Let's Talk About Cancer Treatment
Determining the best possible treatment plan and managing any side effects are among your top concerns. We'll help you turn a sense of overwhelm into calm action.by Erin L. Boyle Health Writer
It’s natural to feel overwhelmed after a cancer diagnosis, and heading into the treatment phase may make you feel even moreso. Cancer therapies have changed rapidly in the last decade or so, with “precision medicine” offering more specialized care targeted to your cancer tumor, as well as less invasive ways to treat the disease. You could end up having a treatment you’ve never heard of—or maybe one you’re familiar with, but with controlled side effects and easier protocols than ever before. Here’s what’s helpful to know.
Our Pro Panel
We went to some of the nation's top experts in cancer to bring you the most up-to-date information possible.
Swati Kulkarni, M.D.
Surgical Oncologist, Associate Professor of Surgery
Feinberg School of Medicine, Northwestern Medicine
Nina Sanford, M.D.
Radiation Oncologist, Assistant Professor
Dedman Family Scholar in Clinical Care, UT Southwestern Medical Center
Lidia Schapira, M.D.
Medical Oncologist, Associate Professor of Medicine at the Stanford University School of Medicine and Director of Cancer Survivorship
Stanford Comprehensive Cancer Institute
While immunotherapy isn’t a good treatment for every cancer patient, clinical studies have shown that patients who have this therapy have “durable” results, meaning they continue to experience good outcomes after treatment is finished.
Here’s how it works: radiation damages the DNA of cancerous cells, thwarting their ability to pass their genetic material on to new cancerous cells. It can destroy the DNA directly, or it can create particles called free radicals that act like an army of soldiers that destroy the invading cancer cells.
You might be surprised to learn that some cancer treatment types do come from nature. Take chemotherapy for example. Three drugs (Vincristine, Vinblastine, and Vinorelbine) derive from plant alkaloids, and are made from the periwinkle plant (catharanthus rosea). Chemo drugs called taxanes (Paclitaxel and Docetaxel) come from the bark of the Pacific Yew tree (taxus). Podophyllotoxins (Etoposide and Tenisopide), another type of chemotherapy, are made from May apple plant. So the natural world is present in perhaps the very chemo drug you’re on.
It targets rapidly developing cancer cells (which tend to grow more quickly than normal cells), stopping them from replicating. One big problem with this treatment, however, is that chemotherapy can’t distinguish between cancerous or healthy cells, so it attacks both indiscriminately. Which is why this drug therapy can have so many side effects, from hair loss to nausea. It’s a balance between receiving enough chemo to kill mutated cancer cells, to stop them from growing, while protecting healthy cells.
What Treatments Are Available for Cancer?
When you think of conventional cancer treatments, your mind probably goes to chemo, radiation and surgery. But there are loads of others that doctors traditionally use.
It’s not unusual for doctors to try more than one treatment, spaced out over weeks and months, as they gage how your body responds to them. Your doctor might even start you on multiple treatments at the same time. Here are the conventional treatments you may be offered.
Watch and Wait
If your cancer is in an early stage and doesn’t appear to be growing, or is growing very slowly, your doctor might decide to closely monitor your condition without giving any treatment until symptoms appear or change.
Surgery is among the oldest treatments for cancer. In fact, the first radical mastectomy for breast cancer was performed in 1890 by William Halsted at Johns Hopkins Hospital in Baltimore. Surgery’s still a top choice for cancer treatment, and its goals remain: to remove the entire tumor, or some of the tumor (called debulking), or to ease cancer symptoms such as pain or pressure. There are also minimally invasive procedures, using laparoscopic surgery, in which doctors create smaller incisions. Advantages: less post-op pain, shorter hospital stays, and minimal scarring.
Radiation Therapy (RT)
RT uses high-powered energy beams, such as X-rays, to kill cancer cells or slow their growth by damaging their DNA. These cells are so damaged, they stop dividing or die, which means they break down and exit the body. RT can take days or weeks to kill cancer cells, and continue to destroy them months later. It can also be used to stop cancer pain and other symptoms from the cancer itself. Picturing a laser gun? Not quite: RT can be delivered by a large machine outside your body (external beam radiation) or an implant inside your body (brachytherapy).
