Technological Evaluation of Cancer
Treatments in Bangladesh
Abstract
Cancer, one of the leading diseases that causes confirm death, is the subject of
widespread fear and taboos. Although the complete elimination of cancer hasn’t
been discovered yet, “the war against cancer” has already been declared worldwide
and research works are ongoing for cancer treatments. Varieties of technologies are
already introduced over the world to combat the severity of it. Cancer is the sixth
leading cause of death in Bangladesh, posing a huge social and economic liability;
currently about 12 lakh cancer patients have been identified and every year around
two lakh new people are being attacked by cancer and 1.5 lakh people die of it.
Nevertheless, Bangladesh still has the lacking of a national cancer registry. This
paper presents a review on the cancer scenario of Bangladesh considering the
incidence rates and the malignancy of it. Along with traditional radiotherapy,
chemotherapy and surgery, available modern technologies of cancer treatments in
Bangladesh and their theory of operations and appropriateness for particular cancer
are also presented so that the general patients or their attendants may choose the
right therapy or the palliation process. This would definitely help the of low- and
middle-income local cancer patients to take proper decision in their major crisis
time.
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Technological Evaluation of Cancer Treatments in Bangladesh
1. Introduction
1.1 Introduction
Cancer, medically known as malignant neoplasia, is a broad class of diseases characterized by
out-of-control cell growth. There are trillions of living cells in a single human body. Normal
body cells grow, divide and die in an orderly fashion. During the early years of a person’s life,
normal cells divide faster to allow him to grow. As he grows adult, most cells divide only to
replace worn-out or dying cells or to repair injuries. Damaged cells sometime divide
uncontrollably and form tumors i.e. general tissue lumps or masses. Tumors grow and may
interfere with the digestive, nervous, and circulatory systems and release hormones that alter
body function. Tumors that remain stationary in one spot and demonstrate limited growth are
generally considered to be benign; hence not cancerous. When tumors successfully spread to
other parts of the body, grow, invade and destroy other healthy tissues; thus metastasis occurred.
Six characteristics of such malignancies have been identified: sustaining proliferative signaling,
evading growth suppressors, resisting cell death, enabling replicative immortality, inducing
angiogenesis, and activating invasion and metastasis.
However, the causes of cancer are diverse, complex and only partially understood. Some factors
may directly damage genes or combine with existing genetic faults within cells and trigger
cancerous mutations. Inherited genetic defects from parents cause approximately 5–10% cancers.
Some could be prevented by maintaining healthy food and lifestyle and being vaccinated against
these infectious diseases. The chances of surviving from the disease vary greatly by the type and
location of the cancer and the extent of the disease at the start of treatment. Cancer can occur at
any stage of life while cancer occurs in children stage pose threat increasingly with age. Cancer
deaths are rising as more people live to an old age with changed lifestyle and the scenario is
much worse in undeveloped countries.
1.2 Global Cancer Malignancy
According to GLOBOCAN database of International Agency for Research on Cancer (IARC),
WHO, 14.1 million cancer patients and 8.2 million cancer-related deaths noticed in 2012, compare
to 12.7 and 7.6 million in the year 2008 respectively,. It is feared to raise the cancer cases to 22
million within next two decades. Major cancer deaths due to cancer in 2012 includes: lung
cancer (1.59 million), liver (0.745 million), stomach (0.723 million), colorectal (0.649 million),
breast (0.521 million), esophageal (0.40 million). Five behavioral and dietary risk factors are
identified for 30% cancer deaths: high body mass index, low fruit and vegetable intake, lack of
physical activity, tobacco and alcohol use. Tobacco use is the most important risk factor for
cancer causing over 22% of global cancer deaths and about 71% of global lung cancer deaths.
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Cancer causing viral infections such as hepatitis B (HBV), hepatitis C virus (HCV) and some
types of Human Papilloma Virus (HPV) are responsible for up to 20% of cancer deaths in lowand middle-income countries. Africa, Asia and Central and South America account for 70% of
the total cancer deaths of world.
In Bangladesh, currently about 12 lakh cancer patients have been identified and every year
around two lakh new people are being attacked by cancer and 1.5 lakh people die of that. IARC
has identified ten leading causes of female cancer deaths in Bangladesh are mouth and orophyrangeal cancer, cervical, breast, esophageal cancer, ovarian cancer, lung cancer,
lymphoma, stomach, liver, colon-rectal cancer and in case of male: mouth and oro-phyrangeal,
lung cancer, esophageal cancer, lymphoma, stomach, bladder, liver cancer, leukaemia, colorectal cancer and prostate cancer. Severities of cancer in children are mainly leukemia,
lymphomas, central nervous system tumors, soft tissue sarcomas and renal tumors. Attributable
fraction of cancer causes in the Bangladeshi patient tends to be dominated by tobacco smoking,
food habit, cancer causing infection, men and women hygiene, and reproductive history among
females rather than the genetic factors. For women, viral and bacterial diseases related cancer
(39.10%) leads obesity (37.10%) and chronic disease (37.03%) excluding food habit. Again,
68% of the cancers of male are caused by tobacco followed by betel leaf (67.55%), hence
entirely avoidable.
1.3 WHO’s Response to Cancer
Each year on 4 February, The cancer day, WHO and IARC support Union for International
Cancer Control (UICC) to uphold strategies to ease the global burden of cancer. The core
functions are to set norms and standards, to promote surveillance and encourage evidence based
prevention, early detection, treatment and palliative tailored to the different socioeconomic
settings. In 2013, WHO launched the “Global Action Plan for the Prevention and Control of
Non-communicable Diseases 2013-2030” that aims to reduce 25% premature mortality from
cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. WHO also announced
that more than 50% cancers are curable, hoping the number would increase in near future. Major
areas of its cancer fight include:
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Increasing political commitment for cancer prevention and control;
Coordinating research on the causes of human cancer and the mechanisms of
carcinogenesis;
Developing scientific strategies for cancer prevention and control;
Generating new knowledge, and disseminate existing knowledge to facilitate the delivery
of evidence-based approaches to cancer control;
Developing standards and tools to guide the planning and implementation of
interventions for prevention, early detection, treatment and care;
Facilitating broad networks of cancer control partners and experts at global, regional and
national levels;
Strengthening health systems at national and local levels to deliver cure and care for
cancer patients;
Providing technical assistance for rapid, effective transfer of best practice interventions to
developing countries.
