Guidelines for Treatment

In many cases, doctors hope to completely eliminate the cancer from the body, thus curing it. Other times, cure is not possible, yet treatment still aims to slow the growth of the cancer so that a person might live longer. Sometimes, treatment is likely to cause more harm than good, and treatment aims only to reduce symptoms that would otherwise cause pain and suffering (palliative treatment).

The earlier a cancer is found, the more likely cure is possible. Advanced cancers and those that recur after initial treatment indicate that the cancer has spread. Cure is then unlikely.

The main types of treatment for cancer are surgery, radiation therapy, and drugs. Surgery is used when possible to completely remove the cancer or partially remove ("de-bulk") it, so that other therapies have a better chance of success. Surgery can also be used to stop bleeding or relieve pressure on a particular structure or organ.

Radiation therapy is directed at a tumor to destroy it or at least to reduce its size. Not all cancers respond to radiation therapy.

Several types of drugs are used to treat cancer. Chemotherapy involves drugs that kill cancer cells. Chemotherapy drugs work by many mechanisms, always targeting something that is unusual about the cancer cells. However, chemotherapy drugs always kill some normal cells as well, and the drugs often cause side effects that can make people feel very ill. Other drugs suppress certain hormones that stimulate cancers to grow and thereby suppress cancer growth. Some newer drugs attack cancerous cells in novel ways, resulting in their death. An example is imatinib for chronic myelocytic leukemia. This drug attaches to and prevents leukemia cells from functioning, thereby resulting in their death.

Immunotherapy stimulates the immune system to attack a cancer or uses antibodies that attach themselves to cancer cells. Such antibodies can be combined with chemotherapy drugs or radioactive agents, so that the drugs go (target) exactly where they are needed, to the cancer cells.

Having other diseases and conditions can complicate cancer treatment. For example, heart failure or impaired kidney function may limit the choices and dosages of chemotherapy drugs usually used to treat certain types of cancer. Chronic liver disease can make the use of chemotherapy drugs more challenging by increasing toxic side effects of several of the drugs. Chronic obstructive pulmonary disease (COPD) can limit the use of radiation that might otherwise be used to treat lung cancers, due to the potentially harmful effects of the radiation to lung tissue already damaged by COPD. However, treatment of a cancer is usually possible in spite of other diseases and conditions.

Some cancers caught early enough can be removed surgically. However, cancers are sometimes located in places that surgery can not reach, such as deep in the brain. Some cancers have already spread, so that removing the original tumor does not offer cure. Therefore, doctors may give additional therapy, such as radiation therapy to eliminate cancer cells in nearby lymph nodes or chemotherapy or hormone therapy to eliminate cancer cells throughout the body. This therapy, termed adjuvant therapy, is commonly used in breast, colon, and head and neck cancers.

If a cancer is known to have spread, surgery is much less likely to improve survival. Instead, the cancer may be treated by radiation therapy and by chemotherapy. Such treatment is less likely to achieve a cure, but it may lengthen survival or at least effectively treat many symptoms.

Often, people with cancer are treated at regional centers that specialize in cancer. Such centers are staffed with doctors and other health care practitioners with expertise in treating cancer. The centers often offer drugs and treatment programs at the forefront of research on possible new treatment approaches.

Some people may participate in a clinical trial, a research study that tests how well new medical treatments work. Although these treatments may still be experimental, they are carefully monitored by review boards of the universities and hospitals involved. Such safety oversight means that people must usually receive care at a hospital or medical center in order to participate in a clinical research trial.

Sometimes, people with cancer decide to seek alternative medicine or a combination of alternative and conventional medicine. Although some alternative therapies may be helpful, people should not rely on them to the exclusion of established effective therapies. People who seek alternative therapies should be sure to discuss them with their doctor.

Some older people with cancer decide not to undergo any treatment other than relief of pain and other suffering. Such a decision is often appropriate when the cancer cannot be cured and the treatment is likely to cause side effects. A person may chose to travel or otherwise get involved in enjoyable activities while feeling well, rather than feeling ill due to treatments. Such decisions must be made with full information about the risks and benefits of treatment and require careful consultation and discussion with a knowledgeable doctor.