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A guide to

Treatment

Cancer treatment is very personalized depending on your diagnosis, overall health, doctor’s recommendation, and your own opinion. For that reason, this guide covers the most common cancer treatments available, their side effects, clinical trials, and alternative treatment options. All treatment decisions should be made with your doctor.

Surgery

Surgery is used in many ways when it comes to cancer, including preventing, diagnosing, staging, and treating cancer. Some people only need one surgery, while others will need many surgeries over time to successfully rid their body of cancer.

Diagnosing Cancer

Surgery can be used to diagnose cancer by taking a small sample of tissue and testing it for cancer. This is called a biopsy.

Staging Cancer

Surgery can be used to stage cancer by looking at the area around the cancer, such as lymph nodes and organs. This allows a doctor to figure out how large the cancer is and if it has spread, which can impact treatment options.

Treating Cancer

When cancer is found in only one part of the body and all of it can be removed during one surgery, it is called a curative or primary surgery. Alternatively, if the cancerous tumor is too large to remove in one surgery or is located nearby other organs, surgery can be used to “debulk” the tumor. The remaining cancer can be treated with radiation, chemotherapy, or other treatments.

Palliative Surgery

When dealing with advanced cancer, surgery can be used to treat an issue, such as discomfort or disability, that is caused by cancer, but not to treat the cancer itself.

Supportive Surgery

This can be the first step in a treatment plan where a surgery is completed to make it easier to get other types of treatment. For example, surgery to place a port for blood transfusions or treatment to enter the body is a type of supportive surgery.

Restorative/Reconstructive Surgery

Surgery can be used to reconstruct a part of the body that has drastically changed due to cancer treatment, such as a breast reconstruction after a mastectomy, or to restore function to part of the body, such as a bone graft.

Preventative Surgery

This surgery removes tissue that is likely to become cancerous if left alone.

All medical procedures have risks and side effects.
Some side effects of surgery include:

  • Pain at the surgery site
  • Infections at the surgery site
  • Bleeding
  • Blood clots
  • Damage to nearby tissues
  • Drug reactions
  • Damage to other organs
  • Slow recovery of other bodily functions

Chemotherapy

Chemotherapy uses drugs to treat cancer. Chemo is mostly used to treat people whose cancer has spread beyond the original tumor because the drugs can travel through your body to find additional cancerous cells. Chemo can be used to cure cancer, control cancer by shrinking tumors or preventing it from growing any further, or ease symptoms caused by cancer.

IV or Injectable Chemo

Typically, IV Chemo is delivered straight to your bloodstream via a catheter in your forearm or hand. This approach can take anywhere from a few minutes (IV push) to a few hours (IV infusion) to a few days (continuous infusion). You could get this type of chemo at home, a doctor’s office, an outpatient center, or the hospital.

Oral Chemo

Oral chemo is a pill, capsule, or liquid that you take by mouth and is usually taken at home. Your doctor will give you clear instructions on how much to take and how often to take it. Oral chemo can be expensive so be sure to understand the cost before undergoing treatment.

Topical Chemo

Topical chemo is a cream, gel, or ointment that you put directly on cancerous skin.

All medical procedures have risks and side effects. Because chemo drugs travel throughout the body to kill cancerous cells, they can sometimes affect normal, healthy cells too. The damage to your health cells can cause side effects, as well as side effects from the drugs themselves. Chemo side effects include:

  • Fatigue
  • Hair loss
  • Easy bruising and bleeding
  • Infection
  • Anemia
  • Nausea and vomiting
  • Appetite changes
  • Constipation
  • Diarrhea
  • Mouth, tongue, and throat problems like sores or pain when swallowing
  • Peripheral neuropathy or other nerve problems, such as numbness, tingling, and pain
  • Skin and nail changes such as dry skin and color change
  • Urine and bladder changes and kidney problems
  • Weight changes
  • Chemo brain, which can affect concentration and focus
  • Mood changes
  • Changes in libido and sexual function
  • Fertility problems

Radiation Therapy

Radiation is one of the most commonly used cancer treatments. Radiation destroys or damages cancer cells by using high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons. Radiation is usually aimed only at the part of the body with cancer, so there is little damage to nearby health cells. It is used to cure or shrink early-stage cancer, prevent the cancer from returning elsewhere in the body, treat symptoms caused by cancer, treat cancer that has come back.