1.3 Cancer Scenario in Bangladesh
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The Bangladesh Bureau of Statistics (BBS, 2008) has stated cancer as the sixth leading cause of
death in Bangladesh, posing a huge social and economic liability. According to the study carried
out by the International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), in 2010,
cancer causes 21 per cent of maternal casualty in the country. However, cancer control or
prevention strategies here are not at all up to the mark. Still in the year 2014, Bangladesh has the
lacking of a national cancer registry. Hospital-based cancer registry has been started recently at
National Institute of Cancer Research Hospital (NICRH) and Oncology Department of
Bangabandhu Sheikh Muijb Medical University (BSMMU). IARC has assessed cancer-related
death rate in Bangladesh was 7.5% in 2005 and projected to increase up to 13% by 2030 if the
current trends of the incidence continue as the national strategy to combat the deadly but
preventable disease is yet to be put into practice.
The main sufferers are the inhabitants of Dhaka zone, maximum 27%, following Comilla, 17%
of the total count. The NICRH and BSMMU cancer registry data have also revealed that more
than 66% of the cancers occur in the age group of 30–65 years, maximum in 50-59 ages. The
majority of the cases are diagnosed when the disease is regional (two-third of all cases) while
20–25% of the cancers are only diagnosed in the localized stage. Disease with distant metastasis
at the time of diagnosis is no more than 15%. Childhood cancers represent only 1% of the overall
incidence of the disease, the successful treatment of cancers occurring in young people results in
considerable saving of years of life. Childhood cancers are curable in 70% cases, but half of the
survivors face long-term sequel. Adolescents with cancer have poorer survival than the children
cancer.
Globally the three most common cancers in Bangladesh are lung, breast and colorectal cancer.
Literature revealed that lung cancer is the leading cancer in male here. Cancer of cervix has been
identified as the 2nd commonest malignancy in female preceded by breast cancer. The WHO
study also observed that 3.6% of the admissions in medical college hospitals for the same age
group are due to the cancers of oral cavity, larynx and lungs. Oral, breast and cervical cancers
together constitute more than 43% of the female cancer burden in Bangladesh. Lung cancer in
males and cervical and breast cancers in females constitute 38% of all cancers in Bangladesh. A
complete overview of cancer incidence rate of year 2007-2011 is presented in tabulated form in
Table1.
Table1: Cancer Occurrence in Bangladesh in the year 2007-2011
Type of Cancer
Incidence rate in
Man (%)
Lung Cancer
Lip and Oral cavity
Other Pharynx
Colo-rectal Cancer
Stomach Cancer
Esophageal Cancer
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Bladder Cancer
Prostate Cancer
Liver Cancer
Leukaemia
13.1
11.9
8.2
6.5
4.7
4.1
4.7
2.2
3.4
2.3
1.5
0.3
Type of Cancer
Breast Cancer
Cervical Cancer
Lip and Oral cavity
Ovarian Cancer
Colo-rectal Cancer
Lung Cancer
Esophageal Cancer
Stomach Cancer
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Liver Cancer
Leukaemia
Incidence rate in
Woman (%)
32.8
26.1
6.5
3.3
2.7
2.0
1.9
1.8
1.3
0.8
0.6
0.4
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2. Overview of Cancer Research
2.1 An Brief History of Cancer Study
The earliest known descriptions of cancer appear in seven papyri (written around 1600 B.C.),
documented in the 19th century. They provided the first direct knowledge of cancer appearance
in early 2500 B.C. Hippocrates (ca. 460 B.C. – ca. 370 B.C.) described several kinds of cancer,
referring them carcinos (Greek of crab or crayfish), as the appearance of the cut surface of a
solid malignant tumor compared with "the veins stretched on all sides as the animal the crab has
its feet, wherefrom it derives its name". Hippocrates, responding Greek tradition not to open the
body, only described the externally visible tumors on the skin, nose, and breasts based on
the humor theory of four bodily fluids (black and yellow bile, blood, and phlegm). According to
the patient's humor, treatment consisted of diet, blood-letting, and/or laxatives. Through the
centuries it was discovered that cancer could occur anywhere in the body, but humor-theory
based treatment remained popular until the the discovery of cells (19th century).
The Latin cancer comes from carcinos meaning crab and oncos (Greek for swelling) for benign
tumors reserving Hippocrates' carcinos for malignant tumors. The suffix -oma, Greek for
swelling, was added to develop the name carcinoma.
The surgical treatment of cancer was discovered in Egypt and dates back to around 1600 BC.
The Papyrus described eight cases of ulcers of the breast that were treated by cauterization, with
a tool called "the fire drill." The writing says about the disease, "There is no treatment." Later in
the 16th and 17th centuries, it became more acceptable for doctors to dissect bodies to discover
the cause of death. The German professor Wilhelm Fabry believed that breast cancer was caused
by a milk clot in the mammary duct. The Dutch professor Francois Sylvius, a follower
of Descartes, claimed that all disease was the outcome of chemical processes, and that acidic
lymph fluid was the cause of the cancer. His contemporary Nicolaes Tulp believed that cancer
was a poison that slowly spreads, and concluded that it was contagious. Hence, the first cause of
cancer was identified by British surgeon Percivall Pott, who discovered in 1775 that cancer of
the scrotum was a common disease among chimney sweeps.
With the widespread use of the microscope in the 18th century, it was discovered that the 'cancer
poison' eventually spreads from the primary tumor through the lymph nodes to other sites
("metastasis"). The German zoologist Theodor Boveri, professor of zoology at Munich
recognized the genetic basis of cancer was in 1902. He postulated that chromosomes were
distinct and transmitted different inheritance factors and mutations of the chromosomes could
generate a cell with unlimited growth potential which could be passed onto its descendants. He
proposed the existence of cell cycle check points, tumor suppressor genes and oncogenes. He
guessed that cancers might be caused by radiation, physical or chemical insults or by pathogenic
microorganisms. Thus, the war against the cancer had started and state of art researches had been
undergone on that purpose.
2.2 Recent Breakthrough in Cancer Research
Though many diseases (like heart failure) may have the worse prognosis than most cases of
cancer, cancer still is the subject of widespread fear and taboos. Though anticipated by common
people, but, unlikely to have a single cure or treatment for all cancer. Cancer treatments have
been developed alongside companion diagnostic tests to target the right drugs to the right
patients, based on their individual biology. The complete elimination of cancer hasn’t been
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discovered yet. Scientists reported in Nature Communications (October 2012) that they have
discovered an important clue of the reason of cancer spreading. It has something to do with their
stickiness properties. Certain molecular interactions between cells and the scaffolding
(extracellular matrix) cause them to become unstuck at the original tumor site; they become
dislodged, move on and then reattach themselves at a new site. The researchers say this
discovery is significant because cancer mortality is mainly due to the metastatic tumors, those
that grow from cells that have traveled from their original site to another part of the body while
primary tumors cause only 10% of deaths. The scientists, from the Massachusetts Institute of
Technology (MIT), claim that finding a way to stop cancer cells from the sticking to new sites
could interfere with metastatic disease, and halt the growth of secondary tumors. The ultimate
solution of the cancer is lying on that point and the solution is imminent. The whole world is
eagerly waiting for that golden day.
