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.
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Surgery
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.
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Radiotherapy
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.
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Chemotherapy
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.
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Other Treatments
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.
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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.
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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.
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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.
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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.