Study investigators from Wake Forest fine-tuned the therapy by employing iron-comprising MWCNTs (multi-walled carbon nanotubes – strands of hollow carbon which are ten thousand fold finer in comparison to a hair in humans) that could be traced inside the body of a patient via the usage of Magnetic resonance imaging (MRI), thus facilitating improved precision delivery of laser therapy and thus enhanced targeting of neoplastic tissue.

The study finding was presented by Xuanfeng Ding, M.S. during the fifty-second AAPM (Annual Meeting of the American Association of Physicists in Medicine). During lab trials, the research group exhibited that a MRI scanner could be used for imaging such particles in animate tissue, observe as they approach a tumor, scorch them using a laser and annihilate the tumor in this process.

In case this sounds like Sci-Fi, it surely isn’t as the work is designed on an investigative method for cancer treatment- LITT. LITT functioning is based on the principle that particular nanoparticles such as MWCNTs could soak up energy from the laser and then transform it to heat. In case zapping nanoparticles while inside the tumor could be done then they would simmer off the energy as heat and obliterate the cancer cells.

But a minor snag with LITT is that even as a tumor could be noticeable lucidly during medican scans, the same is not true in case of nanoparticles. Following administration via shot form, such nanoparticles cannot be traced that might endanger the patients in case nanoparticle zapping is done far the tumor since the abnormal heat can obliterate normal tissues.

The Wake Forest Baptist group have proven for the foremost instant that the nanoparticles could be made noticeable during MRI scanning to facilitate imaging and scorching at the analogous instant. When the MWCNT particles are loaded with iron, they could be easily spotted in during MRI scanning. Employing tissue comprising of rodent tumors, the researchers were able to show that such iron-comprising MWCNT particles could obliterate the tumors after being knocked off with the laser.

Dr. Ding pointed out that to locate the precise site of nanoparticles in the body of humans is critical to therapy. He stated that it was truly enthralling to observe the nanotube labelled tumors start shrinking following therapy.

The outcomes are a segment of the multidisciplinary project carried out by Ding and helmed by Suzy Torti, Prof. of biochemistry, Wake Forest Univ.

An earlier research conducted by this team had shown that laser induced therapy treatment employing a closely-associated nanoparticle, in fact, augmented the long-standing survival in rodent tumors. The subsequent approach by this team is seeing whether the iron-contained nanoparticles could do the analogous thing.

In case this work turns out to be a success, it might be helpful for cancer patients in future, although the technology would have to be proven risk-free and effectual in scientific studies.

Surgery is the main line of treatment for penile cancer along with radiotherapy and chemotherapy. Penis preservation and reconstruction is possible in recent times due to latest operative techniques.

Surgery

The treatment of small-sized cancers located on the surface and not yet metastasized is done by removal of solely the malignant area and small extent of the adjoining area. The removal of the cancer is carried out with the assistance of conventional surgery employing laser or cryotherapy (an iced probe is used for freeze-killing the cancerous cells).

In case only the foreskin has been affected, then circumcision could be done as part of the treatment.

All of the above mentioned treatments are generally on an outpatient basis and could be administered under the influence of local or general anaesthesia on the basis of individual situations.

Wide local excision
In case the cancer has metastasized to a larger area then wide local excision is performed wherein the cancer along with a small section of bordering adjacent normal tissue is removed. The bordering adjacent tissue is vital as it lowers the chances of cancer recurring in the future.
The operative procedure is done under the influence of general anaesthesia and requires a brief hospital stay.

Preservation and Reconstructive Surgery
In case of larger sized cancers present on the penis head, the globular part or the glans would be removed. Under such circumstances, the previous normal appearance could be restored by grafting a part of the skin taken from any other part of the body.

Hospitalisation of nearly 5 days would be necessary and regular wound dressing would be needed for nearly two weeks.

Penectomy
In case the cancer spread is large and has covered a major part of the penis, then partial amputation (partly removing) or total (complete removal of the penis). The operation most apt for the patient would depend on the location of the tumour. In case the tumour is located close to the penile base, then total amputation is the sole choice. This form of operation is presently done less often, as doctors generally are able to preserve the penis.

Reconstructive surgery
In case there are no symptoms of the cancer having metastasized, then penis reconstruction subsequent to amputation could be performed.

This is another kind of operation wherein the procedure performed involves removal of a small part of the skin and the muscle from the arm and utilising it for reconstructing a new penis. At times reconnection of few of the nerves could be done by the surgeons for facilitating sensation and the requisite blood flow for allowing the reconstructed penis to be have an erection.

There could additionally be the removal of a diminutive number of lymph nodes from the groin region for checking whether the cancer has metastasized. In case there is perceivable enlargement of the nodes in the groin area, then generally the course of treatment would involve the removal of all the glands in the groin.

Radiotherapy
Radiotherapy is the treatment of the cancer employing high-power rays for obliterating cancer cells while preserving as much of normal cells as possible.