3. Cancer Facts
3.1 Genetic Alteration by Cancer
The failure of tissue growth regulation fundamentally causes cancer. The somehow affected
genes can be divided into two broad categories: oncogenes (which promote cell growth and
reproduction) and tumor suppressor gene (which inhibit cell division and survival). Malignant
transformation might occur through novel oncogenes formation, the inappropriate overexpression of normal oncogenes, or by disabling of tumor suppressor genes. Such genetic
changes can occur at different levels and by different mechanisms. Any errors in mitosis can
trigger this gain or loss of an chromosome. More common are mutations, which are changes in
the nucleotide sequence of genomic DNA. The series of mutations that alters the behavior of cell
individually is presented in Figure1.
Figure 1: The series of mutations involved in cancer
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3.2 Different Cancer Types
Cancer symptoms are quite varied and depend on where the cancer is located, where it spreads,
and how big the tumor is. In order to choose the exact cancer treatment, it is mandatory to have a
clear insight of the particular cancer symptoms. There are more than 200 different types of
cancer that affect human, and each is classified by the type of cell that is initially affected. An
overview is given bellow:
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Carcinomas which are characterized by cells that cover internal and external parts of the
body such as lung, breast, and colon cancer.
Sarcomas which are characterized by cells those are located in bone, cartilage, fat,
connective tissue, muscle, and other supportive tissues.
Lymphomas which are cancers those begin in the lymph nodes and immune system
tissues.
Leukemias which are cancers those begin in the bone marrow; often accumulate in the
bloodstream.
Adenomas which are cancers those arise in the thyroid, the pituitary gland, the adrenal
gland, and other glandular tissues.
4. Approaches for Cancer Prevention and Treatment
4.1 Prevention and Early Detections of Cancer
Primary prevention, early detection, prompt diagnosis, appropriate treatment and palliative care
are the main strategies for cancer control. Each cancer requires a distinctive mix of these
strategies for its control; however, cancer pre-knowledge and early detection is crucial. More
than 30% of cancer deaths could be prevented by tackling or avoiding following risk factors:
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Tobacco usage
Overweight or obese
Unhealthy diet containing poor fruit and vegetable intake
Shortage of physical activity
Alcohol usage
Transmitted HPV-infection
Urban heavy air pollution
Indoor smoke of solid fuels
Exposure of excess sunlight
There are two components of early detection efforts that may reduce cancer mortality: early
diagnosis before the disease becomes advanced and the screening. Screening, the systematic
application of a test in an asymptomatic population, aims to identify individuals with
abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for diagnosis
and treatment. Typical screening methods are: visual inspection with acetic acid (VIA) for
cervical cancer in low-resource settings or PAP test for cervical cancer in middle- and highincome settings and mammography screening for breast cancer in high-income settings.
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4.2 Post-Cancer Treatments
The primary goals of cancer treatments are always to cure ideally, prolongation of life if possible
and improvement in the quality of life. Treatment of cancer is complex, involving a range of
therapies with psychological support. The principal methods of treatment are surgery,
radiotherapy, immunotherapy and chemotherapy (including hormonal manipulation). Cure or
palliation of specific cancers can be possible from appropriate combination and sequencing of
these modalities. For most common cancer types such as female breast cancer, cervical cancer,
majority of the head-neck cancers and colorectal cancer, state of the art therapy yields a 75% or
greater survival rate (5-year) if detected early and treated according to best evidence. On the
other hand, less than 15% patients survives cancers of pancreas, liver, stomach and lung is Other
cancer types, even though disseminated, such as leukemia and lymphomas in children, and
testicular seminoma, have high cure rates if appropriate treatment is provided. Palliative care is
another urgent humanitarian need for cancer where there is a little chance of cure.
4.3 Treatment Plans of Cancer
Care for cancer patients typically starts with recognition or suspicion of the disease by the patient
or primary health care workers by means of investigations involving imaging technology or
pathology. Accurate diagnosis and treatment comprise the next element of the system. As cancer
treatments are expensive and most patients are poor and from the developing world, appropriate
diagnosis plan is mandatory here. The following section introduces different approaches for
individual cancers (with a summary in Table2) for better understanding and inexpensive decision
making:
01: Bone Cancer
Bone cancer or pain caused by bone metastasis is best treated with an intravenous infusion of
Zoledronic acid that prevents skeletal fractures in patients with prostate cancer or multiple
mylenoma.
02: Brain Cancer
Along with traditional surgery and radiation, another effective therapy for brain cancer is
photodynamic therapy (PDT). By combining a photo-synthesizer and a specific light, PDT would
be relatively selective and specific for certain types of tumors.
03: Breast, Ovarian and Prostrate Cancer
Several therapies are available to breast cancer patients. By combining a few, patients often
achieve a far better outcome than if they had underwent only one therapy. Along with
conventional surgery, cryosurgery and brachytherapy can be employed as they are proved to be
safe, effective, less painful and minimally invasive. The addition of oral medication is also
necessary.
04: Colon Cancer
Screening is effective to decrease the chance of dying from colorectal cancer and recommended
for the patient of 50-75 years old. Sigmoidoscopy or colonoscopy can diagnose localized bowel
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cancer. The common strategy to dealing with colon cancer is conventional surgery. By using
innovative therapies such as PDT (minimally invasive, safe, and less painful), the patient may
achieve a positive outcome.
05: Liver Cancer
For liver cancer Cryotherapy, brachytherapy, and interventional vascular therapy are an excellent
treatment combination that is safe, less painful and minimally invasive; it also provides better
outcomes than the individuals. Another treatment method that can be combined is absolute
alcohol ablation (PEI), a process of using absolute alcohol injections to dehydrate and kill cancer
cells. This treatment has shown very positive results and high cure rates when the lesions are
small and few in numbers. Tumor response has been found as high as 90% for liver cancers
smaller than 2cm in diameter, 70% for cancers of 3cm, and 50% in cases with cancers 5cm in
diameter.
06: Kidney Cancer
Cryotherapy and brachytherapy can be combined with conventional surgery in the general
treatment of kidney cancer. As these two therapies are safe, less painful, minimally invasive,
meaning no incisions, doctors can perform as many surgeries as needed until all the whole cancer
are removed.