External Beam Radiation

This is the most common type of radiation therapy used for cancer treatment. A high-energy ray or particle beam is aimed outside of the body at the cancer. It is usually given during outpatient visits to a hospital or treatment center.

Internal Radiation Therapy (Brachytherapy)

Brachytherapy is when a radioactive implant is placed inside the body in or near the tumor. The implant could be temporary or permanent. Compared to external beam radiation, brachytherapy delivers a higher dose of radiation to a smaller area, thereby protecting nearby health cells.

Systemic Radiation Therapy

This type of radiation uses liquid drugs to deliver radiation therapy throughout your body. Systemic radiation therapy is given orally or intravenously, and allows the radiation to find and gather in places where cancer cells are located.

All medical procedures have risks and side effects. With radiation, there can be early and late side effects.

Early side effects are typically short-term (gone within a few weeks of treatment ending), mild, and treatable.

Late side effects can take months or years to develop and can include:

  • Fatigue
  • Skin changes, such as your skin looking red, irritated, swollen, blistered, sunburned, or tanned
  • Hair loss
  • Mouth problems
  • Low blood counts

Radiation on certain parts of the body can result in specific side effects.

HEAD OR NECK
Radiation to the head and neck can cause:

  • Soreness (or even open sores) in the mouth or throat
  • Dry mouth
  • Trouble swallowing
  • Changes in taste
  • Nausea
  • Earaches
  • Tooth decay
  • Swelling in the gums, throat, or neck
  • Hair loss
  • Changes in skin texture
  • Jaw stiffness

BRAIN

Radiation to the brain can cause:

  • Headaches
  • Hair loss
  • Nausea
  • Vomiting
  • Extreme tiredness (fatigue)
  • Hearing loss
  • Skin and scalp changes
  • Trouble with memory and speech
  • Seizures

PELVIS

Radiation to the pelvis can cause:

  • Bladder problems
  • Fertility problems
  • Changes in your sex life

BREAST

Radiation to the breast can cause:

  • Skin irritation, dryness, and color changes
  • Breast soreness
  • Breast swelling from fluid build-up (lymphedema)

CHEST
Radiation to the chest can cause:

  • Sore throat
  • Swallowing problems
  • Loss of appetite
  • Cough
  • Shortness of breath

STOMACH OR ABDOMEN
Radiation to the stomach or abdomen (belly) can cause:

  • Nausea
  • Vomiting
  • Belly cramps
  • Diarrhea
  • Constipation

Targeted Therapy

Targeted therapy uses drugs to target cancer cells, while avoiding healthy, normal cells. The targeted drugs are used to stop cancer cells from growing or to get cancerous cells to destroy themselves. Currently, only a few types of cancers are treated using targeted therapies, and another treatment type is often used too.

IV Targeted Therapy

Targeted therapy can be delivered straight to your bloodstream via a catheter in your forearm or hand. This approach can take anywhere from a few minutes (IV push) to a few hours (IV infusion).

Oral Targeted Therapy

Oral targeted therapy is a pill, capsule, or liquid that you take by mouth and is usually taken at home. Your doctor will give you clear instructions on how much to take and how often to take it. Oral cancer drugs can be expensive so be sure to understand the cost before undergoing treatment.

All medical procedures have risks and side effects. There are many types of targeted therapy drugs, and the side effects depend on which type of drug you are treated with.

Common targeted therapy side effects include:

  • Changes in how your skin feels
  • Photosensitivity aka you’re more sensitive to light and UV rays
  • Rash that may look like acne
  • Dry skin
  • Itching
  • Red and sore cuticles
  • Hand-foot syndrome
  • Changes in hair growth
  • Changes in hair or skin color
  • Changes in or around the eyes
  • High blood pressure
  • Bleeding or blood clotting issues
  • Slow wound healing
  • Heart damage
  • Autoimmune reactions
  • Swelling

Immunotherapy

Immunotherapy uses your own immune system to fight cancer. This is done by boosting your natural immune system to better attack cancer cells.

Checkpoint Inhibitors

Checkpoint inhibitor drugs help your immune system find and attack cancer cells by better identifying the difference between normal and cancerous cells. These drugs are given via an IV.

Chimeric Antigen Receptor (CAR) T-cell Therapy

CAR T-cell therapy uses your T cells, part of your immune system, to find and destroy cancer cells. First, white blood cells containing T cells are removed for your body. The T cells are then separated and altered by adding a chimeric antigen receptor (CAR) to help them attach to cancer cells, making them CAR T cells. Once enough CAR T cells are grown in a lab, they are placed back in your body via infusion to find and attack the cancer.

