binds to folate receptors, a protein that is commonly found on the surface of many cancers and illuminates tumor cells under near-infrared light. The agent is administered via intravenous infusion within 24 hours before surgery and assists surgeons in visually identifying additional malignant tissue to be removed during the procedure. The approval in lung cancer was based on a clinical trial that evaluated the utility of pafolacianine in visualizing tumors in the lungs that may otherwise be undetected with conventional visualization under white light (373). Molecular imaging using pafolacianine during surgery identified in 19 percent of patients primary lung nodules that surgeons could not find using white light and palpation; additionally, pafolacianine revealed in eight percent of patients additional lesions that were completely missed using white light. The expanded approval of pafolacianine represents a significant advancement in the treatment of lung cancer by enhancing detection of lung tumors during surgery, improving the ability to remove them completely, and reducing the probability of leaving behind cancerous tissue. Improvements in Radiation-based Approaches to Cancer Care Radiotherapy is the use of high-energy rays (e.g., gamma rays and X-rays) or particles (e.g., electrons, protons, and carbon nuclei) to control or eradicate cancer. Discovery of X-rays in 1895 allowed visualization of internal organs at low doses, and the effective use of X-rays at high doses to treat a breast cancer patient a year later established radiotherapy as the second pillar of cancer treatment (see Figure 15, p. 76). Radiotherapy plays a central role in the management of cancer and works primarily by damaging DNA, leading to cancer cell death. The use of radiotherapy in treatment and management of cancer continues to increase, as indicated by a 16.4 percent increase in radiation facilities across the United States between 2005 and 2020 (374). There are many types and uses of radiotherapy (see Sidebar 33, p. 81). However, it is important to note that radiotherapy may also have harmful side effects, partly because of the radiation-induced damage to healthy cells surrounding the tumor tissue (375). Using Surgery for Cancer Treatment Surgery can be used in several ways during the care of a patient with cancer: To diagnose cancer Surgery is performed to obtain a tumor sample for diagnosing cancer. To stage cancer Surgery is performed to determine how far the cancer has spread from the site of origin so that the best treatment plan can be developed for the patient. To cure cancer Surgery is performed to remove the entire tumor if cancer is confined to one area of the body. To debulk cancer Surgery is performed to remove only part of the tumor if it is very large and/or located very close to important organs or tissues. To ease problems caused by cancer Surgery is performed to remove tumors that are causing pain, pressure, or blockages in patients with advanced-stage cancer. SURGERY FOR PATIENTS WITH CANCER CAN BE OPEN OR MINIMALLY INVASIVE. Open surgery When a surgeon makes one or more large cuts to remove the tumor, some surrounding healthy tissue, and maybe some nearby lymph nodes. Minimally invasive surgery When a surgeon makes one or more small cuts, inserting a long, thin tube with a tiny camera, called a laparoscope, into one of the small cuts. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what is happening. Special surgery tools are inserted through other small cuts to remove the tumor and some healthy tissue. Sometimes robotic platforms are used to perform minimally invasive surgeries; this approach provides a magnified stereoscopic vision of the tumor and internal organs and a better ability for surgeons to work within confined spaces. SIDEBAR 31 Advancing the Frontiers of Cancer Science and Medicine AACR Cancer Progress Report 2023 79
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