Exploring Treatment Options
Once you have digested the news that you have cancer, your attention will turn to treating it. Depending on your diagnosis, you may seek out the services of a specialist or cancer center with extensive experience treating your type of cancer. Then, you will partner with your multidisciplinary health care team to make the important decisions ahead.
As you and your doctor work together on a treatment plan that is best for you, bring up what is important to you, from side effects and quality of life to your goals for treatment. Always ask questions and request explanations for anything you do not understand.
Be aware that it is very common for the treatment strategy you begin with to change. Your doctor will continually monitor your condition and make adjustments for a number of reasons. Sometimes a therapy becomes less effective as time goes on; other times, a new mutation may be discovered and a different therapy may offer more promise; or you may reach remission, among other things. Keep in mind that cancer is a fluid condition that presents many challenges, so flexibility and patience are important.
Your treatment plan may include one or more of the following options.
Surgery is the primary method for treating a solid tumor. Removing it may offer the best chance of controlling the disease and keeping it from spreading, especially for people with early-stage disease. Your doctor may also perform a surgical procedure to stage the cancer or to relieve or prevent symptoms that may occur later. Advances in surgical techniques are contributing to shorter recovery times and fewer side effects.
Radiation therapy uses high-energy radiation to destroy cancer cells and shrink tumors. Some people with localized disease or bone pain may receive radiation to specific parts of the body. It may be given prior to a stem cell transplant. It may also be delivered as neoadjuvant therapy to shrink tumors before surgery and as adjuvant therapy to kill remaining cancer cells after surgery.
External-beam radiation therapy (EBRT) uses a machine outside the body to send radiation toward the cancer. Different types of EBRT are available and include three-dimensional conformal radiation therapy, stereotactic body radiotherapy and intensity-modulated radiation therapy. A newer type of radiation, proton therapy, uses charged particles called protons directed to precise locations within the body.
Brachytherapy, also called internal radiation therapy, uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer. Radiation may be delivered at a “high dose rate” (over several hours) or at a “low dose rate” (over a longer period). Alpha emitter radiation therapy uses radiopharmaceuticals, which are drugs that give off targeted radiation, to suppress cancer in the bones and reduce pain.
Drug therapy is available in a variety of forms.
Chemotherapy travels through the bloodstream and affects cells all over the body. It may be given intravenously (IV) or taken orally as a pill and is typically delivered in cycles, with treatment periods followed by rest periods to give your body time to recover.
A specific strategy may consist of a single chemotherapy drug, a combination given at the same time, or drugs given one after another. Chemotherapy may be used alone or with other drug therapies and forms of treatment, such as stem cell transplantation or chimeric antigen receptor (CAR) T-cell therapy.
Immunotherapy harnesses the potential of the body’s own immune system to recognize and destroy cancer cells. By training the immune system to respond to cancer, this strategy has the potential for a response that can extend beyond the end of treatment. Immune checkpoint inhibitors, cytokines, monoclonal antibodies, CAR T-cell therapy and personalized vaccines are some types of immunotherapy approved to treat the types of cancer discussed in this guide. Some are used alone or with other therapies.
Targeted therapy uses drugs to kill cancer cells or stop the progression of disease. They travel throughout the body via the bloodstream looking for specific proteins and tissue environments to block cancer cell signals and restrict the growth and spread of cancer. This therapy targets genes, proteins or other factors that support the tumor. These drugs may be given orally, subcutaneously (by injection under the skin) or by IV through a vein in your arm. Some may be given alone or in combination with other drug therapies. Types of targeted therapies described in this guide include angiogenesis inhibitors, histone deacetylase inhibitors, monoclonal antibodies, proteasome inhibitors and selective inhibitors of nuclear export.
Hormone therapy blocks the stimulating effect of hormones. It slows or stops the growth of cancer and is used because hormones that occur naturally in the body promote the growth of some cancers. Surgery and drug therapies can function as hormone therapy.
Corticosteroids are drugs that can be used alone or in combination with other drug therapies. They can help reduce inflammation and may offer other benefits.
Bone-modifying drugs can treat bone problems caused by some cancers and therapies, such as hormone therapy. These drugs can also prevent further bone damage from occurring.
Surveillance , also called watchful waiting, may be recommended for tumors that appear to be growing very slowly. Postponing treatment allows you to avoid potential treatment side effects for as long as possible while your doctor closely monitors you for signs the cancer has progressed or returned.
Regularly scheduled follow-up appointments that include imaging tests and blood tests will be necessary. It is very important to make and keep these appointments because treatment should begin if cancer progression occurs.
Stem cell transplantation, also known as bone marrow transplantation, is an infusion of healthy stem cells into the body, typically after high-dose chemotherapy.
An autologous transplant uses the patient’s own stem cells, which are collected, filtered, processed and frozen. High-dose chemotherapy and sometimes full-body radiation (conditioning) are given to destroy cancer cells. Then the reserved stem cells are thawed and infused back into the patient’s body.
An allogeneic transplant may be used for patients with a high risk of relapse, those who are not responding fully to other treatments or those who have relapsed disease. Stem cells donated by a family member or an unrelated donor identified through a registry are used.
Radiofrequency ablation (RFA) therapy may be used to treat a tumor that is unresectable (inoperable) or when surgery is not an option for another reason. In this type of therapy, which focuses on the cancer’s location, this minimally-invasive, image-guided procedure kills cancer cells by inserting a needle through the skin directly into the tumor and running electrical current through it to subject the tumor to extreme temperatures. Other types of therapy include microwave ablation (MWA) and cryoablation, also called cryosurgery or cryotherapy.
Plasmapheresis uses a machine to filter plasma out of the blood. Though not a treatment for most cancers, it may be used if the blood has become too thick.
Clinical trials are medical research studies that may offer access to leading-edge treatments not yet widely available. They may be an option at any stage, even as a first-line treatment. Ask your doctor if you are a candidate for a clinical trial.
Treatment Type Analogy
Relating cancer treatments to an everyday activity may help you understand how they work. Think about the treatments a stylist uses on your hair. Your stylist and your doctor both use different strategies to reach their desired goals.
A stylist uses scissors or shears to remove unwanted hair, which is similar to a doctor using surgical tools to physically remove a tumor.
The chemicals used in a perm break down bonds that keep hair straight, much like the way chemical substances in chemotherapy attack cancer cells.
Hair dryers and curling irons use heat (a type of energy) to eliminate moisture or curl hair, much like radiation therapy uses high-energy particles, such as X-rays or protons, to destroy cancer cells. As in radiation therapy, these tools can be used all over your head or targeted to specific sections of hair.
Hair dye affects only the part of the hair strand that needs to change color, much like targeted therapy affects only the cancer cells containing that specific cancer.
Taking vitamins and supplements designed to help your hair grow allows your body to produce more of what your body already makes on its own. Similarly, immunotherapy helps your own immune system attack cancer cells.
Terms to know
You will hear many new words and phrases. These definitions will help.
Adjuvant therapy: Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy or biological therapy.
First-line therapy: The first treatment used.
Local treatment: Directed to a specific organ or limited area of the body and includes surgery, radiation therapy and topical therapy (a lotion or cream that is applied to the skin).
Neoadjuvant therapy: Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Other examples of neoadjuvant therapy include chemotherapy, radiation therapy and hormone therapy. It is a type of induction therapy.
Second-line therapy: Given when the first-line therapy does not work or is no longer effective.
Standard of care: The best treatment known for the type and stage of cancer you have.
Systemic treatment: Typically drug therapies, such as chemotherapy, hormone therapy, immunotherapy and targeted therapy, that travels throughout the body.