Exploring Treatment Options

Advances in medicine and the emergence of multi-disciplinary care are significantly improving the lives of people diagnosed with cancer. Working closely with your doctor is an important part of developing your treatment plan. Together, you will define the goals and potential side effects of treatment and discuss your expectations for your quality of life and sources of support.

Depending on your diagnosis, many treatment options are available that may be used alone or in combination. Not every cancer responds the same way to every treatment, so you and your doctor will work together to determine the best treatment based on a variety of factors, such as your specific type of cancer, tumor characteristics, treatment history and general health.

Your primary treatment is the definitive treatment designed to eliminate the disease. It is sometimes referred to as “standard of care.” In some cases, your treatment plan also may include neoadjuvant or adjuvant therapy. Neoadjuvant therapy is given before primary treatment to help shrink a tumor, often in an effort to make it easier to remove surgically. Adjuvant therapy is given after primary treatment to destroy any cancer cells that may remain and that may be too small for laboratory testing or imaging studies to detect. This follow-up treatment decreases the risk of your cancer recurring (coming back).

Recently, researchers have noticed certain differences in tumors, even when they begin in the same site in the body. This understanding has led to an increased focus on personalized medicine, which uses information about a person’s genes, as well as the behavior of certain proteins, to prevent, diagnose and treat disease.

Personalized medicine includes the use of highly targeted therapies, drugs and other substances (such as biologics) that block the growth and spread of cancer. They do this by interfering with specific molecules — as well as critical communication pathways within and between cells — involved in tumor growth. Specific types of therapy can be based on the detection of tumor biomarkers (substances made by certain cells) expressed in a patient’s own cancer. This is a major advancement in cancer management because it means a targeted therapy is more likely to be effective when given to a person who has specific biomarkers of the cancer. This approach benefits people who don’t have those biomarkers because they are not given treatments that are less likely to work.

Research through clinical trials continues to advance existing strategies and make newer treatment drugs and methods available.

Do not hesitate to get a second or even third opinion before making treatment-related decisions. Your oncologist should be both pleased to and capable of helping you arrange for a second opinion. Many patients mistakenly believe that their oncologist will think poorly of them if they ask for a second opinion, but this is part of a physician’s obligation to you and a request that physicians commonly receive.

Following is general information about the most common ways cancer is treated. It is important to remember that not every person responds to the same treatment in the same way. In addition, not all treatments are available or appropriate for every type of cancer. Drug therapies may be prescribed as brand names, generics or a new form called biosimilars. Treatment may be described as standard of care, first line or second line. Standard of care refers to the best treatments known. First-line therapy is the first treatment given. Second-line therapy is given when the first-line therapy doesn’t work or is no longer effective. Your doctor may recommend one treatment or a combination of the following options. In some cases, additional testing of the tumor or of your DNA may be needed to qualify you for certain types of treatment.

Surgery is the primary method for treating a solid tumor. Removing a tumor may offer the best chance for 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 might otherwise occur later. Advances in surgical techniques are contributing to the likelihood of shorter recovery times with fewer side effects.

Chemotherapy uses powerful drugs to kill rapidly multiplying cells. It may be given intravenously through a small tube inserted into a vein, or taken orally as a pill. Treatment with chemotherapy is known as a regimen, and it 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 or a combination, given at the same time or one after another. It may be used alone or combined with other forms of treatment.

Targeted therapy blocks the growth and progression of cancer by interfering with specific molecules involved in tumor growth and progression. The targeted therapy agents block or modify the molecules on or inside cancer cells that alter signaling pathways, which are complex systems that direct basic cell functions, such as cell division and death. Many targeted therapy drugs are oral medications, and some may be given in combination with other drug therapies.

Hormone therapy acts to block the stimulating effect of hormones, thereby slowing or stopping the growth of cancer. Hormones that occur naturally in the body promote the growth of some cancers. Surgery and drug therapy are types of hormone therapy.

Immunotherapy uses the body’s own immune system to kill cancer cells by using substances (made either by the body or in a laboratory) to find and destroy them. Immunotherapy typically involves destroying only specific cancer cells, which may result in fewer side effects. Immunotherapy is not effective for every person, even if it is approved for that person’s cancer type. Individuals must meet certain criteria to be candidates. Doctors and scientists are involved in clinical trials to study this unusual characteristic, as well as improve existing therapies and develop new ones. Immune checkpoint inhibitors, cytokines, monoclonal antibodies, chimeric antigen receptor (CAR) T-cell therapy and personalized vaccines are some other types of immunotherapy. Some are used alone or with other therapies.

Radiation therapy involves using high-energy X-rays or proton beams to destroy or damage cancer cells. These treatments are given either externally with radiation machines, or internally with radioactive material that is swallowed, injected or implanted in the body. Another form of radiation therapy, known as palliative radiation, can help reduce the effects of symptoms caused by cancer, such as pain.

Stem cell transplantation, also known as bone marrow transplantation, is an infusion of healthy stem cells into the body, typically after high-dose chemotherapy.

Corticosteroids are drugs used to treat some blood cancers and can be used alone or in combination with other drug therapies. Corticosteroids also help reduce inflammation and may offer other benefits.

Clinical trials may be a treatment option if you have a rare type of cancer that hasn’t been studied as much as other types, if your current treatment is not working as well as expected or if you’d like to significantly improve your quality of life.

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.


Surgery =
A Haircut

 

A stylist uses scissors or shears to remove unwanted hair, which is similar to a doctor using surgical tools to physically remove a tumor.

Chemotherapy =
A Perm

 

The chemicals used in a perm break down bonds that keep hair straight, much like the way chemical substances in chemotherapy attack cancer cells.

Radiation Therapy =
Heat-Targeted Tools

 

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.

Targeted Therapy =
Hair Color

 

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.

Immunotherapy =
Vitamins and Supplements

 

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.

 

Additional Sources of Information

 



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