Treatment Option Overview

• How is cancer treated?
  • Surgery
  • Radiation
  • Chemotherapy
  • Hormone therapy
  • Biological therapy
• Are clinical trials (research studies) available?
• Where can people get more information about clinical trials?
• Does cancer always cause pain?

How is cancer treated?

Cancer treatment can include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. The doctor may use one method or a combination of methods, depending on the type and location of the cancer, whether the disease has spread, the patient's age and general health, and other factors. Because treatment for cancer can also damage healthy cells and tissues, it often causes side effects. Some patients may worry that the side effects of treatment are worse than the disease. However, patients and doctors generally discuss the treatment options, weighing the likely benefits of killing cancer cells and the risks of possible side effects. Doctors can suggest ways to reduce or eliminate problems that may occur during and after treatment.

Surgery

Surgery is an operation to remove cancer. The side effects of surgery depend on many factors, including the size and location of the tumor, the type of operation, and the patient's general health. Patients have some pain after surgery, but this pain can be controlled with medicine. It is also common for patients to feel tired or weak for a while after surgery.

Patients may worry that having a biopsy or other type of surgery for cancer will spread the disease. This is a very rare occurrence because surgeons take special precautions to prevent cancer from spreading during surgery. Also, exposing cancer to air during surgery does not cause the disease to spread.

Radiation

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells in a targeted area. Radiation can be given externally by a machine that aims radiation at the tumor area. It can also be given internally; needles, seeds, wires, or catheters containing a radioactive substance are placed directly in or near the tumor. Radiation treatments are painless. The side effects are usually temporary, and most can be treated or controlled. Patients are likely to feel very tired, especially in the later weeks of treatment. Radiation therapy may also cause a decrease in the number of white blood cells, which help protect the body against infection. With external radiation, it is also common to have temporary hair loss in the treated area and for the skin to become red, dry, tender, and itchy.

There is no risk of radiation exposure from coming in contact with a patient undergoing external radiation therapy. External radiation does not cause the body to become radioactive. With internal radiation (also called implant radiation), a patient may need to stay in the hospital, away from other people, while the radiation level is highest. Implants may be permanent or temporary. The amount of radiation in a permanent implant goes down to a safe level before the person leaves the hospital. With a temporary implant, there is no radioactivity left in the body after the implant is removed.

Chemotherapy

Chemotherapy is the use of drugs that kill cancer cells throughout the body. Healthy cells can also be harmed, especially those that divide quickly. The doctor may use one drug or a combination of drugs. The side effects of chemotherapy depend mainly on the drug(s) and the dose(s) the patient receives. Hair loss is a common side effect of chemotherapy; however, not all anticancer drugs cause loss of hair. Anticancer drugs may also cause temporary fatigue, poor appetite, nausea and vomiting, diarrhea, and mouth and lip sores. Drugs that prevent or reduce nausea and vomiting can help with some of these side effects. Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends.

Hormone therapy

Hormone therapy is used to treat certain cancers that depend on hormones for their growth. It works by keeping cancer cells from getting or using the hormones they need to grow. This treatment may include the use of drugs that stop the production of certain hormones or that change the way hormones work. Another type of hormone therapy is surgery to remove organs that make hormones. For example, the ovaries may be removed to treat breast cancer, or the testicles may be removed to treat prostate cancer.

Hormone therapy can cause a number of side effects. Patients may feel tired, or have fluid retention, weight gain, hot flashes, nausea and vomiting, changes in appetite, and, in some cases, blood clots. Hormone therapy may also cause bone loss in premenopausal women. Depending on the type of hormone therapy used, these side effects may be temporary, long lasting, or permanent.

Biological therapy

Biological therapy uses the body's immune system, directly or indirectly, to fight disease and to lessen some of the side effects of cancer treatment. Monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors are some types of biological therapy.

The side effects caused by biological therapy vary with the specific treatment. In general, these treatments tend to cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after the treatment stops.

Are clinical trials (research studies) available?

Yes. Clinical trials are an important treatment option for many cancer patients. To develop new, more effective treatments, and better ways to use current treatments, there are many clinical trials in many hospitals and cancer centers around the country. Clinical trials are a critical step in the development of new methods of treatment. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease.

Where can people get more information about clinical trials?

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI's Cancer Information Service (CIS) (see below) at 1-800-4-CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies, which is available at http://www.cancer.gov/publications on the Internet. This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available on the NCI's Web site.

Does cancer always cause pain?

Having cancer does not always mean having pain. Whether a patient has pain may depend on the type of cancer, the extent of the disease, and the patient's tolerance for pain. Most pain occurs when the cancer grows and presses against bones, organs, or nerves. Pain may also be a side effect of treatment. However, pain can generally be relieved or reduced with prescription medicines or over-the-counter drugs recommended by the doctor. Other ways to reduce pain, such as relaxation exercises, may also be useful. Pain should not be accepted as an unavoidable part of having cancer. It is important for patients to talk about pain so steps can be taken to help relieve it. The fear of addiction or "losing control" should not stop patients from taking pain medication. Patients who take medications for cancer pain, as prescribed by their doctor, rarely become addicted to them. In addition, changing the dose or type of medication can usually help if the patient has troublesome side effects.