Other Cancer

Treatment

Treatment for cancer can be either local or systemic. Local cancer treatments affect cancer cells in the tumor and the area near it. Systemic cancer treatments travel through the bloodstream, reaching cancer cells all over the body. Surgery and radiation therapy are types of local cancer treatment. Chemotherapy, hormone therapy, and biological therapy are examples of systemic cancer treatment.

Surgery is therapy to remove the cancer; the surgeon may also remove some of the surrounding tissue and lymph nodes near the tumor. Sometimes surgery is done on an outpatient basis, or the patient may have to stay in the hospital. This decision depends mainly on the type of surgery and the type of anesthesia.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. For some types of cancer, radiation therapy may be used instead of surgery as the primary treatment. Radiation therapy also may be given before surgery (neoadjuvant therapy) to shrink a tumor so that it is easier to remove. In other cases, radiation therapy is given after surgery (adjuvant therapy) to destroy any cancer cells that may remain in the area. Radiation also may be used alone, or along with other types of treatment, to relieve pain or other problems if the tumor cannot be removed.

Radiation therapy can be in either of two forms: external or internal. Some patients receive both.

  • External radiation comes from a machine that aims the rays at a specific area of the body. Most often, this treatment is given on an outpatient basis in a hospital or clinic. There is no radioactivity left in the body after the treatment.

  • With internal radiation (also called implant radiation, interstitial radiation, or brachytherapy), the radiation comes from radioactive material that is sealed in needles, seeds, wires, or catheters and placed directly in or near the tumor. Patients may stay in the hospital while the level of radiation is highest. They may not be able to have visitors during the hospital stay or may have visitors for only a short time. The implant 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. The doctor will advise the patient if any special precautions should be taken at home. With a temporary implant, there is no radioactivity left in the body after the implant is removed.

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use one drug or a combination of drugs. Chemotherapy may be the only kind of treatment a patient needs, or it may be combined with other forms of treatment. Neoadjuvant chemotherapy refers to drugs given before surgery to shrink a tumor; adjuvant chemotherapy refers to drugs given after surgery to help prevent the cancer from recurring. Chemotherapy also may be used (alone or along with other forms of treatment) to relieve symptoms of the disease.

Chemotherapy is usually given in cycles: a treatment period (one or more days when treatment is given) followed by a recovery period (several days or weeks), then another treatment period, and so on. Most anticancer drugs are given by injection into a vein (IV); some are injected into a muscle or under the skin; and some are given by mouth.

Often, patients who need many doses of IV chemotherapy receive the drugs through a catheter (a thin, flexible tube) that stays in place until treatment is over. One end of the catheter is placed in a large vein in the arm or the chest; the other end remains outside the body. Anticancer drugs are given through the catheter. Patients who have catheters avoid the discomfort of having a needle inserted into a vein for each treatment. Patients and their families learn how to care for the catheter and keep it clean.

Sometimes the anticancer drugs are given in other ways. For example, in an approach called intraperitoneal chemotherapy, anticancer drugs are placed directly into the abdomen through a catheter. To reach cancer cells in the central nervous system (CNS), the patient may receive intrathecal chemotherapy. In this type of treatment, the anticancer drugs enter the cerebrospinal fluid through a needle placed in the spinal column or a device placed under the scalp.

Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given, the dose, how they are given, and the patient's general health, a short hospital stay may be needed.

Hormone therapy is used against certain cancers that depend on hormones for their growth. Hormone therapy keeps cancer cells from getting or using the hormones they need. This treatment may include the use of drugs that stop the production of certain hormones or that change the way they work. Another type of hormone therapy is surgery to remove organs (such as the ovaries or testicles) that make hormones.

Biological therapy (also called immunotherapy) helps the body's natural ability (immune system) to fight disease or protects the body from some of the side effects of cancer treatment. Monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors are some types of biological therapy.

Bone marrow transplantation (BMT) or peripheral stem cell transplantation (PSCT) may also be used in cancer treatment. The transplant may be autologous (the person's own cells that were saved earlier), allogeneic (cells donated by another person), or syngeneic (cells donated by an identical twin). Both BMT and PSCT provide the patient with healthy stem cells (very immature cells that mature into blood cells). These replace stem cells that have been damaged or destroyed by very high doses of chemotherapy and/or radiation treatment.

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