07: Lung Cancer
For lesions on the lung that are larger than 1cm, cryosurgery is ideal: minimally invasive, safer,
more effective and less painful than conventional surgery. However, for spots smaller than 1cm,
PEI is best suited to target the cancer's small size. Brachytherapy can also be used if the lesions
are limited in size and few in number. Chemotherapy and oral medication complete the treatment
plan.
08: Pancreatic Cancer
If the primary tumor is in the pancreas, cryosurgery is an ideal solution that is safer, more
effective, minimally invasive and less painful than the conventional surgery. During the same
session of cryosurgery, it is recommended to add brachytherapy (Iodine-125 seeds implantation).
Depending on patient and the situation, another excellent choice might be interventional local
chemotherapy with the drug Gemzar. Research and experience have shown that the outcomes are
far better when both minimally invasive therapies are combined.
09: Skin Cancer
Photodynamic therapy is an excellent choice for surface oriented skin cancer which is both safe
and effective.
10: Cervical Cancer
Treatment of cervical cancer usually consists of surgery (including local excision) in early
stages, and chemotherapy or radiotherapy in more advanced stages of the disease.
Table 2: A complete overview of the probable treatment plans for various cancers
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Different Cancer
Bone Cancer
Brain Cancer
Probable Therapy
Surgery, Radiation therapy, Chemotherapy.
Chemotherapy, Radiotherapy, Surgery.
Breast Cancer
Colon Cancer
Liver Cancer
Kidney Cancer
Lung Cancer
Ovarian Cancer
Pancreatic Cancer
Prostate Cancer
Skin Cancer
Cervical Cancer
Surgery, Radiotherapy, Chemotherapy, Biological immunotherapy.
Surgery, Chemotherapy, Cell immunotherapy.
Interventional therapy , surgery, chemotherapy embolism
Surgical treatment, Green chemotherapy, Radiotherapy, Immunotherapy.
Surgery, Radiation therapy.
Surgery, Radiation therapy, Chemotherapy, Cell immunotherapy.
Surgery, palliative surgery.
Chemotherapy, Radiotherapy, Surgery, Traditional Chinese medicine.
Super-freezing treatment plus heat treatment, Body cell immunotherapy.
Surgery, Radiation therapy, Chemotherapy.
4.4 Available Cancer Treatments in Bangladesh
In Bangladesh, on an average 50-60% of the patients are treated with radiotherapy, 20% with
surgery and 25-30% with chemotherapy as primary treatment or in combination. This is because
Bangladesh lacks modern cancer hospitals or modern technologies or equipment. It needs around
two hundred thirty radio therapy centers but had only eighteen. There are only fifteen linear
accelerators installed in the country whereas two are in rural areas and twelve cobalt-60
machines and twelve brachytherapy machines. Overall it would need 1,000 oncologists, 600
medical physicists and 500 technicians to face the emerging challenges of cancer treatment.
Recently, the government of Bangladesh updated the list of essential drugs as per the WHO
guidelines but the drugs are yet to be made available for the patient population.
Each medical college has a concerning oncology department and has some facilities, although
the service is not at all up to the mark. Khwaja Yunus Ali Medical College (Enayetpur, Sirajganj)
is the exception here. They only provide the treatment of chemotherapy, surgery and
radiotherapy. Some other hospitals are now establishing their oncology department along with
advance technologies. United Hospital (Gulshan, Dhaka), Apollo Hospitals (Bashundhara R/A,
Dhaka), Delta-Hospital (Mirpur, Dhaka) are in the top of the list. United Hospital has the facility
of chemotherapy, hormone therapy, immunotherapy, targeted therapies with radiation oncology.
Delta hospital provides the facilities of chemotherapy, surgery and radiotherapy. Apollo hospital
provides surgery, cryosurgery, chemotherapy, radiotherapy but the expenses are out of rich of
most people. Ahsania Mission Cancer and General Hospital (Mirpur, Dhaka), Mosabbir Cancer
Care Centre (Dhanmondi R/A, Dhaka), Bangladesh Cancer Hospital and Welfare Home
Complex (BCSHWHC) are three rising cancer cure centers. Contact address and locations are
provided in the Appendix section. Recently on October 2013 first bone marrow transplant center
in DMCH (Dhaka Medical College Hospital) was inaugurated and 10th march 2014 first
successful bone marrow transplant was done. Bone marrow transplant cannot cure all the cancers
but some types of cancer like Thalassemia, (blood cancers) leukemia, aplastic anemia etc.
Recently two Chinese hospitals have initiated their collaboration with Bangladesh to provide
better cancer treatments. Modern Cancer Hospital (Guangzhou, China) has established their
regional office and consultancy center in Gulshan, Dhaka. Also, Fuda Cancer Hospital
(Guangzhou, China) has collaboration with Liver Foundation of Bangladesh (Panthapath,
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Dhaka). They are featuring the modern technologies like PET/CT, RFA, Green Chemotherapy,
Photon Knife, PDT, Endogenic Magnetic Field Thermatology, Cryotherapy etc. These regional
offices are providing initial consultancy, prescription and minimum diagnosis and suggest
appropriate therapies for the patients considering case history and malignancy. They also arrange
appointments and easy travels to the hospitals in China if patients agree to undergo treatments
there. Fuda cancer hospital has also some encouraging vision to establish a modern cancer center
in Bangladesh. This would definitely help the of low- and middle-income local cancer patients to
avoid costly flights.
5. Details of Cancer Diagnosis and Treatment Methodologies
5.1 Diagnostic Methods of Cancer
The WHO (2002) describes the cancer diagnosis as the first step of cancer management. Cancer
diagnosis calls for a combination of careful clinical assessment and a range of diagnostic
investigations, such as endoscopy, imaging, histopathology, cytology and laboratory studies. It
requires the health professional to be alert to the early warnings. It is mandatory to have a
thorough history and clinical examination of any suspicious symptom or sign. Once a diagnosis
is confirmed, it is necessary to ascertain cancer staging (spreading) to evaluate the extension of
the disease and be able to provide treatment accordingly. Some diagnostic methods are listed
below:
Radiological Evaluation
Various imaging methods are efficient in cancer diagnosis like X-ray, Fluoroscopy,
Mammography, Ultrasound, CT scan, Magnetic Resonance Imaging, Nuclear Medicine: Positron
Emission Tomography, Radio nuclide scan and Radioactivity uptake studies on thyroid, bones
etc.
Endoscopy
In oncology, endoscopy is useful to detect the site of primary cancer, to evaluate the extent of
lesion, to perform biopsy and certain therapies like endoprosthesis for esophageal stenosis, laser
therapy etc.
