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Approaches to treating cancer

Concepts of Cancer Therapy—The treatment options for cancer vary in many ways depending on type of cancer, stage and other factors; however, some principles can be applied to all.

Curable or incurable:

These principles include whether the cancer is to be treated for cure (curable disease) or for palliation (non-curable disease).

Adjuvant or neoadjuvant:

Chemotherapy or radiation given after surgery for potential cure (curative intent) is referred to as adjuvant therapy in medical terms. In certain situations, a cancer is treated with chemotherapy with or without radiation before surgery is performed. This is called Neoadjuvant Therapy.

Palliative treatment:

Treatment for a type or stage of cancer that is not considered curable is normally focused on improving control of cancer (prolonging life expectancy) and control of cancer-related symptoms (palliative care), with quality of life as emphasis.

Surgery:

Some types of cancer may be cured by surgery alone if found in an early stage. Some may require additional treatment such as chemotherapy and/or radiation to improve the chance for cure even when the cancer was found in an early stage. Some patients may be treated with radiation alone. Some may require hormonal therapy. Surgery is normally performed in patients who have a tumor which can be surgically removed and is performed by an experienced surgeon.

Adjuvant therapy:

Why might a patient with cancer be recommended to receive chemotherapy, hormonal therapy, radiation, or other therapy (Adjuvant Therapy) after a tumor is completely removed with surgery? This brings about a very important concept in cancer therapy. In many cases, despite gross tumor is removed, a patient may still retain some cancer cells somewhere in their body, say, a few thousands or a few millions, and these many cancer cells cannot be detected by any technology available today. Treatment after surgery, namely, adjuvant therapy, is aimed to eliminate these microscopic cancer cells. If they are not eliminated, they could grow over time to a large tumor, and by that time, in many instances, the cancer is no longer curable. So the best time to eliminate all cancer cells and ensure a cure is when cancer cells are still in minimal numbers that can possibly be eliminated completely.

Risk of Relapse:

This is why Risk of Relapse in an early stage cancer is often discussed and an adjuvant therapy after surgery is aimed to cut down the risk as much as possible.

Chemotherapy:

Chemotherapy may be given by intravenous injection, infusion or by oral tablets in some situations. Intravenous injection and infusion is normally administered in an infusion center or clinic. Some patients may require hospitalization for treatment. Chemotherapy medications may be associated with a variety of side effects. Some patients may be given treatment with biologics such as Herceptin (for a type of breast cancer that’s positive for HER2), and Rituxan (for a type of lymphoma). They are monoclonal antibodies made specifically against certain type of cancer cells. These biologics do not share the same side effects as chemotherapy but have some different side effects.

Hormonal therapy:

Hormonal therapy (also called endocrine therapy) is normally given to patients with breast or prostate cancer. For breast cancer these treatments may include Tamoxifen, Arimidex (Anastrozole), Femara (Letrozole), or Aromasin (Exemestane). For prostate cancer these treatments may include Lupron injection, Casodex, or Flutamide. These medications are normally well tolerated but may cause significant side effects in some patients.

Radiation therapy:

Radiation therapy is directed by radiation oncologists. A course of radiation normally takes multiple treatments and each treatment (each fraction) takes just a couple of minutes.