Types of Treatment

Source: Collect

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2011

The cancer treatment options your doctor recommends depends on the type and stage of cancer, possible side effects, and the patient's preferences and overall health. In cancer care, different types of doctors often work together to create a patient's overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Treatment overview

The most common cancer treatments include surgery, radiation therapy, and chemotherapy. These therapies may be used either alone or in combination with other therapies. Palliative treatment is treatment given to relieve symptoms of cancer and cancer treatment, such as pain. Other cancer treatment options include targeted therapy, immunotherapy, hormonal therapy, and stem cell/bone marrow transplantation. More information on each of these treatments is below. Or, find more details about treatment for a specific type of cancer.

In addition, patients are encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all clinical trial options. Learn more about clinical trials.

The first treatment a person is given is called first-line therapy. If that treatment stops working, then a person receives second-line therapy (and in some situations, third-line therapy may be available). Adjuvant therapy is treatment that is given after the first treatment (such as chemotherapy after surgery). Neoadjuvant therapy is treatment that is given before the primary treatment (such as radiation therapy before surgery).

Before beginning treatment, consider asking the doctor about the goals of treatment, how long the treatment will take, and the potential side effects. Knowing what to expect before treatment begins helps reduce any fear and anxiety you may be feeling about your cancer treatment plan. Find more questions to ask the doctor. It is also important that people with cancer and their families feel comfortable about their doctor and his or her recommended treatment plan. It is always appropriate to seek a second opinion.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is the primary treatment for many types of cancer, and some cancers can be completely removed with surgery alone. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery may also be used to confirm a diagnosis (such as with a surgical biopsy), find out the extent of the cancer (calledstaging), and relieve side effects (such as removing an obstruction to ease pain). Read more about cancer surgery.

Some types of surgery are performed in a clinic or doctor's office instead of the hospital, and the patient returns home the same day. This is called outpatient surgery. Most cancer surgeries, though, are performed in a hospital and the patient must stay at the hospital at least overnight; this is called in-patient surgery. Before any type of surgery, consider preparing a list of questions for the surgeon and review the details of how to best prepare for the surgery. Find out more of what to expect during surgery.

The side effects of surgery depend on the type of surgery and the overall health of the person before surgery. A common side effect ispain, and doctors have ways to provide relief when pain and other side effects occur in most people.

Radiation treatment

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells.
A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Proton therapy (also called proton beam therapy) is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Learn more about radiation therapy.

Radiation therapy is considered a local treatment, as it only affects one part of the body. The goals of radiation therapy include shrinking the tumor before surgery, keeping the tumor from returning after surgery, eliminating cancer cells in other parts of the body, and relieving pain.

Before beginning external-beam radiation therapy, the doctor will plan where to aim the radiation to destroy as much of the tumor as possible while minimizing the exposure of healthy tissue. A person's skin may be marked to show where the radiation will be directed. New computerized techniques help pinpoint the best place to give the radiation. Read more about what to expect when receiving radiation therapy and frequently asked questions about radiation therapy.

Side effects of radiation treatment

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Internal radiation therapy may cause bleeding, infection, or irritation after the implant is removed. Radiation treatment does not make a person radioactive. Most side effects go away soon after treatment is finished. Learn more about the side effects effects of radiation therapy.

Some people, especially children and young adults, may experience long-term side effects from external-beam radiation therapy. People who receive radiation therapy should keep a record of their radiation treatment schedule (including the dose and location of the radiation) and report it as part of their medical history. Long-term side effects may include the risk of a second cancer, infertility (the inability to father a child or maintain a pregnancy), heart problems (from radiation to the chest), gastrointestinal problems (from radiation to the abdominal area), lung fibrosis (scarring or thickening of the lung tissue), neurologic problems, thyroid problems, or osteoporosis (thinning of the bones).

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells' ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication or a hematologist, a doctor who specializes in treating blood disorders. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Learn more about what chemotherapy is and preparing for treatment.

Side effects of chemotherapy

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. However, doctors have made major strides in recent years in reducing many side effects. Before treatment begins, talk with your doctor or nurse about the possible side effects of the specific type and dose of chemotherapy you've been prescribed and how to prevent or relieve side effects if they do occur. Find out more about the side effects of chemotherapy and ways to manage common side effects.

Once treatment is finished, ask your doctor or nurse for a summary of your treatment, such as the drugs and doses used, and any side effects you experienced. Having this information will help a doctor determine if a future health problem is related to the cancer treatment. Learn more about the late effects of cancer treatment.

Targeted therapy

Targeted therapy is a treatment that targets the cancer's specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells, usually leading to fewer side effects than other cancer medications.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

Targeted treatments often have specific side effects involving the skin, hair, and nails or other areas of the body. Learn more about skin reaction to targeted therapies. Talk with your doctor about what side effects to expect and how to manage them.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. The side effects of immunotherapy generally include flu-like symptoms, such as chills, nausea, and fever. Immunotherapy also includes cancer vaccines—an investigational approach to helping the immune system fight cancer. Learn more about immunotherapy.