Pathological Evaluation
Pathological evaluation is the important method for confirmation of the clinical diagnosis that
includes Haematological examination (like examination of peripheral blood smear and bone
marrow); Cytological examination such as Exfoliative cytology: examination of exfoliated cells;
female genital tract, oral cavity, urine examination, gastrointestinal lesions like gastric lavage
etc. Fine Needle Aspiration Cytology (FNAC): to obtain material from organs that do not shed
cells spontaneously (example: breast, thyroid etc.). Aspiration of body fluids: to rule out or
confirm malignant effusions (example: pleural fluid, peritoneal fluid).
Biopsy
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A small chunk of tissue is normally removed from the suspicious site and subjected to
histopathological examination. It may be needed excisional biopsy in small tumors, incisional/
punch biopsy in skin and mucosal lesions, cone biopsy in uterine cervix, needle biopsy in bone
marrow, solid tumors of abdomen and pelvic organs etc.
Immunological Evaluation
Some cancers release biological or biochemical substances into blood circulation in the form of
hormones, enzymes and antigens which lead detection and diagnosis of certain types of cancers.
Such chemicals are called tumor markers.
PET/CT
Positron emission tomography, also called PET imaging or PET/CT scan, is a type of cancer
prevention physical exam. It is the only high-end nuclear medical imaging technology in
anatomical form to image function, metabolism and acceptor. Featuring no wounds, high
resolution and high sensitivity, PET/CT can detect both minimum and potential cancer in early
stage with its 90% accuracy on diagnosis. It is also an efficient tool for treatment plan choosing
and curative effect monitoring; hence may cut down the overall treatment costs.
Figure 12: An example of PET/CT scan
Principle:
The uncontrolled proliferation characteristics of tumor cells like increased DNA synthesis and
raised consumption of metabolizing substrates such as amino, glucose and so are the significant
differences from the metabolism of normal tissue cells. Tumor metabolism can be seen in images
directly by marking and tracking the metabolites or other analogs with radionuclide like 18FFDG (18F-2-fluro-D-deoxy-glucose). Those images can both active and precisely reflect the
differences of metabolism between tumor tissue cells with normal tissue cells.
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Advantages:
Safe and no wounds: the radionuclide for PET image remains in candidate over a short period of
time, which won’t hurt human body. Tumor’s malignancy could be reflected precisely with
PET/CT’s high accuracy on diagnosing tumor benignancy and malignancy while both lymph
node and distant metastasis of tumor can be exactly detected.
Applications:
1. PET/CT can detect minimum cancer in early stage with high sensitivity.
2. Staging tumor scientifically and precisely.
3. Searching for primary lesion and discover metastatic lesion.
4. Monitoring and evaluation of the curative effect of post chemotherapy and surgical therapy.
5. Identify the benignancy and malignancy of tumor, inform the malignant degree.
6. Confirm the biological target of tumor for radiotherapy.
PET/CT accuracy in tumor diagnosis:
Tumor category
Lung Cancer
Colorectal Cancer
Melanoma
Accuracy
94%
90%
100%
Tumor category
Breast Carcinoma
Lymphoma
Ovarian Cancer
Accuracy
90%
95%
90%
5.2 General Cancer Treatments in Bangladesh
Surgery
Surgery or removal of tumor mass plays an important role in the diagnosis, staging, palliation
and treatment of localized cancers. In the early stage of solid tumors or breast, oral cavity,
uterine cervix, colon, prostate and skin cancer, surgery can encompasses a sufficient margin of
normal tissue through this cyto-reduction. Surgery requires the support of other specialties
including anesthesiology, blood transfusion services, pathology (especially onco-pathology) and
critical care nursing. It may also be used in post chemotherapy or radiotherapy to provide local
cancer control and better chances for adjuvant therapy. Surgery is also valuable in oncology
emergencies, to relieve bowel obstruction, promote cessation of bleeding, close perforations,
relieve compression, and drain ascites or pleural effusions. To enhance quality of life for
patients, surgery for reconstruction and rehabilitation can improve function and cosmetic
appearance. However, surgery has adverse effect in lethal or malignant conditions. It is not
advises at all to go for surgery if the cancer cell spread to other part of the body, hence
alternative treatment is mandatory. Each year a lot of worse case has been reported because of
the surgery in metastasis condition.
Radiotherapy
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Radiotherapy, the method of treating diseases with “ionizing radiation” is another important
methodology of local cancer treatment. Around 60-70% cancer patients require radiotherapy for
curative management before or after surgery. The ionizing radiation causes damage to certain
vital structures within the cells and render incapable of further multiplication. These damaging
effects on normal cells are less and reversible whereas irreversible in cancer cells. Palliative
radiotherapy is also of some value in cases of pain secondary to bone metastasis and tumors
causing bleeding or compressive syndromes.
Radiotherapy requires high technology equipment and skilled technicians; may be tele-therapy
(administered from a distance) or brachytherapy (treatment with radioactive substances within
body cavities or tissues). Tele-therapy is administered by cobalt machines or by accelerators with
similar clinical output. Recently most of the global cobalt machines are replaced by Linear
Accelerator. Brachytherapy is delivered by low dose rate, LDR devices (using cesium) or high
dose rate (HDR) devices using iridium or cobalt. HDR can be used for treatment of a wider
variety of cancers than LDR and reduces the need for hospital bed occupancy, but demands more
expertise and higher costs.
Radiotherapy may cause different side effects. Loss of appetite, nausea, and occasionally
vomiting persisting for a week is quite common for patients. The symptoms are mild in nature
and seldom noticed in about 10% of patients, and easily controlled by medicines. Other side
effects depend on the site irradiated and can include mucositis and bone marrow depression.
Long-term side effects may also occur.
Hyperthermia
Hyperthermia destroys tumor cell membrane first and also inhibits synthesis of DNA, RNA and
protein, which induces growth retardation and death of tumor cell; Hyperthermia increases
lysosome activity of tumor cell and cause acid hydrolase release in great amount, which lead to
rupture of epicyte, endochylema overflow and cancer cellular death eventually. Hyperthermia
prevents cancer cell from breathing, which increase anaerobic glycolysis and lead to
accumulation of lactic acid. Increased acidity cause enzymatic activity and cellular death.
Hyperthermia also protects, activate and improve immunity, which enhances the capacity of
cancer cell clearance which is far beyond comparison with traditional radiotherapy,
chemotherapy and even surgery.
Homeopathy
DCA, Dichloroacetate, a drug that kills cancer cells by exploiting a fundamental weakness found
in a wide range of solid tumors with well-studied tolerable side effects. It is a small molecule that
would able to cross the blood-brain barrier to reach otherwise intractable brain tumors. It works
in the human body to promote the activity of mitochondria. After the publication of a technical
paper on DCA in the Cancer Cell journal by Dr. Evangelos Michelakis of the University of
Alberta, it had gained wide popularity. Researchers of his time had assumed that the
mitochondria of cancer cells were irreparably damaged. With his colleagues, Michelakis used
DCA on the mitochondria of cancer cells—which promptly died. DCA is a simple compound
with minimum production cost. Thus, homeopathy evolution in cancer treatment had been
started.