Chemo is, basically, any drug that stops or slows the growth of cancer cells. Chemo can be delivered at two time points in treatment: Before surgery or radiation, to make a tumor smaller, called neoadjuvant treatment; or after surgery or radiation, called adjuvant treatment. It can also be given on its own. It’s commonly administered by IV, which can sometimes be delivered at-home, if your insurance allows it; otherwise, you’re going to a hospital or infusion center for your fill. But did you know, you can also take chemo by mouth, as chemo pills, or liquids you swallow, in the comfort of your own home?
This is where precision medicine—what some call the future of cancer treatment—comes into the picture. Targeted therapy is specific to the cancer cells that make up tumors. There are two basic types of targeted therapy:
Small-molecule drugs (so tiny, they can center and target issues within cells)
Monoclonal antibodies (these proteins attach to specific targets on cancer cells, stopping them in a variety of ways)
The small-molecule drugs are taken as pills or capsules, while the monoclonal antibodies are given by needle.
Immunotherapy, also known as biological therapy, harnesses your body's immune system to fight cancer. Cancer can thrive because your immune system doesn’t recognize it as an invader. Immunotherapy can help your immune system recognize the cancer and attack it. How? You can receive immunotherapy by IV, pills or capsules, as a topical cream, in your bladder, even as a treatment vaccination.
Some types of cancer, like breast cancer and prostate cancer, are fueled by your body’s hormones. Removing those hormones or blocking their effects may cause the cancer cells to stop growing. You can do so by taking pills (sometimes as maintenance therapy, when you’re in complete remission and continue taking drugs to stay that way), through injection, or through surgical removal of the organs that release hormones (ovaries, testicles).
Bone Marrow Transplant/Stem Cell Transplant
Bone marrow is the material inside your bones that makes blood cells. A bone marrow transplant, also called a stem cell transplant, using your own cells or cells from a donor, allows your doctor to employ higher doses of chemo to treat your cancer. It may also be used to replace diseased bone marrow or bone marrow destroyed by high doses of chemo or radiation.
What About Complementary and Alternative Treatments?
You or your doctor may want to look beyond conventional treatments, to what’s known as complementary and alternative (CAM) treatments. Complementary treatments are done along with traditional treatment, and include:
Alternative treatments are offered instead of conventional treatment like surgery or chemo and include:
Some complementary treatments, like acupuncture, can help with the side effects of conventional treatments, like nausea and vomiting, research has shown. But a study in JAMA Oncology also shows that many people fail to tell their doctors about complementary therapies they’re using, which could be a big mistake, because even supplements can make a difference in your treatment, and could change—or worsen—the outcome of your conventional care.
So be sure to tell your doc about any vitamins you take, chiropractic work you undergo, and other therapies you try. And don’t be shy asking about any alternative treatment you’re interested in, as well.
How Does My Doctor Know What Treatment to Recommend?
Your healthcare professional will plan your recommended cancer treatment plan based on factors including your cancer type and stage. They’ll likely use clinical practice guidelines in cancer treatment, published regularly by leading cancer societies, to create the most up-to-date roadmap. Each cancer type has different treatment needs, ranging from where your primary tumor originated to how advanced your cancer is, including if it’s spread (known as metastasized).
Your individual situation matters, too. Do you have health concerns that might impact treatment? (Chronic disease, we see you.) Can you travel to receive a certain treatment, or would you prefer to stay local and undergo only what your nearby treatment center offers? And what will your health insurance pay?
You and your doctor will also want to discuss the potential risks and benefits of each treatment option:
Cure/remission: What’s the chance of achieving a cure or cancer remission?
Recurrence: Could the cancer return even with treatment?
Outcome: What are the chances of living longer with or without this treatment?
Quality of life: How will this treatment affect that, and your independence?
Personal, family considerations: What do you and your family prefer, in terms of treatment types?
You’ll want to discuss your options with loved ones, close friends, oncology social workers, clergy, another person with your same type of cancer if possible, or anyone who can be a good sounding board. Keep in mind that your doctor will give you a cancer treatment plan recommendation based on these factors, but it’s just that—a recommendation. It’s always a good idea to seek a second opinion. You can ask your doctor if he/she can suggest a specialist or another cancer doctor who might have insights into your specific cancer case. Your doctor should be fine with you asking another physician to confer on their treatment plan (in fact, if they aren’t, you might want to seek a more collaborative doctor anyway).
