Cancer Treatment Explained

What decides cancer treatment?

Before recommending treatment, the cancer team may consider:

• the exact cancer type
• the organ where it started
• the stage and whether it has spread
• the pathology report
• tumour biomarkers or molecular changes when relevant
• previous treatments
• age and general health
• other medical conditions
• the expected benefits and possible side effects
• the patient’s preferences and treatment goals

Treatment may involve one approach or a combination of several approaches.

Surgery

Removing the cancer when it can be safely removed.

Surgery is commonly used for cancers that are confined to one area.

Depending on the cancer, surgery may remove:

• the tumour alone
• nearby tissue
• lymph nodes
• part or all of an affected organ

Surgery may be the only treatment needed for some early cancers.

In other situations, chemotherapy, radiotherapy, targeted therapy, immunotherapy or hormone therapy may be given before or after surgery.

Radiotherapy

Using high-energy radiation to damage cancer cells.

Radiotherapy is directed at a particular area of the body.

It may be used:

• as the main treatment
• before surgery
• after surgery
• together with chemotherapy
• to relieve symptoms such as pain, bleeding or pressure

Modern radiotherapy techniques aim to treat the tumour while limiting exposure to surrounding healthy tissue.

Chemotherapy

Medicines that kill or stop the growth of rapidly dividing cancer cells.

Chemotherapy can circulate throughout the body and is used in many different cancers.

Depending on the situation, chemotherapy may be used to:

• cure certain cancers
• reduce the risk of recurrence
• shrink cancer before another treatment
• control cancer that has spread
• relieve symptoms caused by cancer

Targeted therapy

Treatment aimed at specific changes that help cancer cells grow or survive.

Some cancers contain identifiable proteins or genetic alterations that can be targeted with particular medicines.

Examples may include changes involving:

• HER2
• EGFR
• ALK
• BRAF
• other relevant molecular targets

A targeted treatment is useful only when the tumour has the relevant target, so appropriate biomarker testing may be required.

Targeted therapy is not automatically better or less toxic than chemotherapy. The right treatment depends on the individual cancer.

Immunotherapy

Helping the immune system recognise or attack cancer.

Immunotherapy has changed treatment for several cancers, but it does not work for every cancer or every patient.

Biomarkers such as:

• PD-L1
• MSI/MMR status
• selected tumour or molecular features

may sometimes help doctors decide whether immunotherapy is appropriate.

Because immunotherapy activates the immune system, it can occasionally cause inflammation of healthy organs such as:

• lungs
• bowel
• liver
• skin
• thyroid
• other organs

Hormone therapy

Blocking hormones that help certain cancers grow.

Hormone therapy is particularly important in some:

• breast cancers
• prostate cancers

Depending on the cancer, treatment may:

• reduce hormone production
• block the effect of hormones on cancer cells

Hormone treatment may continue for months or years.

Stem-cell transplantation

Stem-cell transplantation is mainly used for selected blood cancers and bone-marrow disorders.

It allows doctors to restore blood-forming cells following intensive treatment.

Stem-cell transplantation is a specialised treatment and is not used for most solid tumours.

Why are treatments often combined?

Different treatments attack cancer in different ways.

Surgery → chemotherapy

Surgery removes visible cancer while chemotherapy may treat microscopic cancer cells that cannot be seen on scans.

Chemotherapy + radiotherapy

In selected cancers, chemotherapy can make cancer cells more sensitive to radiation.

Chemotherapy + immunotherapy

This combination is now used in several advanced cancers and in some earlier-stage cancers.

Treatment combinations depend entirely on the cancer type and clinical situation.

What does “curative” treatment mean?

Curative treatment is given with the intention of eliminating the cancer and achieving long-term disease control or cure.

It does not mean that cure can ever be guaranteed.

What does “palliative” treatment mean?

Palliative treatment does not mean that nothing can be done.

When cancer cannot currently be cured, treatment may still:

• shrink or control cancer
• relieve symptoms
• prevent complications
• prolong life
• preserve quality of life

Some people with advanced cancer can live for prolonged periods while receiving effective treatment.

The most important question

Why is this particular treatment being recommended for me?

A patient should understand:

• the goal of treatment
• the expected benefit
• important side effects
• available alternatives
• how response will be assessed
• what happens if the treatment does not work

Cancer treatment should be personalised rather than chosen simply because another patient received the same medicine.