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Sarder Homeo Hall (green road, Dhaka) is the leading one in homeopathic cancer treatment in
Bangladesh since 1978. Many cancer patients have completely cured following the prescription
provided by it but the ultimate recovery is not guaranteed in each case. Other homeo centers like
Arambag Homeo Hall, Green Homeo Hall are also improving in cancer treatment.
Chemotherapy
Chemotherapy is the milestone in cancer treatment. It applies cytotoxic chemo drugs (chemical
agent) to kill tumor cells, suppresses the growth and proliferation of cancer cells, and improves
the differentiation of cancer cells. A small list of cytotoxic chemotherapy drugs listed below: Alkylating agents that modify/damage cancer cell DNA and block the replication of
DNA, therefore interfering with the growth of cancer cells.
 Antimetabolites that block the enzyme pathways needed by cancer cells to live and grow.
 Antitumor antibiotics that block certain enzyme and cancer cell changes, thus affecting
DNA.
 Mitotic inhibitors that slow cancer cell division or hinder certain enzymes necessary in
the cell reproduction process.
 Nitrosoureas that impede enzymes that repair DNA.
25-30% patients require chemotherapy as primary or combinational therapy. It is curative in
certain cancers e.g. Hodgkin disease, high-grade non-Hodgkin lymphomas; palliative in many
cancers, and used as adjuvant therapy for some cancers including breast cancer, ovarian cancer
and colorectal cancer. However, chemotherapy is ineffective in hepatobiliary cancers, pancreatic
cancer, thyroid cancer, and central nervous system cancers among others.
Self-limited and reversible acute side effects of chemotherapy are usually fall in blood count,
hair loss, nausea; vomiting, constipation, diarrhea, anemia, and depression of the immune
system. There may be more drug specific side effects like cardio-toxicity, nephrotoxicity,
neurotoxicity etc.
5.3 Available Treatments in Collaboration with Fuda and
Modern Cancer Hospital:
Green Chemotherapy
Because of decreased immunity and normal tissue cell damage, patients sensibly cherish more
desired to have a therapy with less side effects. Modern Cancer Hospital Guangzhou (China)
modified conventional chemotherapy with means, minimizing its side effects while maximizing
the efficacy, which is believed to be a new chemical weapon to treat malignant tumor. With the
advantages of reduce side effects, those chemotherapies applied in the hospital are considered as
green chemotherapies. Advantages of green chemotherapy are many as increased therapeutic
effects shrink the tumor till it disappears; control the growth and metastases of tumor; palliated
symptoms and improved quality of life; it prolong the life expectancy of patients.
Green chemotherapy works in four separate ways: molecular targeted therapy, chronochemotherapy, local infusion chemotherapy, two-way infusion chemotherapy. Molecular
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targeted therapy is based on the theory of molecular biology and pathogenesis of cancer. It
kills cancer cells directly by specifically blocking the passage of epidermal growth factor
receptor without any mild damage to normal tissue cells.
In chrono-chemotherapy, chemotherapy is performed by multiple channels in accordance with
human biological clock, too. Chemo drugs will be given when tumor cells are active and
believed to be most susceptible while keeping normal cells inactive.
In Local infusion chemotherapy, anticancer drugs are infused through blood supplied artery to
target and kill the tumor with high drug concentration. To enhance the therapeutic effects and
effective destruction of residual cancer cells and tiny lesions while to minimize side effects at the
same time, chemo medicine is usually given in a local artery infusion manner. Subcutaneous
port-catheter is placed in a point, and one placement can serve many times of infusion
chemotherapy generally. Local intra-arterial infusion plus warm pleural infusion chemotherapy
consist of the Two-way infusion chemotherapy.
RFA
Multipolar Radiofrequency ablation (RFA) is a newly accepted minimally invasive paracentesis
to treat solid tumors. It is an image-guided technique that inactive and destroys tumor cells by
introducing a heat generator into the tumor. Ablation is such the process of targeting and affects
tumor strongly while no side effect happens to normal tissues around. The result of RFA is same
as invasive surgery like a special knife without operation; hence called “Ablation knife”.
Figure 13: The schematics of RFA Treatment
Procedure:
With needle of radio-frequency ablation and multipoint temperature monitoring system, RFA’s
highest temperature could reach up to 125oc. The safety is assured with the real time monitoring
over the targeted region during operation. Initial steps are local anesthesia and localization before
puncture. Then an electric probe with ten pins on the leading end is inserted into the tumor via
percutaneous (skin) puncture under image guidance like DSA (Digital Subtraction
Angiography), CT scan, type-B Ultrasonic, magnetic resonance guidance. Ten small pins would
stretch to grasp the tumor firmly like an umbrella when they open up. Under high frequency
current, high speed ionic vibration and friction would happen to the tissue around the pins to
generate heat, like a heating ball formation around tumor tissues. When the temperature reaches
80-100oc, tumor trapped by flames would be heated and coagulation necrosis occurs on the
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tumor and part of tumor cells would be killed. The procedure lasts about 30-45 minutes to die
away cancer cells.
RFA Advantages:
As a green therapy, it carries little damage to human body. No operation is needed here, only a
skin therapy would be performed with toponarcosis. After the distribution of puncture sub-needle
inside tumor, the relation of ablation electrode and tumor can be monitored precisely under 3D
imaging technique and possible to avoid blood vessels and blood arteries. RFA also features small
trauma, little pain, minimal side effects, stable therapeutic effect, fast restoration, short treatment
cycle, precise and safe, also same effect as surgical excision.
Applications:
RFA is frequently used to treat liver cancers; two most common types are: hepatocellular
carcinoma (a primary liver cancer) and colon cancer that metastasizes from the colon to the liver.
In general, RFA is most effective treating primary tumors that are less than one and a half inches
in diameter and the quantity less than 3gm.
Photon Knife
Photon Knife is also named as 3D-Conformal Radiotherapy and Multiple Fields Non-coplane
Conformal Therapy. It is the technique where the beams of radiation used in treatment are
shaped to match the tumor. Previously, radiation treatments were used to match the height and
width of the tumor, meaning that healthy tissue was exposed to the beams. More precisely
Identification and treatment of the tumor is possible because of advances in imaging technology.
