Treatment Overview

Types of Cancer Treatment

There are many types of cancer treatment. The types of treatment that you receive will depend on the type of cancer you have and how advanced it is.

Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. When you need treatment for cancer, you have a lot to learn and think about. It is normal to feel overwhelmed and confused. But, talking with your doctor and learning about the types of treatment you may have can help you feel more in control.

When used to treat cancer, surgery is a procedure in which a surgeon removes cancer from your body. Usually, but not always, the first line of treatment is some form of surgery and this is usually done by the consultant surgeon. There may be two types of surgery, i.e. radical surgery or palliative surgery. Radical surgery involves the complete surgical removal of the tumour and some surrounding tissue, and the draining lymph nodes. The aim is to remove all of the cancerous growth before it spreads to other sites of the body and to cure the patient. With palliative surgery, conducted when the complete removal of the tumour may not be possible, only limited surgery is done to relieve symptoms. Following surgery the patient is then referred to the oncologist to decide if any further treatments are required.

Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors.

  • At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.
  • Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.
  • The type of radiation therapy that you may have depends on many factors, including its type, size, tumour location, closeness of tumour to sensitive normal tissues, your medical conditiona nd age etc.

Radiation can be used to treat cancer or improve cancer symptoms. When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments, such as pain, tumour bleeding and so on.

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgerychemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

Part of the Body BeingTreated Possible Side Effects
  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Skin changes
  • Headache
  • Blurry vision
  • Fatigue
  • Hair loss
  • Skin changes
  • Swelling (Edema)
  • Tenderness
  • Fatigue
  • Hair loss
  • Skin changes
  • Throat changes, such as trouble swallowing
  • Cough
  • Shortness of breath
Head and neck
  • Fatigue
  • Hair loss
  • Mouth changes
  • Skin changes
  • Taste changes
  • Throat changes, such as trouble swallowing
  • Less active thyroid gland
  • Diarrhea
  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Sexual problems (men)
  • Fertility problems (men)
  • Sexual problems (women)
  • Fertility problems (women)
  • Skin changes
  • Urinary and bladder changes
  • Diarrhea
  • Fatigue
  • Hair loss
  • Sexual problems (men)
  • Fertility problems (men)
  • Sexual problems (women)
  • Fertility problems (women)
  • Skin changes
  • Urinary and bladder changes
Stomach and Abdomen
  • Diarrhea
  • Fatigue
  • Hair loss
  • Nausea and vomiting
  • Skin changes
  • Urinary and bladder changes

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to treat cancers, i.e. cure, lessen the chance it will return, or to stop or slow its growth; to ease cancer symptoms by shrinking tumours that can cause pain or other problems. It could be given with other treatments e.g. to downsize tumour before surgery (neoadjuvant chemotherapy); to destroy cancer cells that may remain after treatment with surgery or radiation therapy (adjuvant chemotherapy) or help other treatments work better (given concurrently with radiation) and kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy Can Cause Side Effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

These include: Anemia (low red cell count), easy bruising, constipation, diarrhoea, vomiting or nausea, oedema (swelling), hair loss, fertility issues (both men and women), infections (neutropaenia), sleep issues, skin and nail changes, urinary issues etc. Speak to your oncologist or nurse and they can help ease you from these side effects.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:

  • Asking someone to drive you to and from chemotherapy
  • Planning time to rest on the day of and day after chemotherapy
  • Asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects.

Chemotherapy may be given in many ways. Some common ways include:

  • Oral
    The chemotherapy comes in pills, capsules, or liquids that you swallow
  • Intravenous (IV)
    The chemotherapy goes directly into a vein
  • Injection
    The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
  • Intrathecal
    The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord
  • Intraperitoneal (IP)
    The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
  • Catheter
    A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood.
  • Port
    A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port.
  • Pump
    Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. The rest period gives your body a chance to recover and build new healthy cells.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Immunotherapy is a type of treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

Several types of immunotherapy are used to treat cancer. These treatments can either help the immune system attack the cancer directly or stimulate the immune system in a more general way. These include:

  • Checkpoint inhibitors, which are drugs that help the immune system respond more strongly to a tumour. These drugs work by releasing “brakes” that keep T cells (a type of white blood cell and part of the immune system) from killing cancer cells. These drugs do not target the tumour directly. Instead, they interfere with the ability of cancer cells to avoid immune system attack.
  • Adoptive cell transfer, which is a treatment that attempts to boost the natural ability of your T cells to fight cancer. In this treatment, T cells are taken from your tumor. Then those that are most active against your cancer are grown in large batches in the lab.The process of growing your T cells in the lab can take 2 to 8 weeks. During this time, you may have treatments such as chemotherapy and radiation therapy to reduce your immune cells. After these treatments, the T cells that were grown in the lab will be given back to you via a needle in your vein.
  • Monoclonal antibodies, also known as therapeutic antibodies, which are immune system proteins created in the lab. These antibodies are designed to attach to specific targets found on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Other monoclonal antibodies directly stop cancer cells from growing or cause them to self-destruct. Still others carry toxins to cancer cells. Because therapeutic monoclonal antibodies recognize specific proteins on cancer cells, they are also considered targeted therapies.
  • Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

Types of immunotherapy that enhance the body’s immune response to fight the cancer include:

  • Cytokines, which are proteins made by your body’s cells. They play important roles in the body’s normal immune responses and also in the immune system’s ability to respond to cancer. The two main types of cytokines used to treat cancer are called interferons and interleukins.
  • BCG, which stands for Bacillus Calmette-Guérin, is an immunotherapy that is used to treat bladder cancer. It is a weakened form of the bacteria that causes tuberculosis. When inserted directly into the bladder with a catheter, BCG causes an immune response against cancer cells. It is also being studied in other types of cancer.