Radiotherapy is infrequently employed as an alternative to surgery when the person is not fit enough to undergo surgery or does not desire to undergo surgery.

Radiotherapy could be employed for the treatment of lymph nodes that have been affected in the groin part for reducing the risk of the cancer metastasizing.

Radiotherapy could also be employed for treatment of symptoms like pain in case the cancer has reached other areas of the body such as the bones.

External radiotherapy
It is generally administered as a sequence of brief treatments given on a daily basis wherein high power x-rays are focussed onto the location of the cancer with the assistance of a machine. The treatment is generally offered on weekdays and each session lasting for about fifteen minutes. The number of treatments that would be given are dependent on the kind and size of the cancer, however the complete course for treating early stages of the cancer normally lasts for about 6 weeks.

Prior to the radiotherapy session, the radiographer would accurately position the patient on to a seating place. The patient would be alone in the room during the course of the session and can communicate with the radiographer who could view and speak to the patient from another room.

Radiotherapy is a painless procedure; however one is required to stay totally motionless for few minutes during the treatment session.

Radioactive Implants
Radioactive implants also called brachytherapy could be given during radiotherapy. Under the influence of general anaesthesia, tiny radioactive wires are meticulously placed on the inflicted spots of the penis. The wires remain in their position for nearly five days and are then taken out. This form of treatment is generally employed for treatment of smaller sized cancers located on the glans. When the implants are positioned on the penis, the person would be required to remain in a secluded room in the hospital to avert needless radiation exposure to others.

Side effects
At times there could be side effects that could arise due to radiotherapy treatment. By the time the person reaches the concluding phases of the treatment, the skin on the penis could turn tender and could break down. Long-standing radiotherapy could cause the normal tissues to thicken and stiffen (fibrosis). In few men, it could lead to the tube carrying urine via the penis (the urethra) to narrow thus causing immense discomfort during passage of urine. In case there has been urethral narrowing, then it could be treated by a surgery for stretching or dilating the area. This is performed by inserting a fine tube into the urethra and done under the influence of general anaesthesia.

Chemotherapy
It employs the use of cancer-combatant or cytotoxic drugs for annihilating cancerous cells. It could be administered with a single drug or many drugs given together. Chemotherapy is at times given for the treatment of very small-sized, early stages of cancers that are restricted to the foreskin and the glans (end of the penis).

Chemotherapy could be administered in tablet form or via injection, intravenously in case of highly advanced stages of the cancer. It could be given alongside surgery or radiotherapy or both.

The benefits of laparoscopic and other minimal invasive operative approaches are widely acknowledged. Subsequent to laparoscopic surgery there are briefer hospitalization, lesser pain endured and swifter recuperation. NewYork-Presbyterian/Weill Cornell have been offering these techniques since long, and are continuing to be vanguards of improvement, using the minimally invasive technique to ailments and conditions that were earlier deemed curable solely through open surgery approach. Till lately, rectal cancer was one such ailment and treating it through laparoscopic surgery continues to be debatable.

Dr. Jeffrey Milsom, chief of colon and rectal surgery from the NewYork-Presbyterian/Weill Cornell stated that rectal surgery is intrinsically more complicated as compared to colon surgery. As the pelvic space of the body where the rectum is located is a tapered cavity that makes rectal tumors quite inaccessible. Operative success is dependent on not just the total extraction of the malignant tumor and repairing the rectum, but also on reinstating continence. Hence due to these grounds, rectal cancer has been a tricky ground for application of advancements in minimally invasive surgery.

The preliminary reports on the usage of laparoscopic surgery among patients with rectal cancer illustrated an increased occurrence of cancer-positive cells present at the periphery of the extracted tumors when evaluated against open surgery. The surfacing of these reports has lead to matters getting postponed further. Former data implied that as an outcome, more number of patients’ cases could undergo a local relapse of rectal cancer subsequent to laparoscopic surgery as compared to open surgery. However, the present study rebuts these preliminary findings.

In between January 1999 – December 2006, 3 colon and rectal surgeons namely Dr. Milsom along with his associates Dr. Toyooki Sonoda and Dr. Sang Lee carried out treatment on 103 patients having central or lower rectal cancer employing a surgery known as total mesorectal excision (TME), conducted through laparoscopic-assisted (LAP)or hand-assisted laparoscopic (HALS). To collect pertinent information and investigate results, Dr. Milsom and his group depended on in-patient and out-patient medical documentation, telephonic interrogations with patients and benchmark actuarial survival computations. Regular follow-ups for these patients were done till 5 years.

Dr. Sonoda, one among the chief surgeons of the study proclaimed that these results were at par with the best results noted in open surgical approaches for cancer treatment and recovery. He further added that when one sums in all the benefits of laparoscopic surgery, it appears distinctly obvious that this is a technique that has the potential to develop into the surgical benchmark.