Figure 14: An example of Photon Knife Treatment
Procedure:
Photon knife, shorted for photon isotron system, kills tumor cells by photon radioactive ray. It is
named as photon knife because of equivalence in effects as surgery. It uses the targeting
information to focus the tumor precisely while avoiding the healthy surrounding tissue. This
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exact targeting makes it possible to use the higher levels of radiation in treatment, which are
more effective in shrinking and killing tumors.
Advantages:
1、It is possible to avoid surgery, bleeding, suffering and risks. Photon radioactive ray cause
death of tumor tissue inside human body; hence minimize incidence of infectious complications.
2、It can be applied to many vital sites where surgery is not allowed, such as beside great
vessels of the heart, hilum of lungs and recurrent adhesive parts after surgery.
3、Multiple co-planes could be set based on dimensional shape of tumor for an overall attack to
tumor tissue.
4、Accumulated dose of multiple co-plane radiation makes it easy to provide fatal doses to kill
tumor.
5、Mulitple fields, multiple angles and conformal radiation are performed exactly to tumor
tissue under the control of modernized computer, with low rates for side effects.
Applications:
Photon Knife is most useful for tumors that are close to important organs and structures in the
body. It can be used to treat prostate cancer, cancer of the food pipe (esophageal cancer), lung
cancer, bladder cancer, pancreatic cancer, liver cancer, head and neck cancers, brain tumors etc.
PDT
Photodynamic therapy (PDT) is a non-invasive therapy using photo sensitizer and laser to
effectively destroy cancer cells which was approved by the US FDA for clinical application in
1996 and approved for clinical application by Chinese SFDA in 2003.
Procedure:
PDT is comparatively simple with minimal trauma to patients and also surgery less; it is easier
for patients to accept as it bases on the interaction of light with cancer cells. It needs to inject
photo sensitizer 48 hours before the treatment and infuse photo sensitizer into body through
intravenous drip. After photosensitizer enters the body normal cells excrete all the
photosensitizer out within 48 hours. So that photosensitizes will remain only in the tumor cells.
The tumor cell can be killed by the action of oxidation. The necrosis with occur on the process
tissues.
Advantages:
1. Low toxicity: Only the photosensitizer which goes into tissues reaches a certain concentration
and gets sufficient light-struck that the photodynamic reaction would be active to kill tumor cells
only.
2. Minimal invasive: Because it is not an operation, the pain is small featuring no wound.
3. Target oriented: The main target of photodynamic therapy is the lesions within illumination
and the little harm to surrounding tissues.
4. Rapid therapeutic effects: PDT action would take effects within 48 to 72 hours.
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Applications:
PDT can be used in mouth, esophagus, stomach, colon cancer and bronchus. PDT can also help
cancer patients indirectly to win the fight against cancer.
Endogenic Magnetic Field Thermatology
In endogenic magnetic field thermatology, electric field interfering is produced at intersection
where two currents of different frequencies square cross deeply in human body, which heats
tumor tissue up to 42.5℃～43.5℃ and lasts for more than 40 minutes. It not only has direct
cytotoxic effect on tumor cell, but also may improve therapeutic effectiveness of chemotherapy
and radiotherapy, improve immunity; thus, prevent tumor metastasis.
Figure 15: An example of Endogenic Magnetic field Thermatology
Principle:
Blood vessels are twisty and distended in tumor tissue, also resistance of blood flow is obstinate
and receptors of blood vessels are morbid which lead to its insensibility to temperature, poor
thermal diffusivity under heat, high focusing property and 5-10oc higher than normal tissue;
whereas the normal cell can endure high temperature of 42.5 - 43.5oc over a long period of time.
With high focusing property, Endogenic magnetic field thermatology system kills tumor cell
(that of 5-10 oc temperature more than normal cells) by heating the tumor without affecting
normal cell or any ill effects like arrest of bone marrow or phalacrosis etc.
Advantages:
1.
2.
3.
Very little side effect
Precise temperature control by sophisticated computer system
Heating to superficial and also deep-seated tumors
Applications:
1.
2.
3.
Mainly superficial tumor
Thoracic ascites
Deep-seated tumor of thoracic cavity, abdominal cavity and pelvic cavity
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4.
Lung cancer, esophageal cancer, gastric cancer, intestinal tumor, liver cancer, oophoroma
and uterine cancer etc.
Interventional therapy
Growth and spread of tumor depend on formation of vessels through which tumor obtains
necessary oxygen and nutrition. Thus blockage of tumor vessel can cut down the blood supply
leading to death of tumor cell due to shortage of oxygen. The combination of interventional
embolization and chemotherapeutics are known as chemo interventional embolization. Also,
anti-cancer drugs are infused into tumor tissues through catheter under CT guidance to starve
cancer cell. The key of getting remarkable curative effect is to ensure precise chemical medicine
injection and suppository with puncture vascular anatomy and imaging foundation.
Advantages:
Featuring small wound and minimum side effects, interventional chemotherapy is especially
suitable for the patients in middle and advanced stages. It can relieve the pain and extends
patients life.
Cryotherapy
Cryotherapy is the medical technique popular in both ancient and modern times. Ice was used to
treat infected wounds and various knife injuries thousands of years ago. Ar-He knife, a kind of
cryotherapy is the first technique employing space rocket guidance technology with efficacies of
ultra-low temperature and thermotherapy. Ar-He knife is the precise apparatus approved by the
US FDA for accurately targeting and killing cancer cells.
Principle:
Cryotherapy, an important ablation procedure, made up of ultra-low temperature and
thermotherapy. The temperature of freezed tumor tissue could reach 120-165oc below zero in a
dozen of seconds and turn into ice ball when the Argon gas is quickly released through needle
point. The tumor tissue inside the ice ball is trapped in a “starving and extreme cold” condition;
no blood or oxygen supplies could be maintained in the ultra-low temperature of 165oc below
zero and results in the coagulation necrosis. For instance, this ice-ball surrounds the huge lung
tumor or others which is 1cm around the tumor. Ice crystals form rapidly inside and outside of
the tumor cells’ venule and arteriole. The temperature, in contrast, could reach 20-40oc when
Helium is rapidly released through needle point; the freezed ice ball is then defrosted and
blasted, hence destroyed completely. The speed and duration of that cooling-heating as well as
size and shape of ice ball can be precisely monitored and controlled.
Procedure:
Cryotherapy, like an ordinary injection, insert freezing needle (percutaneous) into tumor and
infuse Argon to cause rapid drop in temperature inside tumor and then switch to Helium to heat
the ice ball under ultrasound or CT guidance. At least two cycles of alternating cooling and
heating procedures is employed. Freezing is supposed not to be suspended until ice ball covers
the whole tumor and its surrounding tissues of 5 to 10mm in thickness. Multiple freezing needles
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should be employed for larger tumors. Sometimes, two or three procedures are required when
necessary.
