Overview of Treatment Options

After a cancer diagnosis, most people want as much information on the disease as possible. While this information should be useful to you, it cannot replace the advice and information given to you by your health care team.

Your treatment plan depends mainly on the type of cancer and the stage of the disease, as well as a person’s age and general health. Patients and their loved ones should dialogue with their health care team to determine the goals of therapy.

Most treatment plans include surgery, radiation therapy, or chemotherapy. Some involve hormone therapy or biological therapy. In addition, stem cell transplantation may be used so that a patient can receive very high doses of chemotherapy or radiation therapy.

Surgery

In most cases, a surgeon removes the tumor and some tissue around it. Removing nearby tissue may help prevent the tumor from growing back. The surgeon may also remove some nearby lymph nodes. Side effects depend mainly on the size and location of the tumor and the type of operation.

Radiation Therapy

Radiation therapy, or radiotherapy, is an important treatment option for many cancers. Approximately 50 percent of cancer patients receive radiation therapy at some point in the course of their illness.

Radiotherapy kills cancer cells by placing invisible electromagnetic energy in those cells, which disrupts the cellular DNA and causes the cancer cells to die. Critical to the successful use of radiotherapy in treating cancers is targeting the radiation to the cancer, while limiting exposure to nearby normal organs and tissues.

Radiation oncologists are physicians specially trained in the use of radiotherapy to treat cancers. When considering patients for possible radiotherapy, radiation oncologists choose either:

  • External beam radiotherapy
  • Internal radiation (brachytherapy)

Most patients are best treated with one or the other of these options, while a minority will require both.

External beam radiotherapy uses a high-energy radiation beam produced by a large machine, typically a linear accelerator. The beam is focused on the cancer often from multiple angles. The beam is shaped carefully to limit exposure of normal structures next to the cancer. Treatments usually are given daily, five days a week, for one to eight weeks, depending on the cancer. Most patients receiving external beam radiotherapy are outpatients for the entire course of treatment, and many are able to maintain normal, or near-normal, lives during their therapy.

Accurate targeting of external beam therapy requires both appropriate personnel and equipment with sophisticated capabilities. St.Vincent Cancer Care is proud to offer experienced staff and state-of-the-art linear accelerators with the following options for treatment:

  • 3-dimensional conformal radiotherapy
  • Intensity-modulated radiotherapy (IMRT)
  • Rapid-arc radiotherapy (proprietary to Varian)
  • Image-guided radiotherapy (IGRT)
  • Stereotactic Radiosurgery (SRS)
  • Stereotactic Body Radiotherapy (SBRT)

Internal radiation, or brachytherapy involves the placement of an actual radioactive source within the patient’s cancer to deliver extremely high doses of radiation to the tumor. Such radioactive sources deliver radiation over very limited distances so exposure to nearby normal tissues can be limited. At St.Vincent, the most common radioactive source used is a high-dose-rate (HDR) source, which allows most of our brachytherapy patients to receive their treatments as outpatients. Common diseases for which brachytherapy is used include breast, uterine, cervical, lung, and esophageal cancers.

Occasionally, internal radiation is given orally, as for certain thyroid cancers, or intravenously, as for certain lymphomas or for cancers that have spread to the bone. These treatments also are available at St.Vincent Cancer Care.

Chemotherapy

Chemotherapy is the use of drugs that kill cancer cells. Most patients receive chemotherapy by mouth or through a vein. Either way, the drugs enter the bloodstream and can affect cancer cells all over the body.

Chemotherapy is usually given in cycles. People receive treatment for one or more days. Then they have a recovery period of several days or weeks before the next treatment session. Most people have their treatment in an outpatient part of the hospital, at the doctor's office, or at home. Some may need to stay in the hospital during chemotherapy.

Targeted Therapies

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. Targeted cancer therapies are being studied for use alone, in combination with other targeted therapies, and in combination with other cancer treatments, such as chemotherapy.

Immunotherapy

Immunotherapy is treatment that boosts or restores the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called biological therapy, biological response modifier therapy, biotherapy, and BRM therapy.

Peripheral Stem Cell Transplant (Bone Marrow Transplant)

Transplantation of blood-forming stem cells enables patients to receive high doses of chemotherapy, radiation, or both. The high doses destroy both cancer cells and normal blood cells in the bone marrow. After the treatment, the patient receives healthy, blood-forming stem cells through a large vein. New blood cells develop from the transplanted stem cells.

Hormone Therapy

Some cancers need hormones to grow. Hormone therapy keeps cancer cells from getting or using the hormones they need. Hormone therapy uses drugs to prevent hormones from working or surgery to remove organs that make hormones, such as the ovaries or testicles.

Questions to Discuss with Your Health Care Team and Loved Ones Before Treatment Begins

  • What is my diagnosis?
  • Has the cancer spread? If so, where? What is the stage of the disease?
  • What is the goal of treatment?
  • What are my treatment choices and how do they meet my treatment goal?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What can I do to prepare for treatment?
  • How often will I have treatments? How long will my treatment last?
  • Will I have to change my normal activities? If so, for how long?
  • What is the treatment likely to cost? Will my insurance cover the costs?
  • What new treatments are under study? Would a clinical trial be appropriate for me?
  • What treatment plan do you recommend for me? Why?