may include the cells of the hair follicles, digestive tract lining, and bone marrow. But nowadays treatment options have undergone a lot of modification by which these side effects can be well countered.
Various options of drugs are available to treat different types of cancer including the following:
Alkylating agents: These kinds of agents prove to be extremely beneficial during the cell’s resting phase. The various kinds of alkylating agents that are employed in chemotherapy treatment include the following:
Nitrosoureas are unique from the rest for choices in chemotherapy treatment due to their ability to cross the blood-brain barrier and treating tumors of the brain.
Plant alkaloids: Plant alkaloids employed for chemotherapy treatment are derived from plants. These include vinca alkaloids, taxanes, podophyllotoxins, and camptothecan analogs. The plant alkaloids are cell cycle specific agents, which enables them to attack the dividing cells in various stages of their division cycle.
Antimetabolites: This kind of chemotherapy treatment involves substances that are similar in composition to the normal substances present in the cell. When these substances get incorporated in the process of cellular metabolism, then the cell is no longer able to divide. They are also cell cycle specific and can be classified further according to the substance in the cell with which they interfere.
Topoisomerase inhibitors: When the topoisomerase enzymes in the body ( topoisomerase I and II) are inhibited as a result of chemotherapy drugs, then those drugs are referred to as topoisomerase inhibitors. During the chemotherapy, the topoisomerase enzymes are responsible for controlling structural manipulation of the DNA which is necessary for the purpose of replication.
Miscellaneous antineoplastics: Different types of drugs make each chemotherapy treatment process unique. Enzymes, retinoids, adrenocortical steroid inhibitor, ribonucleotide reductase inhibitor or antimicrotubule agents can be used as chemotherapy drugs.
Intensity-modulated radiotherapy (IMRT) is a type of conformal radiotherapy, a technology that enables the radiation oncologist to precisely target the tissues with cancer cells. . In this type of radiation therapy for cancer, the radiation beams closely take up the shape of the area that is being targeted.
IMRT is delivered through the standard radiotherapy machine, which is also known as the linear accelerator (LINAC). This machine has a device called multileaf collimator, which possesses lead leaves that can move independently to form a shape that best fits the target area.
Because the radiation beams can take up the shape of the target area, high dosage of radiation can be delivered to kill the cancer cells while minimizing exposure to the non-cancerous cells and tissues. IMRT proves to be highly effective in the case of head and neck cancer among other types of cancer.IMRT for prostate cancer is now available across all major hospitals around the world.
The efficiency of IMRT has already been tested for multiple cancers, including breast cancer. Latest advancements improving the efficacy of radiotherapy, however, continue to take place in the field of healthcare. This radiation treatment for cancer is already being used as a standard treatment for some cancer types.
Stereotactic radiotherapy (SRT) is a type of technique used to precisely target radiation beams at the tumour. This is one of the latest innovations in the field of radiation therapy. Since this treatment requires special equipment, machine, and expertise, this treatment is not widely available across all cancer treatment hospitals.
SRT involves treatment of a tumour with the help of a special machine known as a linear accelerator (LINAC). This machine is used to deliver external radiation therapy in the case of normal radiation therapy and intensity-modulated radiation therapy (IMRT).
SRT treatment involves of small daily doses of radiation, which are also known as fractions. The patient may be advised to undergo anywhere between 3 to 30 fractions in a day, depending on the extent of cancer and the size of the area that is being targeted. SRT is mostly used for the treatment of smaller lesions and tumours and is less than 3 cms in size.
Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) are types of SRT. SRS is also known as Gamma Knife surgery. It involves exposing the tumour to a very high dose of radiation in one to five fractions. Gamma Knife surgery is usually used for the treatment of a tumour in the central nervous system (CNS).
On the other hand, SBRT is a special procedure used for the treatment of tumours located outside the central nervous system. In this approach, radiation is delivered through different directions or positions of the body. It can be used for the treatment of small tumours in the lungs, pelvis, prostate, pancreas and other organs as well.
SRT is mostly used for the treatment of the following conditions:
Gamma Knife surgery is different from CyberKnife radiation. The latter is used for the treatment of cancerous and non-cancerous tumours as well as other medical conditions. CyberKnife treatment is actually a frameless robotic radiosurgery system that delivers a high dose of radiation to the targeted location.
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