Advantages:
1.
2.
3.
4.
Physical therapy with low rates of side effects with high achievement ratio
Surgery-free, mild bleeding and minimally invasive, also cost-effectiveness
Possible to apply to almost all kinds of solid tumors
It can be performed alone or in conjunction with chemotherapy and radio therapy
or other surgery
5. Remarkable therapeutic effects, easy maintenance and patient-friendly
6. As tumor recurrence is often detected after surgery, this procedure can be used for
cancer anti-recurrence
Biological therapy
The biological therapy mobilizes immunocompetence by mobilizing defense mechanism of the
body or having aid from biological agent. Biological therapy includes cytokine treatment,
immune cell therapy, gene therapy, molecular targeted therapy and antibody treatment etc. First,
it needs to draw immune cell from patient, then culture the cell in vitro using bio technology and
biological agents; later give the cell antigen information of killing tumor cell. Finally, culture the
cell in large amount. After the preparation, it needs to re-infuse the cells with antigen
information back into patient’s body. These cells are just like missiles, which attacks and kills
tumor cells actively without hurting normal tissues.
Biological Immunotherapy
Biological Immunotherapy, a kind of tumor biotherapies kills and wounds tumors directly or
induces into patients the anti-tumor immunoreactions via transfusing immunocyte with antitumor
activity.
Human are born with an immune system which gives a protective reaction when invaded. It is
like an armed force which will attack and destroy external bacteria virus and variant cancer cells
as long as they enter the human body. Generally, cancer patients have low immunity;
immunocyte in their blood are insufficient in fighting against cancer cells' development, which
resulted in the unceasing multiplication and spreading. Immunotherapy effects by increasing
immunocyte amount to restore human immune function and to strengthen human body’s
immunity to cancer.
Procedure:
Initially, patients are given injection to increase immunocyte amount in blood; next, to draw
some blood sample from the patient via blood machine and collect mononuclear cells of
autologous peripheral blood, then send it to a special laboratory where immunocyte in slight
amount will be separated out for clonal propagation. About ten days later, larger amount of
immunocyte (such as DC cell) would be cultured and then transfused back into patient's body, so
that patient's immunity can be strengthened by increasing immunocytes amount (increasing
human body guard) directly.
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Figure 16: An example of biological immunotherapy procedure.
Advantages
Immunotherapy uses patient’s own immunity to resist and combat against cancer cells. Although
they have been cloned and propagated in lab, the immunocytes are still patients’ own cell. So
they will not result in reject reaction; therefore, it is the safest treatment with fewer side effects.
Immunotherapy may reinforce therapeutic efficacy as it reduce the possibility of relapse or
metastasis.
Stem Cell Transportation
Stem cell technique is one of the regenerative medicine technologies that adopt autologous stem
cells for implantation. Stem cells are just like trees that can sprout branches and leaves, blossom
and fruit. Scientists define stem cells as a primitive cell possesses’ self-renewal capacity and
multiple-differentiation potential. They are also called "multifunctional cells" by medical circle
as they can differentiate into a variety of functioning cells (such as skin, muscle or bone) and
histoorgans under certain conditions. Stem cells are from two sources: embryos which are
formed during the blastocyst phase of embryological development (embryonic stem cells) and
also adult stem cells (tissue).
Some natural creatures have regenerative functions like house lizard can regenerate missing tails
and leaches can regenerate whole body by tiny body segments etc. This magical regeneration
technique has stimulated scientist’s interests to pry the profound mystery and apply this
technique to modern medicine. To use for transplants, three possible sources of stem cells are:
bone marrow, the bloodstream (peripheral blood), and umbilical cord blood from newborns.
Although bone marrow was the first source used in stem cell transplant (1950), peripheral blood
is used most often today.
Procedure:
First step of stem cell therapy is to take bone marrow blood and embryonic tissues from patient,
second to isolate, purify and multiply stem cells in vitro ( outside the body, through breadboard
cultural method); third, to transfuse stem cells’ suspension back to patient’s liver, next, stem
cells would settle in the liver and differentiate into hepatic cells.
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Figure 17: The process of stem cell transportation.
Key factors determine the effect of stem cells implantation:
1. Stem cells’ qualitative factor.
2. Input means. Hepatic artery interventional therapy, portal vein input method, intravenous
infusion and trans-hepatic implantation are used internationally.
3. Efficient treatment circle based on patient’s specific conditions and less spending.
Clinical applications
It implants the in vitro cultured stem cells into human body via specific implantation technology
to replace natural or pathological dead cells. It is an epoch-making revolution for treating varied
intractable diseases (e.g. hepatic cirrhosis). Currently, stem cells implantation are internationally
used for treating type 1 and type 2 diabetes, diabetic foot, hepatocirrhosis, serious disease of the
liver, nephritic syndrome, lupus nephritis, femoral head necrosis, myasthenia gravis, masculine
sexual dysfunction and peripheral vascular diseases, those are very hard to be treated via
conventional therapies.
Table 3: Available Cancer Treatments in Bangladesh with their application area
SL
1
2
3
4
5
6
7
8
9
Treatment Name
Application Area
Chemotherapy
Surgery
PET/CT
RFA
Green Chemotherapy
Photon Knife
PDT
Endogenic Magnetic
Field Thermatology
Cryotherapy
Bone Cancer, Breast Cancer
Lung Cancer, Breast Cancer
Breast, Lung, Prostate, Brain Cancer
Liver cancer
Kidney Cancer
Prostate, Lung, Bladder, Liver, Esophageal, Brain, Pancreatic
Mouth, esophagus, stomach, colon and bronchus
Esophageal cancer, lung cancer, gastric cancer, intestinal tumor,
liver cancer, Oophoroma and uterine cancer etc.
Prostate cancer. Lung Cancer
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6. Conclusion
A large number of cancer patients sought treatment abroad due to a lack of trust in local
physicians and in the service system. Local medical personnel should address the reason behind
patients seeking treatment abroad and make the achievements in cancer treatment easily
accessible to the masses. Mechanisms should be set up to decide the guidelines for integrating
treatment resources with early diagnosis and screening programs. A number of recommendations
are needed including bringing down the costs of diagnosis and therapy, creating mass awareness
on food habits and lifestyle, diagnosis with molecular technology, adequate pathological
facilities, easy procurement of diagnostic and therapy equipment, post-procurement service,
public private partnership and designated cancer treatment centers. Immunization program,
training of radio oncologists, medical physicists and technicians, national seminar and
conferences are also mandatory. In addition, treatment approaches should include psychosocial
support, rehabilitation and close coordination with palliative care to ensure the best possible
quality of life for cancer patients.
7. Reference
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
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