Accounted for in the initial part of the present year in the specialized academic journal of the American Society of Colon & Rectal Surgeons, the study was carried out in one organization. This detail alongside its moderately small-sized sample, dearth of randomization and comparatively squat follow-up time period all suggest the requirement of large-size, randomized researches prior to the discoveries being deemed ideal.

Dr. Milsom cited that his operative team is presently partaking in two similar studies, one in partnership with the American College of Surgeons Oncology Group or ACSOG.

The staging of the cancer is the extent of cancer proliferation. When colon cancer gets diagnosed, the doctor would ascertain the stage in which it lies in order to decide the best course of treatment. The stages of colon cancer include:

• Stage 0 (Duke A stage) – The foremost stage wherein the cancer is restricted to the mucosa or inner lining of the colon or rectum – additionally known as carcinoma in situ.
• Stage I (Duke B stage) – When cancer has spread from the inner lining of the colon or rectum, but has still not reached past the rectum or colon wall.
• Stage II (Duke C stage) – The cancer has metastasized through or within the colon or rectum wall though not yet spread to the close by lymph nodes.
• Stage III (Duke D stage) – The cancer has spread to the close by lymph nodes, though other body parts are still spared.
• Stage IV (Duke E stage) – When the cancer has metastasized to other regions of the body, inclusive of the other organs like the liver, the membrane that lines the stomach cavity, lungs or ovary.
• Recurrent – The cancer has relapsed subsequent to treatment and could majorly impinge on the rectum, colon or other areas of the body. Researchers have uncovered that the occurrence of biomarker in the regional lymph nodes is a self-determining interpreter of disease recurring in those with colorectal cancer.

Colorectal Cancer Treatment

The line of treatment is decided on the basis of varied factors like the size and location, the cancer staging, if or not it is recurring, and the present general health condition of the patient. Treatment alternatives involve chemotherapy, radiotherapy and surgery.

• Surgery – This is the most widely used treatment method for colorectal cancer wherein the malignant tumors and any lymph nodes in their vicinity would be taken out. The lymph nodes are removed during the operative procedure as they are the foremost location where the cancers tend to proliferate to. At the end of the operative procedure the bowel is sutured. In particular cases, the rectum might need to be totally removed and a colostomy bag would then be attached as a substitute for drainage purposes. The colostomy bag is used in collection of feces and is normally placed provisionally – at times it might be a long-standing measure when the ends of the bowels cannot be joined. In case of early cancer diagnosis, the surgery might be the sole treatment essential in curing colorectal cancer. The surgery would aid in allaying the symptoms even if it occasionally could not cure the cancer.
• Chemotherapy – In this procedure a chemical or medicine is given either orally or intravenously for annihilating the cancerous cells. It is generally a pre-surgery procedure in order to shrivel the tumor. A study revealed that advanced colon cancer cases that were given chemotherapy and that had a family history of the disease, were observed to have a notably lower probability of cancer relapse and fatality.
• Radiotherapy – Radiotherapy employs high-power radiation rays for obliterating the cancer cells, and additionally impedes their proliferation. This form of treatment is widely used in treating rectal cancer or as a pre-surgery procedure for shrinking the tumors. At times a combination of chemotherapy and radiotherapy are offered following surgery for lowering the likelihood of a relapse. Researchers from the Medical College of Wisconsin Cancer Center at Milwaukee have discovered that the CXCL12 protein that is usually responsible for controlling movements of the intestinal cells have the potential of impeding the spread of colorectal cancer.

Prognosis (Chances of Recovery)

If not treated, the malignant tumors would metastasize to other areas of the body. The likelihood of total recovery depends majorly on how promptly the cancer was detected and treated. The recovery would depend on numerous factors like:

• The staging of the cancer during the time of detection.
• If a hole or obstruction was formed in the colon due to the cancer.
• Whether the cancer has relapsed.
• The overall health condition of the patient.

Colorectal Cancer Prevention:

The likelihood of developing colorectal cancer could be majorly lowered by adopting the following strategies:

• Undergoing routine screenings – This is particularly important when one has previously developed colorectal cancer or one is past sixty years of age, having a family history of cancer or having Crohn’s disease. Few experts have stated that people should carry out regular screening once they have crossed fifty years of age.
• Nutrition – Consuming daily diet rich in fiber, fruits, veggies and good-quality carbohydrates. Lowering or if possible, stopping the intake of red and processed meat. Substituting saturated fats with optimal-quality fats like avocado, olive oil, fish oil and nuts. But a confounding study has revealed that in spite of vegans having an overall reduced risk of getting cancers, their chances of developing colorectal cancer is much higher in comparison to meat consumers.
• Exercise – Inculcating moderate forms of physical activity on a regular basis has proven to have a major affect on decreasing the chances of developing colorectal cancer.
• Maintaining idyllic bodyweight – Maintaining a healthy body weight as those who are overweight or obese increase their chances of developing several cancers inclusive of colorectal cancer.