Talking about cancer

1988/06/01 Agirre, Jabier - Medikua eta OEEko kidea | Irazabalbeitia, Inaki - kimikaria eta zientzia-dibulgatzaileaElhuyar Fundazioa Iturria: Elhuyar aldizkaria

The San Sebastian Oncology Institute is known for its great work in the field of oncology. In this same annex, Dr. Irigarai provides illustrative details on the history of the Institute. To know the current situation, we went to the doctors Jesus Mª Karrera and Lurdes Aritziturri and the nurse Mari Jose Pérez.
Jesús Mª Karrera and Lurdes Aritziturri.
Elhuyar- What progress has been detected in the treatment of cancer?

Answer - Saying what advances are observed in cancer treatment is not a simple matter. For example, cancer does not have the only cause. Advances should be seen from different aspects, such as epidemiology and prevention.

What does Onkologikoa do on a preventive level? On the one hand, in the field of prevention, it carries out a series of radio programs in the form of presence or information. On the other hand, it cannot have a great presence in the press, which is a hospital and not a newspaper. Many times we see that we cannot distribute the information as we want, but that is out of our hands. We have a triptych to promote prevention and facilitate early diagnosis.

In the US, approximately 50% of cancers are cured. Our level is 35%. This 15% difference can be eliminated by carrying out adequate preventive work without major difficulties.

Elhuyar- What do you do about early diagnosis?

Answer- Early diagnosis only makes Onkologikoa, especially in women. Breast cancer and gynecology cancer. At the gynecological level, the Papanikolau cytology and the breast cancer mammography are performed.

Tool used in the treatment by cesium.

The thermographs and are not usually performed. Discarded technique. Usually scans are performed and then a mammography and a xerography are requested. In a few xeromamographies. Then cytology, but as screening or screening. The most used are exploration and mammography.

Elhuyar- In what scope do you make an early diagnosis with men?

Answer - What we are doing in men is at the level of otorrino (larynx) and at the level of digestive system (right). Currently, diagnostic blood culture and bleeding tests are mainly used.

On the other hand, the techniques currently used in the diagnosis are the scanner and nuclear magnetic resonance. We do not have this type of tools in the Oncological Institute, since in Gipuzkoa there are other centers and it is not necessary. When we need a scanner, we take the patient to the Residence where the scanner is made. These techniques are used to check the size of the tumor. We normally use ultrasound and radiography for this task. In the field of nuclear medicine we make gammagrafía.

A highly developed technique lately is that of monoclonal antibodies. It has two applications: one for being able to identify the tumor at the diagnostic level and another at the treatment level. This last aspect is not yet very advanced. Monoclonal antibodies introduce the drug into the body and take it directly to the place where the tumor is located. A treatment of this type presents evident advantages for being direct and specific. The drug should not rotate throughout the body to reach the tumor. Thanks to monoclonal antibodies it will move directly to the necessary place.

Another technique that we use for diagnosis is that of markers. Markers are substances that cause diseases in the body and indicate the presence of tumors. They are unspecific and do not have sufficient sensitivity to determine the tumor. They are identified by blood tests.

Elhuyar - What can you say about treatment?

Electronic microscope.

Answer- We mainly work at the surgical level. We perform the so-called conservative or non-mutilating surgery. In mastectomies, for example, the previous trend was to remove all the breast (as we have done here), but the current trend is to keep the breast as much as possible. We try to remove only the tumor instead of mastectomy. Subsequently, the radioactive iridium needles are placed around the place where the tumor was located.

Depending on the size and degree of penetration of the tumor, a load is applied to the iridium. These needles are usually implanted a few days, for example three days. It is a very suitable technique because it only has a local effect. These needles are also used in lesions of the lips, tongue, and cheek, apart from the breasts.

However, when the tumor is removed, the entire breast is not removed and the prosthesis is applied in the same intervention, in this case silicone.

Another technique used in treatment is surgery and radiation therapy, interoperative radiation therapy. When the patient's body is open in the operating room, it is taken and taken to the radiology service. There we give him the necessary dose with Betatron and we close the operating room again.

Elhuyar- When is interoperatory radiation therapy performed?

Answer - First the operating theatre is accessed and it is checked if the disease can be eliminated by intervention. Many times it is not possible and then it leads to radiation therapy and finally returns to the operating room to finish the operation. For example, let's take the case of a brain tumor. Open the patient and see that the tumor has poor location. Then the Betatron is applied to remove the tumor.