Will I Have Side Effects from Cancer Treatment?
Yes, it’s very possible, unfortunately. The good news is there are plenty of options for managing them.
You’re probably familiar with the common side effects of chemo—hair loss, nausea and vomiting, foggy “chemo brain.” These can be eased with careful management of treatment, and usually stop when therapy ends.
These side effects can include pain, nausea and vomiting, peripheral neuropathy (nerve damage), constipation, sleep issues, and breathing problems. Different treatments can have different side effects, from the potential for infections from surgery to annoyances related to targeted therapy, like dry skin, nail changes, and hair depigmentation.
Some side effects can be serious, life-threatening even, including infections, deep vein thrombosis, pulmonary embolism, and tumor lysis syndrome. Cancer.net has a useful guide to when you should call your doctor if you’re worried about side effects.
Whatever side effects you’re experiencing, supportive care, also called palliative care, can help you cope. This includes medication; nutrition/dietary changes; meditation; exercise; and emotional and spiritual support (for family caregivers and children, too). Tell your doctor, oncology nurse, or oncology pharmacist about any side effects as soon as you experience them so they can help.
Now, let’s clear up a common misconception: Palliative treatment does not mean you’re “giving up” or you need hospice care (care typically given you’re in the final stage of a terminal illness). It can be used throughout your cancer care journey, and into survivorship (also known as when you’re finished your cancer treatment and celebrate in Hawaii), too.
Can Cancer Treatment Cure Me?
Much depends, of course, on the stage when you were diagnosed and your specific case, but with so many big advances in cancer treatment in the last few decades, it’s very possible.
Five-year survival rates (the percent of people alive after five years after diagnosis or starting treatment) for some cancers, including the most common cancer types in men and women, prostate cancer and breast cancer, and leukemia in children, are now 90% or better. The five-year survival rate for all cancers in the U.S. is about 67%.
Who Will Be on My Cancer Care Team?
You’ll be seeing a whole lot of healthcare professionals in the coming weeks and months, and sometimes, even years. You might not see everyone listed here (it’s an exhaustive list), but here’s a quick who’s who when it comes to cancer care:
Primary care doctor (also known as a family doctor, general practitioner, internist)
Medical oncologist (handles drugs/medicine in cancer)
Radiation oncologist (gives radiation therapy treatment, with the help of a medical dosimetrist, who oversees the dosage of radiation, and a medical physicist, who assists in radiation-based treatments)
Surgical oncologist (performs surgery to remove cancerous tumors, as well as biopsies)
Hematologist-oncologist (diagnoses and treats blood cancers, like leukemia)
Pediatric oncologist (specializes in children’s cancer care)
Oncology pharmacist (oversees medicine application)
Other specialists (including but not limited to gastroenterologist, dermatologist, gynecologist, endocrinologist)
Oncology nurse (assists in overall cancer care)
Pathologist (reads lab tests to determine cancer diagnosis and type)
Diagnostic radiologist (conducts imaging tests for diagnosis and treatment)
Holistic Support and Resources
Patient navigator (helps you communicate with your healthcare providers)
Case manager (addresses financial questions)
Oncology social workers (counsels on emotional issues, including for caregivers and children)
Psychologists/Psychiatrists/Therapists (assists in emotional care, including for caregivers and children)
Physical therapist (assists with physical recovery or rehabilitation)
Dietician/nutritionist (advises on special diets to maximize treatment success)
How Do I Choose a Good Healthcare Team?
Assembling your own personal A-team of knowledgeable, collaborative docs is key to successful treatment. If you’re not sure who your insurance company covers, call the number on the back of your insurance card and ask if your coverage is limited to who’s in-network or if you can “shop around” for cancer doctors and institutions in your area.
