Cancer Treatment Options

Common treatments for cancer include:

  • Surgery
  • Chemotherapy
  • Radiation Therapy
  • Immunotherapy
  • Targeted Therapy
  • Clinical Trials

There are also other forms of treatment depending on cancer type such as biologic therapy, immunotherapy, bone marrow transplant, stem cell transplant, etc. Your oncologist may recommend a combination of treatment options.

Another way to receive treatment is through a clinical trial. For some cancer types, clinical trials may be the best treatment option.

As you and your doctor explore the treatment options open to you, make sure you find out the answers to the following:

  • What are all my treatment options?
  • Am I eligible for a clinical trial?
  • What are the chances my cancer will come back after these treatments?
  • What do we do if the cancer comes back or the treatment doesn’t work?
  • What are the long-term and short-term side effects of treatment?
  • How will my normal activities change as a result of treatment?

When you meet with your doctor, it can be helpful to bring someone else with you. That way, there’s someone else to hear what is said and to ask questions. Here are some other tips for talking with your doctor:

  • Write out your questions ahead of time.
  • Write down the answers your doctor gives you.
  • If you don’t understand something, ask your doctor to say it in a different way. It’s important that you understand, and you have a right to know.

What is chemotherapy?

Chemotherapy (chemo) uses medicines that prevent cancer cells from growing and spreading. Chemotherapy medicines destroy cancer cells or prevent them from dividing. Chemo affects your whole body because it goes through your bloodstream. Chemo doesn’t refer to one treatment, but many. There are a lot of different chemotherapy medicines. Some targeted therapies are also considered chemotherapy.

What is chemotherapy like? What happens?

Your medical oncologist will tell you what type of chemotherapy is best for you.

Every chemo regimen or chemo round is made up of cycles. This means a period of treatment followed by a period of recovery. For example, you may get chemo one day and then have a few weeks to recover with no treatment. That would be one cycle. Several cycles make up a complete chemotherapy regimen.

Chemotherapy can be given a few different ways.

  • Intravenously (IV): As an IV infusion, the medicine comes through a thin needle (IV) in a vein in your hand or lower arm. An oncology nurse will insert the needle before each infusion and take it out afterwards.
  • Injection: As a single shot into a muscle in your leg, arm, hip, or under the skin in the fatty part of your stomach, leg or arm.
  • By mouth (Orally): As a pill or capsule. You may sometimes take oral chemo medicines at home.
  • Through a port: A port is a small disc made of plastic or metal. This is inserted in your chest during a short outpatient surgery. It is about the size of a quarter and sits right under your skin. A catheter (soft thin tube) connects the port to a large vein. A thin needle right delivers the chemo medicine into the port. You can also get your blood drawn through the port.
  • Through a catheter in your chest or arm. This is a soft thin tube that is inserted into a large vein. This is done in a short outpatient surgery. The other end of the catheter stays outside your body.

A catheter or port makes chemotherapy easier and more comfortable each time, as you don’t have to be restuck each time, like with an IV or injection. You healthcare team will teach you how to check for infection. The port or catheter will be removed when you finish treatment.

Chemotherapy is usually an outpatient procedure, but it can take one to several hours to finish as infusion. You may be asked to stay for monitoring if your immune system is low or you are experiencing other side effects.

What are the possible side effects?

Chemotherapy not only weakens and destroys cancer cells at the site of the tumor, but throughout the body as well. Chemotherapy usually affects all fast-growing cells.

Unfortunately, this means that chemo can unintentionally harm the development of normal cells like your hair, nails, mouth, and digestive tract.

The side effects chemo causes depend on the type of chemotherapy you receive and how many cycles you receive. The most common side effects of chemo are:

  • Nausea and vomiting
  • Fatigue or tiredness
  • Confusion, forgetfulness (“chemo brain”)
  • Decreased blood counts, sometimes with bruising, bleeding, or infection
  • Sores inside your mouth
  • Numbness in your hands and feet
  • Diarrhea
  • Increased urgency to have a bowel movement or urinate

If you experience side effects, call your doctor right away. It is better to address side effects right away, and there are numerous drugs available to help manage side effects.

