Cancer: Choosing a Treatment Program
What are the different kinds of cancer
treatment?
The three most common types of
cancer treatment are surgery, radiotherapy and
chemotherapy. Treatment is aimed at removing the cancer
cells or destroying them in the body with medicines or other
agents.
Surgery can be very
successful in treating some kinds of cancer, but it isn't an
option for all people. If the cancer is in the form of a
malignant tumor and the tumor is in one place (localized), it
may be possible to safely "cut out" the tumor and any
surrounding affected tissue. Surgery may not be possible if
the cancer has spread to other areas of the body or if the
tumor cannot be removed without damaging vital organs, such as
the liver or brain.
Radiotherapy uses
radiation — in the form of a special kind of x-ray, gamma rays
or electrons — to damage cancer cells so that they can't
multiply. There is usually no pain during therapy.
Radiotherapy may sometimes be the only treatment needed, or it
may be used with other therapies, such as surgery. A
combination of surgery and radiotherapy may be used for tumors
that grow in one place.
Chemotherapy uses
medicines to attack the cancer cells. Just the word
"chemotherapy" can cause a lot of fear because the side
effects can be severe. However, not all people experience
severe side effects. The side effects of chemotherapy can
often be reduced with other medicines.
Chemotherapy is usually used when
the cancer has spread to other areas in the body. Chemotherapy
can also be used in combination with surgery and radiation.
Sometimes the tumor is surgically removed and then
chemotherapy is used to make sure all the cancer cells are
killed.
Another kind of treatment is
biological therapy. This treatment uses proteins to
trigger the body's immune system to produce more white blood
cells (or lymphocytes). Two lymphocytes that can attack and
kill cancer cells are the T-cell and the B-cell. The proteins
boost the ability of the T-cell and B-cell lymphocytes to kill
cancer. Biological therapy can also be used in combination
with surgery, radiation therapy or chemotherapy.
Hormone therapy is
sometimes used to treat breast or prostate cancer. The hormone
estrogen can make breast cancer tumors grow faster. Similarly,
the hormone testosterone can make cancerous tumors in the
prostate grow faster. Drugs that contain other hormones may be
used to block the effects of estrogen and testosterone. In
other cases, surgery to remove the ovaries or the testicles
may be used. Removing these organs reduces the amount of
estrogen or testosterone in the body.
Hormone therapy is often used in
addition to chemotherapy or radiotherapy.
Other specialized treatments may
be available. Your doctor may talk to you about these
treatments if they are an option.
How do I decide what treatment option to
use?
Your doctor, or a team of
doctors, will help you understand your options and will
recommend options for treatment. You may not have a choice in
the treatment. Many factors are involved, including the stage
that your cancer is in, what organs are affected, and the type
of cancer that you have. Some cancers, such as skin cancer,
are easier to treat than others. Your age and health, as well
as the potential side effects of treatment, may also be
factors in how much control you have over your treatment plan.
You and your doctor will want to
consider both the advantages and disadvantages of each
therapy. In addition, you and your doctor will want to discuss
alternative therapies in case your cancer doesn't respond to
treatment.
What are clinical trials?
Clinical trials are used to
research new ways of treating people with cancer. After a new
medicine goes through many tests — both in the lab and on
animals — it is tested on people with cancer who volunteer to
take part in a clinical trial. The trial helps doctors decide
whether a medicine is safe and effective. It also helps
determine the correct dosages that patients should
receive.
Cancer trials are run differently
than some other clinical trials. In other types of trials,
patients taking new medicines are compared with patients who
receive no medicine at all (called a placebo or "sugar pill").
It would not be ethical for doctors to give people with cancer
a sugar pill containing no medicine. So, cancer trials compare
patients receiving a current medicine with patients receiving
the new medicine. Doctors hope that the trial will reveal that
the new medicine works better than the current one.
There are some advantages to
taking part in a clinical trial. Patients who do may receive
the newest and best medicines available. Also, patients are
monitored very closely throughout the trial, so their overall
health often benefits. Finally, patients who take part in a
clinical trial may not have to pay for the medicine they
receive. The company or organization that sponsors the trial
will usually provide the medicine at no charge, and will pay
for extra testing and doctor visits.
Clinical trials also come with
some risks. The medicines you may receive in a clinical trial
usually have not been approved by the U.S. Food and Drug
Administration (FDA). The medicine may have unwanted side
effects, or it may not work as well as doctors hope it will.
You may have to commit more time to your treatment if you take
part in a clinical trial, and you may have to have more
frequent tests.
If you think you might want to
take part in a clinical trial, talk to your family doctor. He
or she can tell you about the possible benefits and risks and
can help you look for a trial. You may also want to check the
National Cancer Institute's Web site (see "Other
Organizations") for more information and a searchable list of
clinical trials.
I sometimes don't understand what my
doctor is saying. What do I do?
Tell your doctor that you don't
understand. You need to be aware of what's going on at each
stage of your treatment, including all the options ahead of
you. You may want to use a 3-ring binder to take notes in
during your appointments. Write questions in your binder that
you want your doctor to answer. You can also record all of
your conversations, and then make notes in your binder from
the tape. It's important that you understand what your doctor
tells you, and that your doctor is aware if you don't
understand. Be honest with your doctor. Never hold back any
information, even when answering questions about how you feel,
or answering questions about how you understand what he or she
is saying.
Who does what in my treatment
program?
Cancer treatment can be
very complex. What kind of cancer you have, the stage that
it's in, and the treatment program you go through affects what
health care professionals you see.
Your family physician may
oversee your treatment and rehabilitation programs, and can
help answer questions you have. Sometimes an oncologist
may manage your treatment program, but your family physician
may take over once therapy is completed. An oncologist is a
doctor who specializes in treating people with cancer.
A surgeon may do the
operation to cut out as much cancerous tissue as possible. A
pathologist will examine your tissue that is removed
during a biopsy or surgery to check for signs of cancer.
Radiation oncologists administer radiotherapy. The
radiation oncologist is often assisted by diagnostic
radiologists, radiotherapy technologists and radiation
physicists, who plan treatment and check the radiation dosages
to ensure that treatment is as safe as possible.
Oncologists,
family physicians and internists often
prescribe chemotherapy medicines, hormones and other drugs.
Laboratory technicians or nurses may draw your
blood for tests.
Nutritionists help
evaluate your diet and help you plan your meals during and
after treatment. Physical therapists can help you keep
your muscle tone and restore your ability to move around if
there are any changes to your body from treatment.
Psychologists, psychotherapists and other counselors,
such as clergy or social workers, can help you
talk through your feelings. Pharmacists mix the
complicated medications and check that you are getting the
correct dosages.
Other Organizations
Susan G. Komen Breast Cancer
Foundation
http://www.breastcancerinfo.com
800-462-9273
American Society of Clinical
Oncology
http://www.asco.org
National Cancer Institute:
Clinical Trials
http://www.nci.nih.gov/clinical_trials/
American Cancer
Society
http://www.cancer.org
800-ACS-2345