Immunotherapy is not yet as widely used as surgerychemotherapy, and radiation therapy. However, immunotherapies have been approved to treat people with many types of cancer. Many research are still in progress.

Immunotherapies may also cause severe or even fatal allergic reactions. However, these reactions are rare.

Targeted therapy is a type of cancer treatment that targets the changes in cancer cells that help them grow, divide, and spread

As researchers learn more about the cell changes that drive cancer, they are better able to design promising therapies that target these changes or block their effects. Most targeted therapies are either small-molecule drugs or monoclonal antibodies.

Small-molecule drugs are small enough to enter cells easily, so they are used for targets that are inside cells.

Monoclonal antibodies are drugs that are not able to enter cells easily. Instead, they attach to specific targets on the outer surface of cancer cells.

Most targeted therapies help treat cancer by interfering with specific proteins that help tumors grow and spread throughout the body. They treat cancer in many different ways. They can:

One reason that cancer cells thrive is because they are able to hide from your immune system. Certain targeted therapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other targeted therapies help boost your immune system to work better against cancer.

  • Stop cancer cells from growing.

Healthy cells in your body usually divide to make new cells only when they receive strong signals to do so. These signals bind to proteins on the cell surface, telling the cells to divide. This process helps new cells form only as your body needs them. But, some cancer cells have changes in the proteins on their surface that tell them to divide whether or not signals are present. Some targeted therapies interfere with these proteins, preventing them from telling the cells to divide. This process helps slow cancer’s uncontrolled growth.

Tumours need to form new blood vessels to grow beyond a certain size. In a process called angiogenesis, these new blood vessels form in response to signals from the tumor. Some targeted therapies called angiogenesis inhibitors are designed to interfere with these signals to prevent a blood supply from forming. Without a blood supply, tumors stay small. Or, if a tumor already has a blood supply, these treatments can cause blood vessels to die, which causes the tumor to shrink.

  • Deliver cell-killing substances to cancer cells.

Some monoclonal antibodies are combined with

toxinschemotherapy drugs, and radiation. Once these monoclonal antibodies attach to targets on the surface of cancer cells, the cells take up the cell-killing substances, causing them to die. Cells that don’t have the target will not be harmed.

  • Cause cancer cell death.

Healthy cells die in an orderly manner when they become damaged or are no longer needed. But, cancer cells have ways of avoiding this dying process. Some targeted therapies can cause cancer cells to go through this process of cell death.

Targeted therapy can cause side effects. The side effects you may have depend on the type of targeted therapy you receive and how your body reacts to the therapy. The most common side effects of targeted therapy include diarrhea and liver problems. Other side effects might include problems with blood clotting and wound healing, high blood pressure, fatigue, mouth sores, nail changes, the loss of hair color, and skin problems. Skin problems might include rash or dry skin. Very rarely, a hole might form through the wall of the bowel or gallbladder.

There are medicines for many of these side effects and may prevent the side effects from happening or treat them once they occur. Most side effects of targeted therapy go away after treatment ends.

Hormone therapy is a treatment that slows or stops the growth of breast and prostate cancers that use hormones to grow. It can be used for shrinking tumour prior to other therapy like radiotherapy (neoadjuvant), or lower risk of tumour recurring (adjuvant) or destroy cancer cells that have returned or spread to other parts of the body.

Hormone therapy falls into two broad groups, those that block the body’s ability to produce hormones and those that interfere with how hormones behave in the body. Because hormone therapy blocks your body’s ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

Some common side effects for men who receive hormone therapy for prostate cancer include:

Some common side effects for women who receive hormone therapy for breast cancer include:

  • Hot flashes
  • Vaginal dryness
  • Changes in your periods if you have not yet reached menopause
  • Loss of interest in sex
  • Nausea
  • Mood changes
  • Fatigue

Side effects of hormonal therapy usually do not interfere with work and can improve with time.

Informed Decision

Many patients upon receiving the diagnosis of cancer illness, are overwhelmed, anxious and frightened. Many are also eager to start treatment as soon as they can. It is important however, to understand the disease and available treatment options well so that one can make a rational decision in selecting the treatment path.

Informed decision refers to shared decision making between the patient and the treating doctor, in which the patient is able to select a treatment that is consistent with his or her needs, values and preferences.

Many factors can influence cancer treatment decisions and these include the treatment efficacy, safety and cost as well as how the treatment can impact on work and quality of life, possible need to hire a caregiver and opportunities to participate in a clinical trial.

For many, the visits to the doctor can be a daunting one and patients often bring along their family members and close ones for moral support. The consultation with the doctor should equip the patients with the knowledge on the type of cancer they are having and the extent of it, the necessary investigations to complete the staging of the cancer and the available treatment options, treatment costs and potential side effects that may arise from the treatment. Many patients are also appreciative if they are recommended a support network to share experiences on.

Many patients also find that their priorities and perception of their treatment choices change over time. Again, it is important to let the doctor knows this so that the expectations of the patient are aligned to those that can be offered by the health care team.