This is surgery, but in the field of radiation therapy there are treatment sessions. Betatron is important because it is technically better. Formerly the radio was used. Currently it is done with a probe, applying the sessions from outside. It is not necessary to implant or place radio needles. It is more comfortable for the patient.

Elhuyar- We have heard that you also do treatments with tranquility.

Answer- We use the laser above all at the gynecological level and of otorrino. At the gynecological level, if the tumor is small, a laser evaporation is done. The laser does not operate. This takes some points and aromatizes their tissues and the wound in them can be cured.

It is also used at the level of otorrino, but at the level of otorrino one cannot speak of antitumor use. The effects of the laser on tumors are not yet proven. When there are problems, such as obstruction, it is used to open, expand.

The final point to treat is immunotherapy, that is, the use of the resources that the body itself generates. The body produces a number of substances to fight the disease. Our job would be to enhance these substances, extract some cells from the body, manipulate them and re-introduce them. In this house it is not done because we do not do basic research; we do clinical treatment. We do not have the necessary structure for basic research. This problem of immunotherapy, however, is still at the level of research.

Could you explain what is the treatment with Elhuyar- Cesio?

Mª José Pérez.

Answer - It is done with a probe and from outside. Cession is a radioactive material used in intracavitary irradiation. Here we have the afterloading device. This means that when radioactive material is applied it is not in our hands. This application mode is called cold. When it is inside, the device is launched remotely and by means of a control. It is then when the probe enters. To know what intraforic radiation is, it must be taken into account that the radioactive source penetrates into a natural cavity. The irradiation is very large, but a few centimeters away there is hardly anything. It has a local effect.

Elhuyar- And how do you put the probe?

Answer - When you have to get into the uterus you have to open it and with Hegar tube it opens until 9. The probe is then introduced. Other tubes, one in the bladder, and one in the rectum, are included. The three are different and are used together. Those in the bladder and rectum are to measure the irradiation that comes, since if we reach a safe level we will have fistula. One of them is of treatment and another of control.

Treatments are usually combined: on the one hand, radiation therapy is given from the outside and on the other, radiation therapy is done from the inside. These applications are made once a week. Relatively long applications compared to external radiotherapies: It lasts approximately 20-25 minutes. For us it is very easy to apply, it is very comfortable. For the moment we have not had fistulas. For the sick is also quite comfortable because he can lead a normal life.

Instead of using the first assignment, the radio was used. The radius had obvious disadvantages: to have the same efficacy, it was necessary to have more time inside, in addition in the bladder and rectum it was not controlled and when the patient was isolated it was unsustainable to have to be alone for a long time. Mortality has decreased considerably with the use of cesium.

Elhuyar- Can cancer be vaccinated?

Answer- I think there will be no cancer vaccine. There may be some immunotherapy. For example, take some lymphocytes, manipulate them in some way, and get the same job as the vaccine with them. There are also many types of cancer.

Elhuyar- Do you want to say something more to finish?


Answer - Yes. I would like to add something about laser treatment. At present, it is an alternative treatment, in which a conization was previously performed. A bad consequence of this technique is the greater ease of abortions in pregnancies. Today we use laser instead of conization. Conization is performed, but when authentication is used the laser, not the electrocautery. A conical tissue disappears or disappears and is therefore called conization, and a month later that neck is the same as before. We have been two years and so far with quite good results.

We had to repeat it, but not generally in dysplasias, but repeat the treatment in dilomas and there is also no impediment to repeat the treatment. The treatment is outpatient and does not require anesthesia. Before, p. For example, light dysplasia was not treated. It could also happen that these dysplasia are spontaneously delayed (a regression occurred) and the technique, the conition, being very aggressive, was not used. At present, light dysplasia or cams are also treated, since with laser cauterization the technique has much less risk.

In chemotherapy treatments there is a novelty that we have not mentioned: it is called port-a-cath. It is a small device that is placed under the skin by surgery and is used to inject drugs. In this way, the need to look for the patient's vein is eliminated and discomfort and discomfort are reduced. The drug is injected into this apparatus that contains a membrane and is responsible for the dispersion, extension of the apparatus in the body. From the outside the patient is only noticed a small lump.