Cytokines

Cytokines are a type of protein in the body that affect the growth of cells that help your immune system respond effectively. Cytokines are injected into your body either under your skin, into muscle, or into a vein and are used to treat cancer and manage chemotherapy side effects.

Monoclonal Antibodies

Monoclonal antibodies are lab-made cells that act like antibodies in your immune system to find and attack cancer cells. They are given via an IV.

Side effects of checkpoint inhibitors include:

  • Diarrhea
  • Fatigue
  • Cough
  • Nausea
  • Skin rash
  • Poor appetite
  • Constipation
  • Muscle and joint pain
  • Infusion reactions similar to an allergic reaction
  • Autoimmune reactions 

Side effects of CAR T-cell therapy include:

  • High fever and chills
  • Trouble breathing
  • Severe nausea, vomiting, and/or diarrhea
  • Feeling dizzy or lightheaded
  • Headaches
  • Fast heartbeat
  • Feeling very tired
  • Muscle and/or joint pain
  • Changes in consciousness
  • Confusion or agitation
  • Seizures
  • Shaking or twitching (tremors)
  • Trouble speaking and understanding
  • Loss of balance
  • Allergic reactions during the infusion
  • Abnormal levels of minerals in the blood, such as potassium, sodium, or phosphorous 
  • A weakened immune system
  • Low blood cell counts

Side effects of cytokines include:

  • Flu-like symptoms including chills, fever, fatigue, confusion, nausea, vomiting, or diarrhea
  • Low blood pressure
  • Heart problems including abnormal heartbeat and chest pain
  • Low white blood cell counts
  • Skin rashes
  • Hair thinning

Side effects of monoclonal antibodies include:

  • Fever
  • Chills
  • Weakness
  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Low blood pressure
  • Rashes

Stem Cell and Bone Marrow Transplants

Stem cell transplants, also called bone marrow transplants, replace the bone marrow cells in your body that have been destroyed by cancer and/or other treatments for cancer with healthy bone marrow cells.

Autologous Stem Cell Transplants

Autologous transplants use your own stem cells. Your stem cells are removed from your bone marrow or blood, stored by freezing, and then thawed and given back to you later.

Tandem Transplants

A tandem transplant does two autologous transplants using your own stem cells.

Allogeneic Stem Cell Transplants

Allogeneic transplants use stem cells from a donor with tissue similar to yours. The stem cells are removed from your donor’s bone marrow or blood, stored by freezing, and then thawed and given to you.

Short-term side effects of stem cell or bone marrow transplants:

  • Mouth and throat pain
  • Nausea and vomiting
  • Infection
  • Bleeding
  • Interstitial pneumonitis and other lung problems
  • Graft-versus-host disease
  • Hepatic veno-occlusive disease (VOD)
  • Graft failure

Long-term side effects of stem cell or bone marrow transplants:

  • Organ damage
  • Relapse (the cancer comes back)
  • Secondary (new) cancers
  • Abnormal growth of lymph tissues
  • Infertility (the inability to produce children)
  • Hormone changes, such as changes in the thyroid or pituitary gland
  • Cataracts (clouding of the lens of the eye, which causes vision loss)

Hormone Therapy

Hormone therapy is used to treat cancers that depend on hormones to grow, specifically breast and prostate cancers. These drugs travel throughout the body to block or alter hormones to slow or stop the growth of cancer.

Oral Drugs

Oral hormone therapy drugs are given via a pill, capsule, or liquid that you take by mouth. They are usually taken at home and your doctor will give you clear instructions on how much to take and how often to take them.

Injectable Drugs

Hormone therapy can be given through an intramuscular (IM) injection in the arm, leg, or hip, or through a subcutaneous (SC or sub-Q) injection given under the skin of the belly. Injections can be given in a treatment center, doctor’s office, or at home.

Surgery to Remove Hormone-Making Organs

Some surgeries are also considered hormone therapy, such as removing the testicles to treat prostate cancer or the ovaries to treat breast cancer.

