Cancer Treatment

There are many types of cancer treatment. The types of cancer treatment that you have 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 cancer treatments, such as surgery with chemotherapy and/or radiation therapy. You may also have immunotherapy, targeted therapy, or hormone therapy.

Types of Cancer Treatment

Cancer treatment with radiation Therapy

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones.

How Radiation Therapy Works against Cancer

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.

There are two main types of radiation therapy, external beam and internal.

External Beam Radiation Therapy

External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

Internal Radiation Therapy

Internal radiation therapy is a cancer treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.

Internal radiation therapy with a solid source is called brachytherapy. In this type of cancer treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body.

Internal radiation therapy with a liquid source is called systemic therapy. Systemic means that the treatment travels in the blood to tissues throughout your body, seeking out and killing cancer cells. You receive systemic radiation therapy by swallowing or through a vein, via an IV line.

The type of radiation therapy that you may have depends on many factors, including:

• The type of cancer;
• The size of the tumor;
• The tumor’s location in the body;
• How close the tumor is to normal tissues that are sensitive to radiation;
• Your general health and medical history;
• Whether you will have other types of cancer treatment;
• Other factors, such as your age and other medical conditions.

When cancer treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

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

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 surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other cancer 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.

When radiation is combined with surgery, it can be given:

• Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return;
• During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation;
• After surgery to kill any cancer cells that remain.

Cancer treatment with chemotherapy

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:

• Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth;
• Ease cancer symptoms;
• Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.

When used with other treatments, chemotherapy can:

• Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy;
• Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy;
• Help other treatments work better;
• Kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. 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.

The most common side effect is fatigue, which is feeling exhausted and worn out.

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;
• Intra-arterial (IA): the chemotherapy is injected directly into the artery that leads to the cancer;
• Topical: the chemotherapy comes in a cream that you rub onto your skin.

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when the cancer treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

• 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. Be sure to watch for signs of infection around your catheter. See the section about infection for more information;
• 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. See the section about infection for more information;
• 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.

There are many different chemotherapy drugs. Which ones are included in your cancer treatment plan depends mostly on:

• The type of cancer you have and how advanced it is;
• Whether you have had chemotherapy before;
• Whether you have other health problems, such as diabetes or heart disease;
• Where You Go for Chemotherapy.

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

• Your type of cancer and how advanced it is;
• Whether chemotherapy is used to;
• Cure your cancer;
• Control its growth;
• Ease symptoms;
• The type of chemotherapy you are getting;
• How your body responds to the chemotherapy.

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Cancer treatment with immunotherapy

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

Types of Immunotherapy

Many different types of immunotherapy are used to treat cancer. They include:

Monoclonal antibodies, which are drugs that are designed to bind to specific targets in the body. They can cause an immune response that destroys cancer cells.

Other types of monoclonal antibodies can “mark” cancer cells so it is easier for the immune system to find and destroy them. These types of monoclonal antibodies may also be referred to as targeted therapy. See Targeted Therapy for more information.

Adoptive cell transfer, which is a treatment that attempts to boost the natural ability of your T cells to fight cancer. T cells are a type of white blood cell and part of the immune system. Researchers take T cells from the tumor. They then isolate the T cells that are most active against your cancer or modify the genes in them to make them better able to find and destroy your cancer cells. Researchers then grow large batches of these T cells in the lab.

You may have treatments 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. The process of growing your T cells in the lab can take 2 to 8 weeks, depending on how fast they grow.

Cytokines, which are proteins that are 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.

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.

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.

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

Immunotherapy Can Cause Side Effects

Immunotherapy can cause side effects, which affect people in different ways. The side effects you may have and how they make you feel will depend on how healthy you are before treatment, your type of cancer, how advanced it is, the type of therapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during the cancer treatment.

The most common side effects are skin reactions at the needle site. These side effects include:

• Pain;
• Swelling;
• Soreness;
• Redness;
• Itchiness;
• Rash.

You may have flu-like symptoms, which include:

• Fever;
• Chills;
• Weakness;
• Dizziness;
• Nausea or vomiting;
• Muscle or joint aches;
• Fatigue;
• Headache;
• Trouble breathing;
• Low or high blood pressure.

Other side effects might include:

• Swelling and weight gain from retaining fluid;
• Heart palpitations;
• Sinus congestion;
• Diarrhea;
• Risk of infection.

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

Different forms of immunotherapy may be given in different ways. These include:

• Intravenous (IV): the immunotherapy goes directly into a vein;
• Oral: the immunotherapy comes in pills or capsules that you swallow;
• Topical: the immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer;
• Intravesical: the immunotherapy goes directly into the bladder.

You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often and how long you receive immunotherapy depends on:

• Your type of cancer and how advanced it is;
• The type of immunotherapy you get;
• How your body reacts to treatment.

You may have cancer treatment every day, week, or month. Some immunotherapies are given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to the immunotherapy, and build new healthy cells.

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