Hormonal therapy

Several types of cancer, including some breast and prostate cancers, only grow and spread in the presence of natural chemicals in the body called hormones. Hormonal therapy treats cancer by lowering the amounts of hormones in the body. It is usually used to treat cancers of the prostate, breast, thyroid, and reproductive system. As with any treatment, hormonal therapy has side effects, and most of these go away after a person finishes treatment. However, the side effects depend on the drug used and often affect men and women differently. Refer to individual Cancer Type sections for more information about hormonal therapy and specific side effects.

Stem cell/bone marrow transplantation

A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the blood stem cells that are typically being transplanted, not the actual bone marrow tissue.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and the patient's age and general health. Read more about bone marrow and stem cell transplantation and the side effects of this treatment.

Palliative care

In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person's symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. Regardless of a patient's treatment plan, it is important to discuss any supportive care needs with the health care team. They are there to help ease symptoms, such as pain, but they need to know what the patient's concerns are to be the most effective.

n this section you'll find information about the physical side effects that can be caused by different cancer treatments.

Chemotherapy Effects

Chemotherapy drugs are powerful medicines that can cause side effects. Some of these side effects are discussed below in other sections, but if you're looking for information on the side effects most commonly caused by chemotherapy, this is a good place to start.

Radiation Therapy Effects

Radiation therapy can cause side effects by damaging normal, healthy cells near the cancer. Some of the side effects of radiation therapy are discussed below in other sections. But if you're looking for information on the most common side effects from radiation therapy, start here.

Pain

Pain can be caused by cancer itself or by certain treatments, such as surgery. Go here to learn more about cancer-related pain and how it can be managed and treated.

Nausea and Vomiting

Nausea and vomiting are among the most feared side effects of cancer treatment. While many people treated for cancer have bouts of nausea and vomiting, there are medicines that work well to control these side effects. Find out more about preventing and treating nausea and vomiting here.

Fatigue

Fatigue is one of the most common and distressing side effects of cancer and its treatment. Fatigue from cancer treatment is often more intense than the feelings of being tired we all have from time to time. Learn about cancer-related fatigue and how to manage it here.

Anemia

Anemia is having a lower than normal number of red blood cells in your blood. Red blood cells carry oxygen throughout your body. Not having enough of them can result in feeling weak, tired, or short of breath. Find out more about cancer-related anemia and what can be done about it here.

Lymphedema

Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. This build-up causes swelling (or edema), most often in the arms or legs. Lymphedema can result from surgery or radiation therapy to treat certain cancers. Go here to learn more about lymphedema.

Infections in People with Cancer

Infections in people who have cancer or are getting cancer treatment can be more serious than those in other people. They can also be harder to treat. By learning more about them, you and your family may be able to help prevent problems that infections can cause.

Second Cancers Caused by Cancer Treatment

Some cancer treatments such as chemotherapy and radiation therapy may increase a person's risk of developing a different types of cancer later in life. Here we discuss the risk of second cancers that may be linked to past cancer treatment.

Sexual Side Effects in Men

Men and their doctors often do not talk about the effects of cancer treatment on their sex lives. Men may feel uneasy talking about sex with a professional like a doctor or even with a close sex partner. In this section, we answer questions and offer information about cancer, sex, and sexuality to help you have open, honest talks about your sex life.

Sexual Side Effects in Women

Women and their doctors may not talk about the effects of cancer treatment on their sex lives. Some women may feel uneasy talking about sex with a professional like a doctor or even with a close sex partner. In this section, we answer questions and offer information about cancer, sex, and sexuality to help you have open, honest talks about your sex life.

Fertility and Cancer: What Are My Options?

Cancer and its treatment can sometimes affect a person's ability to have children. Here we offer information on how cancer treatment can affect fertility, ways to preserve fertility before treatment, and fertility options available after treatment.

Dealing with Symptoms at Home

This guide offers general information about caring for a person with cancer at home. It lists the more common problems people with cancer experience, signs of problems you can look for, and some ideas for things you can do if problems come up.

I Can Cope Online Class - Managing the Effects of Illness and Treatment

For a quick, easy way to learn important facts and practical tips about cancer and related issues, participate in our interactive online program, I Can Cope—Online. There is never any charge to participate, and you set the pace—whenever and wherever is most convenient for you. This class focuses on managing the effects of illness and treatment.

Ostomies

An ostomy (or stoma) is a surgical opening made in the skin as a way for waste products to leave the body. An ostomy can allow wastes to leave from the intestines (ileostomy or colostomy) or from the bladder (urostomy). The guides in this section explain the different types of ostomies, why they might be needed, and how they might affect a person's life.

Tools to Monitor Treatment

These worksheets (in PDF format) can help you keep track of your side effects and medications so that you can better communicate with your health care team about them.