ONCOLOGY PATIENTS

Oncological therapies

The primary objective of cancer treatment is eradicating the disease.
In the case of metastasised disease and/or advanced stages, the objective is palliative care, prolonging life while maintaining an appropriate quality of life.
Therapies can be aimed at combating the tumour (tumour treatments) or alleviating the symptoms caused by the tumour or the treatments (palliative care).

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TREATMENTS

ONCOLOGICAL THERAPIES

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Oncological radiotherapy uses ionising radiation alone or in combination with other therapies for locoregional treatment of cancer and other non-neoplastic diseases that bring about changes to genetic material.

Radiation penetrates the material medium (organs or body parts) and interacts with it, releasing energy and triggering biological alterations in living tissues, especially in cancer cells, to combat them and cure the patient.

Approximately 60–70% of cancer patients receive some form of radiotherapy during the course of their disease.

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The aim of treatment may be:

  • Curative/radical: To cure the patient and/or prolong disease-free survival.
  • Palliative: To control secondary symptoms of the tumour or its metastases (pain, compression, haemorrhage, etc.).
  • Prophylactic: Irradiating a region of the anatomy with high risk of metastatic lesion after radical treatment.

Radiotherapy can be administered as follows:

  • Exclusive/radical: The patient receives only this treatment.
  • Neoadjuvant: Administered prior to other cancer treatments.
  • Adjuvant: Administered after other cancer treatments.
  • Intraoperative: Administration in a single, high dose during surgery.
  • Concomitant: Administered at the same time as chemotherapy in order to obtain better results than if they are administered separately.

Radiotherapy can be administered in two ways:

  • External: The radiation source is at a distance from the patient (linear accelerator).
  • Internal: This treatment uses encapsulated radioactive isotopes that are introduced into the patient's tissue or natural cavities. This is known as BRACHYTHERAPY.

Scientific and technological advances of recent decades have made it possible to perform radiotherapy with great precision, which mitigates and minimises side effects.

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Side effects that may occur regardless of the area treated

  • Fatigue
  • Weakness
  • Anorexia
  • Anxiety

Haematologic abnormalities

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Adverse side effects caused by ionising radiation are locoregional side effects in the treatment area that result from the effect on the surrounding healthy tissue in the tumour area.

  • Acute side effects appear during treatment or immediately after concluding treatment, are usually reversible, and disappear without clinical complications. Acute side effects appear earlier in tissues with a high capacity for rapid cell proliferation, such as mucous membranes, bone marrow and skin.
  • Late side effects occur after a latency period of months or even years after radiotherapy has been completed. They are generally considered irreversible and progressive. Tissues with a slower reproductive capacity will be more resistant to irradiation, with side effects appearing later.

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RADIATION DERMATITIS

Radiation dermatitis involves more or less pronounced alterations to the skin in the radiotherapy treatment area. It is related to the total radiation dose and dose fractionation, the size and location of the treated area, the irradiation technique used, consecutive and/or simultaneous treatments, and individual patient variables. This is the most common side effect.

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ORAL MUCOSITIS / XEROSTOMIA

Mucositis is an inflammatory reaction to radiotherapy that appears as erythema, swelling or ulceration. This can cause pain and bleeding and increases the risk of superinfection. The affected mucosa appears reddened and swollen.

Xerostomia is the feeling of a dry mouth due to a decrease in saliva production caused by a dysfunction of the salivary glands. Saliva in the oral cavity is very important for preventing an imbalance of microorganisms in the oral cavity (dysbiosis), which can lead to tooth decay, gum disease, bad breath, and other conditions.

Xerostomia is characterised by lower quality (more viscous and stickier) saliva and less saliva. You may also notice a salty taste that makes chewing, phonation and swallowing more difficult.

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VAGINAL MUCOSITIS

Vaginal mucositis is inflammation of the mucous membrane that lines the vagina. It can happen as the result of cancer treatments and is reversible.

Symptoms may include pain, burning, itching, redness, swelling, abnormal vaginal discharge and discomfort during sexual intercourse. It is important to consult your oncologist if these symptoms appear.

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Chemotherapy involves administering one or a combination of several antineoplastic cytotoxic agents. Most of these agents are administered intravenously, but they can also be administered intramuscularly or orally.


They have a systemic effect in the body and cause side effects in tumour cells as well as healthy tissue. The frequency and length of chemotherapy treatment depends on the type of cancer, the goals of the treatment, the drugs administered, and how well the body responds to treatment.

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Transient side effects

1. Haematological side effects

  • Anaemia, which causes tiredness due to a reduction in red blood cells.
  • Increased risk of infection due to a decrease in white blood cells.
  • Increased risk of bleeding due to a decrease in platelets.

2. Mucosal side effects

  • Oral, vaginal, rectal or other mucositis.
  • Pain and increased risk of bacterial and/or fungal superinfection. Bleeding may occur.

3. Neurotoxicity:Neuropathies in the hands and feet that cause tingling, sensory disturbances, pain and reduced strength.

4.  Alopecia:Partial or complete hair loss.

5. Alterations to the fingernails and toenails that can lead to changes in:

  • Pigmentation: Melanonychia (darkened nails), leukonychia (whiteness of the nails) and Beau's lines (ridges or dents).
  • Bacterial/fungal infection: Periungual lesions (paronychia or pyogenic granuloma).
  • Structure, growth and thickness: Toxic effects on the nail plate. Changes to pigmentation, weakness and/or brittleness, onycholysis and onychomadesis. Subungual splinter haemorrhages (weak, thin and brittle nails).

 6. Muscle and joint pain

7. Ovarian toxicity:Can cause irregular or absent periods, which may or may not improve later. In addition, the absence of menstruation is often accompanied by menopausal symptoms such as hot flashes, irritability, loss of bone mineral density, vaginal dryness, etc.

8. Cardiac toxicity: Can lead to tiredness, swelling, a choking feeling, and angina pectoris (rare).

9. Liver toxicity: Inflammation of the liver caused by cancer medications. It is important to watch for symptoms such as jaundice, abdominal pain, fatigue, nausea and vomiting. If you experience these, tell your oncologist.

10. Kidney toxicity: Damage or injury to the kidneys caused by cancer drugs. The kidneys are responsible for filtering and excreting waste products and toxins from the body, so damage that impairs their function can have serious health consequences. Symptoms of kidney toxicity can include changes in urine, swelling, fatigue, nausea, vomiting, itchy skin and changes in blood electrolyte levels.

11. Pneumonitis: A rare side effect. It is inflammation of lung tissue caused by cancer drugs, which usually improves with appropriate treatment. It is important to pay attention for symptoms such as shortness of breath, persistent cough or chest pain. Tell your oncologist if you experience these.

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Permanent side effects

1. Cardiomyopathies
2. Neurotoxicity (peripheral sensory neuropathy)
3. Sterility

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Surgery

Oncological surgery is the speciality that focuses on treating cancer and its complications with surgery.

Surgery is currently used as a curative treatment option for many types of cancer and is often combined with other treatments such as chemotherapy and/or radiotherapy as part of a multidisciplinary approach to cancer.

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Other therapies

Immunotherapy represents a major revolution in the advancement of cancer treatment. It reactivates and stimulates the patient's defences in the fight against tumours and uses a range of products of biological origin.

Oncological therapies are classified as:

1. Biological therapies

  • Non-specific immunotherapies
  • Oncolytic viruses
  • Cancer vaccines
  • CAR-T cell

2. Targeted therapies

  • Monoclonal antibodies

Small-molecule therapies

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