The National Cancer Institute (NCI) can help when selecting an effective cancer treatment facility. Its Cancer Centers Program recognizes 71 NCI-Designated Cancer Centers in 36 U.S. states and the District of Columbia as delivering “cutting-edge cancer treatments” to people across the nation. Another resource to find cancer care: The Commission on Cancer (CoC), a program of the American College of Surgeons (ACoS), has an online database of more than 1,500 cancer centers across the U.S. that are “committed to [providing] the best in cancer diagnosis and treatment.”
How Can I Receive the Best Cancer Care/Treatment?
Want to up the chances of your treatment being as effective as possible? These nine tips might shed some light:
Bring someone with you. A family member or friend at your doctor appointments and treatments can make all the difference when you have chemo brain or just can’t process any more info.
Take notes. Or ask the person with you to take them. This way you can review what you learned later, when you’re maybe calmer and more receptive to hearing. This way you won’t forget details, either.
See if it's OK to digitally record the visit. Some clinicians may cringe or be uncomfortable; most will not. You can then use a sound app on your smartphone to record the conversation. And that’ll give you a recording that can be shared with family members or can be played back to fill in any memory gaps.
Ask questions. Including, who is responsible for my care at this phase in my treatment? When it comes to your care, you should know what’s going to happen, when. See the NCI for other questions to ask during your treatment.
Be clear. Talk to your doctors as honestly and clearly as you can. And ask them to do the same, including explaining any medical language you may not understand. You can use the NCI’s dictionary of cancer terms or the National Human Genome Research Institute’s Talking Glossary of Genetic Terms if you need more help understanding cancer language.
Respect how you feel. Part of being an engaged patient means paying attention not only to what is being said about your treatment, but how you feel while undergoing it. Are you exhausted? In pain? Nauseated? How you feel matters, and it’s by telling your team how you’re responding to your meds that they can make improvements.
Loop in other docs. Make sure your primary care doc is up on your treatment and receiving documentation from all your healthcare professionals.
Collect notes, records, files in one place. Binders or expandable folders are great places for all the papers you gather during your cancer journey. Have a written or digital document going, with notes, contact information for key people on the team (especially if you need after-hours care for potential side effects), and next treatment steps.
What About Clinical Trials for Cancer Treatment?
Clinical trials are studies to investigate new ways of treating a condition. Thousands of clinical trials for cancer are happening all the time. By participating, you might gain access to newer treatment options that aren’t yet U.S. Food and Drug approved and in use for the general public, if you are eligible.
The National Cancer Institute (NCI) has clinical trials listed at its website; you can also find out about open trials by calling 1-800-4-CANCER (1-800-422-6237).
- Efficacy of Acupuncture for Cancer: Hematology/Oncology Clinics of North America. (2009). “The Value of Acupuncture in Cancer Care.” ncbi.nlm.nih.gov/pmc/articles/PMC2642987/
- Reporting Complementary Treatment: JAMA Network. (2019). “Prevalence and Nondisclosure of Complementary and Alternative Medicine Use in Patients With Cancer and Cancer Survivors in the United States.” jamanetwork.com/journals/jamaoncology/article-abstract/2730130
- Clinical Trials: National Cancer Institute. (n.d.). “Clinical Trials Information For Patients and Caregivers.” cancer.gov/about-cancer/treatment/clinical-trials
- Choosing a Doctor and a Hospital: American Cancer Society. (2016). “Choosing a Doctor and a Hospital.” cancer.org/treatment/finding-and-paying-for-treatment/choosing-your-treatment-team/choosing-a-doctor-and-a-hospital.html
- NCI-Designated Cancer Center: National Cancer Institute. (n.d.). “Find a Cancer Center.” cancer.gov/research/nci-role/cancer-centers/find
- Database on Cancer Centers: American College of Surgeons Commission on Cancer. (n.d.). “Search For Cancer Centers.” facs.org/search/cancer-programs
- Questions to Ask: National Cancer Institute. (2018). “Questions to Ask About Your Cancer Treatment.” cancer.gov/about-cancer/treatment/questions
- Cancer Terms: National Cancer Institute. (n.d.). “Dictionary of Cancer Terms.” cancer.gov/publications/dictionaries/cancer-terms
- Genetic Terms: National Human Genome Research Institute. (n.d.). “Talking Glossary of Genetic Terms.” genome.gov/genetics-glossary