Cancer treatment options and decisions

The methods and protocols available to treat cancer and its symptoms. Most cancer treatment involves a combination of methods. There are a number of conventional treatment options for cancer:

• SURGERY FOR CANCER, in which the doctor performs an OPERATION to remove the cancer, is the treatment of first choice for most solid tumors (cancer that develops in organs and tissues other than the BLOOD, LYMPH, or BONE MARROW). The surgery generally removes the tumor and a safe margin of healthy tissue surrounding the tumor in the attempt to prevent stray cells at the tumor’s periphery from migrating into other tissues. Sometimes the operation to remove the cancer involves removing an entire structure or organ to obtain such a margin.
• RADIATION THERAPY may precede or follow surgery or may be the sole or an adjuvant treatment. Radiation therapy targets high-energy particles at the cancer cells. The energy-radiation- disrupts the ability of the cancer cells to grow and divide. The cells die, and the body’s natural mechanisms (such as PHAGOCYTOSIS) eliminate their debris. Radiation before surgery shrinks the tumor. The main purpose of radiation therapy after surgery is to kill any lingering or stray cancer cells. The oncologist may also combine radiation therapy with CHEMOTHERAPY or IMMUNOTHERAPY for an additive effect. Adverse side effects generally stay localized (remain in the area exposed to the radiation).
• Chemotherapy uses drugs to kill cancer cells. Like radiation therapy, chemotherapy may precede or follow surgery to shrink tumors or kill residual cancer cells, serve as the sole treatment, or function as an adjuvant treatment in combination with other treatment methods for optimal effectiveness against certain types of cancer. Because chemotherapy affects the entire body, it can have significant side effects.
• Immunotherapy, also called biological response modification, uses methods to enhance the ability of the body’s natural IMMUNE SYSTEM functions to target cancer cells for containment and destruction. Genetically engineered substances such as MONOCLONAL ANTIBODIES (MABS), INTERFERONS, and INTERLEUKINS are among the immunotherapy agents oncologists may administer to boost the IMMUNE RESPONSE.
• HORMONE THERAPY targets HORMONE-driven cancers such as PROSTATE CANCER, OVARIAN CANCER, ENDOMETRIAL CANCER, and BREAST CANCER. These cancers require hormones, typically ESTROGENS or TESTOSTERONE, to grow. Treatment either suppresses or boosts the presence of these hormones in the body. HORMONE THERAPY for breast cancer, for example, deprives the woman’s body of estrogen or the ability to use it, and hormone therapy for prostate cancer deprives the man’s body of testosterone or the ability to use it. Hormone therapy for prostate cancer may also include administration of estrogen in a further effort to shut down the tumor’s hormone sources.
• BONE MARROW TRANSPLANTATION is a treatment option for LEUKEMIA, MULTIPLE MYELOMA, and lymphoma. BONE marrow transplantation replaces cancerous bone marrow with healthy marrow from a genetically matched donor called an allogeneic transplants (a syngeneic transplant when the donor is an identical twin). An autologous transplant uses the patient’s own bone marrow, which is an option only when the cancer is in remission or when it does not involve the bone marrow. Bone marrow transplantation may sometimes be a treatment option for other types of cancer though has not proven to be as effective as originally hoped.
• Stem cell transplantation may be a treatment option in cancers that do not involve the bone marrow. The person’s stem cells (precursors for red blood cells, white blood cells, and platelets) are gathered from the person’s blood, then reinfused into the person after CHEMOTHERAPY.

Though there are established approaches, called treatment protocols, for most types of cancer, cancer treatment is highly individualized and treatment decisions evolve as a collaboration between the person who has cancer and the health-care team providing care for the person. The treatment decision process begins with consideration of the cancer’s type, stage, and grade-the characteristics of the cancer cells, how widespread within the body the cancer is, and how aggressive the cancer cells are in their growth pattern. Other important factors include the person’s age and overall health status, any other health conditions, and the person’s preferences or goals for treatment.

INFORMATION MANAGEMENT

Because there is so much information to absorb and sort through when it comes to CANCER TREATMENT OPTIONS AND DECISIONS, it is a good idea to have a trusted family member or friend go along for key doctor visits to take notes. This lets the patient focus on the discussion with the doctor during the visit with the opportunity to later go over the notes and consider the options.

Sometimes there are clear “best” choices for treatment. Other times there are several treatment options that are likely to produce similar results. A person whose cancer is widespread (metastatic) by the time of diagnosis may choose only palliative treatment-treatments to relieve PAIN and other symptoms-or may choose to enter a clinical trial, a research study evaluating a new treatment that shows promise for the person’s particular type or stage of cancer. Each treatment method has benefits and risks, which are important to consider when evaluating the various options.

A second opinion consultation from another oncologist (cancer specialist) is often helpful when there are numerous treatment options or when treatment options appear slim. Different oncologists may view the same person’s situation differently based on their level of experience and knowledge of specific cancers or treatments. Oncologists who practice through medical centers affiliated with research facilities, such as are common at large universities that have medical schools, often know of the newest drugs and therapies under evaluation in current or upcoming clinical trials.

There is an abundance of information about cancer available on the Internet and in publications; sorting through it all to determine what is reliable and what is potentially useful for an individual is confusing and often overwhelming. Because there are no controls over the content of Web sites in particular, a large amount of information is, unfortunately, inaccurate or potentially harmful; with the emotional factors that surround a cancer diagnosis, it is important to make treatment decisions based on sound principles. Many cancer treatment centers have staff and resources to help people put such information into contexts that are relevant for their personal situations. The American Cancer Society (www.cancer.org) and the US National Institutes of Health’s (NIH’s) National Cancer Institute (www.cancer.gov) provide numerous resources to help people sort through treatment claims and methods.

See also ALTERNATIVE AND COMPLEMENTARY REMEDIES FOR CANCER; BLOOD STEM CELLS; CANCER PREVENTION; COPING WITH CANCER; DIAGNOSING CANCER; END OF LIFE CONCERNS; QUALITY OF LIFE; STEM CELL; SURGERY BENEFIT AND RISK ASSESSMENT.

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