Treatment

Surgery to remove a tumor is the most frequent treatment. In general, the surgeon removes the tumor to healthy tissue and the affected lymphnodes, in order to remove malignant cells that may lead to a recurrence or need a new surgical operation. The surgery varies with the affected organ.

Chemoteraphy is a method using cytostatics to destroy affected cells. Chemotherapy drugs are systemic medicine, meaning that they enter the blood stream and they are spread all through the body. Most chemotherapy drugs are given intravenously. Chemotherapy can be combined with radiotherapy in a primary treatment that substitutes surgery, or it may be used to shrink the tumor before surgery. For more information on chemotherapy treatments, you can download the SRC brochure: Chemotherapy

Radiotherapy is a method using X rays to destroy cancer cells. It is a form of local therapy, meaning that its effects are limited to that certain area. Doctors can indicate radiotherapy together with chemotherapy as a primary treatment that replaces surgery, especially for tumors that have dimensions and a position that make them hard to be operate on. Radiotherapy in combination with chemotherapy can be used to shrink the tumor before surgery, as well. Radiotherapy also improves cancer symptoms. You can read about using radiotherapy in cancer treatment in the SRC brochure: Radiotherapy.

Laser therapy is using a high density ray of light to destroy cancer cells. Only the tumor cells of the treated area are destroyed, but it can only be used in certain types of cancer.

Photodynamic therapy is a type of laser therapy that involves using certain medicine that are absorbed by the cancer cells; when exposed to a special source of light, medicine is activated and destroys cancer cells. It can only be used in certain types of cancer.

Immune therapy uses the body’s immune system to fight against cancer. The cells of the immune system find and destroy cancer cells. Biological therapies are used to stimulate or enhance the body’s ability to fight against cancer. This form of therapy can be used after surgery, as a single form of treatment, or together with chemo- and radiotherapy. The majority of treatments of this kind are given intravenously.

Hormonal therapy is used for certain types of cancer in organs whose activity can be influenced by certain hormones or their absence. In this category there are included: breast and cervical cancer, prostate, thyroid cancer.

New methods of treatment and new medicine are being researched, but in order to beneficiate from this new possiilities, you have to be included in clinical trials, organized in oncological institutes where there is the possibility of monitoring the patient.

Follow up after treatment. It is very important for the patient to come for periodical check-ups after finalizing the initial treatment. This check-ups are done, usually, every 3 months in the first 2 years, every 6 or 12 months in the following period of time. The majority of relapses appear in the first 5 years after discovering the initial lesion. The patient must strictly respect doctor’s advice on the activities permitted after surgery and the lifestyle he must have.

What you have to do to receive treatment

• Visit your family doctor – obtain a referral to a specialist physician.
   
• Visit a specialist – for consultation and referral to an oncologist – if needed.
   
• Visit the oncologist for establishing the diagnosis.
   
• Programming is necessary because of the medical staff being overworked.
   
• The right to a second opinion – it means consulting a second specilaist.
   
• Treatments – are done either through admission in the hospital or in an outpatient system. Treatments prescribed by physicians must be followed exactly, not following them leads to worsening of the disease. Adjuvant therapies are only complementary, they help strenghten the immune system. They cannot cure cancer. The role of the psychologist is essential in being cured. Cancer treatment is free in Romania.
   
• A diagnosed patient doesn’t need a referral from the GP every time he visits the oncologist.
   

Documents needed for the Oncology Department

• Referral from the family doctor or a specialist physician
   
• Identity card
   
• Health Insurance certificate or a pension cupon / student certificate. For persons from other counties, the County Health Insurance Department stamp is needed on the certificate that proves that the person paid health insurance and a copy of the last payment order of health insurance by the company where you work.
   
• Blood tests and investigations done earlier
   
• New or old treatment from the sheet card index
   

Blood tests and other investigations

After the consultation, one of the following imagistic investigations may be indicated by the oncologist, varying with the diagnosis established by the oncologist and the location of the tumor: X-ray, ecography, mammograph, scintigraphy, tomography, MRI.

The investigation may be done for free with the referral of the oncologist or another specialist physician, by following treatment protocol. The investigation may be done for a charge if you do not have a referral, but with the consent of your attending physician.

Who can have free investigations?

• In an outpatient system – persons who have a referral from the family physician or a specialist physician, within the limits of the funding available from the Health Insurance Department.

 
• All the patients admitted to hospital.

When must investigations be paid by the patient?

• When people do not have legal documents needed for Health Insurance Department coverage of the tests

 
• When patients are not admitted to hospital.

 
• After exhausting the funds for the following months.

Laboratory tests

Lab tests are done for free for patients admitted to hospital, for persons who have a referral from an oncologist or a specialist, within limitations of fund that are assigned monthly. After exhaustion of the funds, patients have two possibilities: to be included on a waiting list or pay for tests themselves.

Types of tests that are covered by the Health Insurance Department are: hematology, biochemistry, immunology. Tumoral markers – specific test for the positive or differential diagnosis of the tumor – are not covered by the Health Insurance Department. Admitted patients always have free lab tests.

Medication

Medication necessary for treatment are given in oncology in an outpatient system or with patients admitted to the hospital. After primary treatment, a follow up stage is the next step in cancer treatment on a period of time established by the physician. Medicine for follow up – given orally, are released – according to the new regulation since April 2007 – on the basis of a prescription given by the physician, by open circuit pharmacies.

Cytostatics are given under strict supervision by the oncologist, in oncology wards.

Analgetics and narcotic drugs are given if the patient is in pain – only 40% of patients have pains – starting with small pain.

Morphine and its derrivatives (narcotic drugs) are given in hospital under doctor supervision and the treatment continues only if it is required.

Narcotic drugs are given only by certain pharmacies. The way they can be obtained is the following: based on the medical letter given by the attending phyician, the family doctor releases a standard form that must be approved by the Public Health Authority - ASP (former Public Health Department). The ASP issues a authorization for releasing the prescription drugs valid for three months. On behalf of this authorization, the family doctor releases a prescription that covers the necessary medication for 15 days. If dosage changes, the whole process must be repeated. The authorization must include 3 copies, one for the family doctor, one for the pharmacy and one for the patient. Do not throw the authorization away! The police has the right to control these authorizations.

Analgetics, antiemetics and adjuvant medication is released in a partial coverage system. The cost of narcotic drugs – the patient must pay for part of the derrived cost obtained from the dfference of the referrence cost and the actual cost established by each pharmacy.

The price of medicine for cancer treatment was raised very much in the last period of time. Because of this, the costs cannot be covered by the Health Insurance Department. A solution would be the patients paying for medication. If this were the case, medicine could be ordered and bought directly from certain pharmacies. Adjuvant medication such as vitamins, nature products for improving the immune system functioning are not available for free and the patient must buy them himself.

The cytostatic treatment requires following a diet that you can find in the SRC brochure:Diet and cancer.