As a newly diagnosed cancer patient, the thought of treatment can be overwhelming. It’s important to understand the different options available to you so that you can make informed decisions about your care. Here’s a quick rundown of the most common types of cancer treatment:
Surgery: Surgery is a procedure in which a doctor removes the cancerous tumor from your body. This can be done through a small incision or a large one, depending on the size and location of the tumor. Surgery is often used to treat early-stage cancers or to remove any remaining cancer after other treatments have been completed.
Radiation Therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. This treatment can be delivered externally, through a machine that directs the radiation to the tumor, or internally, through a small device placed directly into the tumor. Radiation therapy is often used to shrink tumors before surgery, or to kill any remaining cancer cells after surgery.
Chemotherapy: Chemotherapy is a treatment that uses drugs to kill cancer cells directly. These drugs can be given orally or through an IV, and they travel throughout the body to reach cancer cells in other parts of the body. Ultimately targeting the replicating DNA or dividing cell. This is not specific to just cancer cells, but any normal cell that are also dividing. A reasonable response in the metastatic setting is a tumor that is shrinking or stable however most often these responses are not durable for the long term with few exceptions. Side effects are often seen include nausea, vomiting, diarrhea, immunosuppression, mouth ulcers, hand foot symptoms, neuropathy, need for transfusion. There are specific class effects depending on which drugs are used. Some chemotherapies are mild for most folks such as 5FU. Combinational with doublet or triplet agents will often significantly increase the side effect profile and often need preventative anti-emetics and prophylactic growth factor support to hasten the immune cell recovery.
Immunotherapy: Immunotherapy is a treatment that helps the body’s immune system fight cancer cells. This can be done through drugs that activate the immune system or through the removal of immune system cells that are blocking the immune response. Ultimately the holy grail is to active the T cells which can include checkpoint inhibitors, vaccines, immuno-modulators targeting the tumor microenvironment, intra-tumoral therapies, and cellular therapies. Responses are more often durable on and off therapy depending on tumor type. Side effects include immune related rash, diarrhea, coughing, hepatitis and endocrinopathies (hypothyroidism, adrenal insufficiency, hypophysitis, type 1 diabetes). Most of these adverse effects can be controlled with steroids or stronger immunosuppresive treatment. Most of these adverse effects are reversible with few exceptions such as vitiligo and endocrinopathies that will more likely than not need lifelong replacement.
Targeted therapy: Targeted therapy is a treatment that targets specific genes or proteins that are found in cancer cells. Often oncologist will order a molecular test such as a next generation sequencing or PCR or IHC test to determine if any specific target of interest is present. If so, then these alterations are actionable or targetable with treatment. Good examples include HER2, BRAF, CKIT, RET, ALK, NTRK, etc. Responses can occasionally durable depending the target and drug used. Sometimes certain mutations can be a negative biomarker meaning certain drugs that normally would be active for a particular tumor type will not work at all when a specific mutation is present. KRAS mutations for example, in colorectal cancer would exclude the use of EGFR inhibitors. When targeted therapy is used, these drugs can block the activity of these genes or proteins or through drugs that inhibit the growth of new blood vessels that feed the cancer.
Hormonal therapy: Hormonal therapy is a treatment that targets hormones that are found in cancer cells. This can be done through drugs that block the activity of these hormones or through surgery to remove the organs that produce these hormones. Hormonal therapy is often used to treat certain types of cancer by depriving these cancer cells of the hormone that are stimulating its growth such as breast cancer and prostate cancer targeting estrogen and testosterone respectively.
Liver directed therapy:
Ablation of liver tumors: Ablation is a procedure that uses heat or cold to destroy cancer cells in the liver. This can be done through radiofrequency ablation, in which a needle is inserted into the tumor and high-frequency electrical energy is used to heat and destroy the cancer cells, or through cryoablation, in which a probe is inserted into the tumor and extreme cold is used to freeze and destroy the cancer cells. Ablation is often used to treat small liver tumors that cannot be removed surgically.
Chemoembolization: Chemoembolization is a procedure that combines chemotherapy and embolization. Embolization is a procedure in which a small plastic or metal bead is placed in the blood vessels that feed the tumor, cutting off the blood supply to the cancer cells. Chemotherapy drugs are then delivered directly to the tumor through the embolized vessels. This procedure is often used to treat liver tumors that have spread to other parts of the body.
Radio-embolization: Radio-embolization is a procedure that combines radiation therapy and embolization. Tiny beads that contain radioactive material are placed in the blood vessels that feed the tumor, delivering radiation directly to the cancer cells. This procedure is often used to treat liver tumors that have spread to other parts of the body and cannot be treated with surgery or other forms of radiation therapy.
It’s important to remember that treatment for cancer is not one-size-fits-all, and the type and combination of treatment will vary depending on the type and stage of cancer you have. Your cancer care team will work with you to create a treatment plan that is tailored to your individual needs.
If you have any questions or concerns about your treatment options, be sure to ask your cancer care team for more information. They are there to support you every step of the way.”
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
Embrace the opportunity to engage with Dr. Sajeve’s expertise, and feel empowered to explore the vast expanse of oncology with renewed curiosity and understanding on “Ask MedOnCMD“