What can I do to prepare?

Chemotherapy can drain most of your energy. There are some things you should take care of before you start chemo:

  • Get your teeth cleaned and get a dental check-up. Chemo weakens your immune system, so you may be more vulnerable to infections caused by bacteria that are dislodged during teeth cleaning.
  • Get any heart tests (like an EKG) that your doctor recommends.
  • If you’re a woman, get a Pap smear, if you’re overdue. Chemo can alter the results of your Pap smear, so get one beforehand.
  • Organize your rides to treatment. Ask a friend or family member to take you.
  • Find someone to help around the house. Line up someone to help with your daily chores such as cleaning, grocery shopping, and cooking.
  • Join a support group or talk to a survivor.
  • Talk to a registered dietitian about making the best food choices before and during treatment.
  • Tell your doctor all the vitamins, supplements, over-the-counter and prescription medicines you take.
  • Pack a bag to take with you on treatment days. Include books, cards, music players, a journal and pens, or anything else to pass the time.
  • You may also want to take a blanket, jacket, or warm socks.
  • Talk to your doctor about hair loss. If you plan to wear a wig, go ahead and get it so you can match it to your hair color and style. You may also want to stock up on scarves and hats to keep your head warm.
  • Buy unscented soap, shampoo, and detergent. Chemo can make you sensitive to some smells.

What is radiation?

Radiation therapy is also called radiotherapy or just radiation. It is a very effective way to destroy cancer cells.

As defined by the National Cancer Institute, radiation is the use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill and shrink tumors.

What is radiation like? What happens?

Radiation can be delivered in three ways:

  1. External-beam radiation therapy: With external-beam radiation therapy, the radiation comes from outside your body. It is targeted at a specific area of the body. This therapy usually consists of daily treatments over several weeks. A machine called a linear accelerator (LINAC) is the most common machine used to give external-beam radiation. The most common type of external-beam radiation is three-dimensional conformal radiation therapy (3D-CRT). This uses computer software to direct the radiation to a very precise area of the body. There are many other forms of external-beam radiation therapy. Your radiologist will know which is right for you.
  2. Internal radiation therapy (brachytherapy): With internal radiation therapy, a radiologist places radioactive material inside the body. These “seeds” give off radiation to destroy nearby cancer cells. The seeds may be placed inside the body with needles, catheters, or minor surgeries. Some of the seeds are permanent, and some are temporary. The permanent seeds stop giving off radiation over time. They do no damage by remaining in the body.
  3. Systemic radiation therapy: With this type of therapy, the patient swallows or receives injections of a radioactive substance. This substance helps destroy cancer cells throughout the body. Radioactive iodine, a specific type of systemic radiation, is commonly used for thyroid cancer. Other types of systemic radiation may be used for hematological cancers.

What are the possible side effects of radiation?

The goal of radiation is to kill as much cancer as possible while preserving normal tissue. However, there can still be adverse side effects.

The side effects of radiation therapy depend on:

  • The type of radiation therapy
  • The dose of radiation
  • The part of the body that is being treated

Here are a few examples of possible side effects:

  • Red, dry, and tender skin at treatment site
  • Hair loss in the treated area
  • Fatigue
  • Radiation to the abdomen may cause nausea, vomiting, and diarrhea.
  • Radiation to the pelvic region may cause infertility.
  • Radiation to the chest and neck may cause dry, sore throat, and some trouble swallowing.
  • Salivary gland damage
  • Stiff joints from fibrosis (a buildup of scar tissue at the treatment site)
  • Some types of systemic radiation cause you to emit radiation in your sweat or other bodily fluids. If this is the case, you will need to avoid children and pregnant women until the radiation has left your body. Your radiologist can give you a safe time frame.

Most of the side effects of radiation are short term, but some may be long term.

Very rarely, radiation can increase your risk for some cancers, but your radiologist will consider benefits of treatment versus risk of a secondary cancer when deciding the dosage of radiation. If you have radiation therapy and chemotherapy at the same time, your side effects may be worse.

Tell your healthcare team about any new or worsening side effects. Most side effects can be easily managed.