Side effects of hormone therapy used to treat prostate cancer include:

  • Hot flashes
  • Decreased sexual desire
  • Erectile dysfunction (trouble getting an erection)
  • Bone loss and a higher risk for fractures
  • Fatigue
  • Weight gain (especially around the belly) with decreased muscle mass
  • Memory problems
  • Increased risk of other health problems

Side effects of hormone therapy used to treat breast or endometrial cancer include:

  • Hot flashes
  • Vaginal discharge, dryness, or irritation
  • Decreased sexual desire
  • Fatigue
  • Nausea
  • Pain in muscles and joints
  • Bone loss and a higher risk for fractures
  • Higher risk of other types of cancer, stroke, blood clots, cataracts, and heart disease

CLINICAL TRIALS

What are clinical trials?

Clinical trials are a type of research to figure out the best way to prevent, detect, diagnose, and treat different cancers. They’re a way to find out what does and doesn’t work when it comes to cancer, and develop new approaches to eradicate cancer most effectively.

How do clinical trials work?

Before a clinical trial can even start with human patients, it has to be tested on cells and/or animals in a lab setting. After that, the research has to be approved by the FDA. Only then can a clinical trial start researching a new drug or treatment on people with cancer. There are different phases that clinical trials go through to make sure they are safe and effective for patients.

  • Phase 0 – Does the drug work and how?
  • Phase I – Is the drug safe?
  • Phase II – Does the drug work?
  • Phase III – Is the drug better than what’s already available on the market?
  • Phase IV – What else do we need to know?

Should I sign up for a clinical trial?

That’s a very personal question depending on your diagnosis, treatment, prognosis, and other factors. You should talk to your doctor if you are considering looking for or signing up for a clinical trial. And make sure you understand the pros and cons of being a part of a clinical trial before you opt in.

Benefits of clinical trial participation include:

  • Helping advance cancer research
  • Getting a treatment that’s not available otherwise
  • Feeling more in control of your health
  • Seeing your medical team more often so they can monitor you
  • Having some or all of your medical and other expenses paid for during the trial (this isn’t true for all clinical trials)

Risks of clinical trial participation include:

  • Facing unknown side effects that could be worse than from standard treatments
  • The new treatment not working for you
  • Having more doctor visits or testing
  • Not having a choice or knowing which treatment you get
  • Not having the cost of the clinical trial covered by insurance

How do I sign up for a clinical trial?

If you are interested in searching for a clinical trial, visit the National Cancer Institute’s database of clinical trials.

COMPLEMENTARY TREATMENTS

Complementary treatments use your body, your mind, or nature to improve your quality of life and treat health issues surrounding cancer, but not to treat the cancer itself.

 

When standard treatments like chemotherapy and radiation aren’t effectively managing someone’s cancer or their treatment side effects, they may choose to supplement their treatment with complementary therapies. Combining standard and complementary treatments is called integrative medicine.

Safe and commonly used complementary therapies used to relieve symptoms include:

  • Acupressure – Using pressure on specific parts of the body
  • Acupuncture – Placing very thin needles into the body
  • Aromatherapy – Using essential oils
  • Art therapy – Using creative activities
  • Biofeedback – Using monitoring devices to control bodily functions, such as heart rate, blood pressure, temperature, sweating, and muscle tension
  • Guided Imagery – Concentrating on an object, sound, or experience to calm your mind
  • Labyrinth Walking – Walking along a circular pathway to meditate
  • Massage Therapy – Manipulating, rubbing, and kneading the body’s muscles
  • Meditation – Using concentration or reflection to relax the body and calm the mind
  • Music Therapy – Using music to enhance the quality of life
  • Nutrition – Eating specific foods and/or monitoring your nutritional intake
  • Physical Activity – Moving your body to relieve symptoms, such as tai chi or yoga
  • Reflexology – Using pressure on specific points on the feet and/or hands
  • Spirituality and Prayer – Using spirituality, religion, and/or prayer

Insurance companies have started covering the cost of some complementary treatments. Speak with your doctor and insurance provider if you are interested in exploring a complementary method to your overall cancer treatment.

WHAT ABOUT WEED?

Many people find that marijuana can help manage symptoms of cancer and side effects of treatment. This can include nausea and vomiting, pain, lack of appetite, anxiety, depression, and sleeplessness.

 

Anything that works to ease your symptoms should be supported!

 

Unfortunately, only a small amount of research has been conducted on the use of marijuana to help with cancer, however limited studies have found positive results. Due to this lack of research, we support patients and caregivers in responsibly using weed to manage symptoms related to cancer care. We do encourage you to consider using edible or topical weed products rather than smoking because inhaling marijuana smoke can pull harmful substances into your body, including many of the same ones that are found in tobacco smoke.

Weed is not federally legal or accessible across the United States. However, it has been legalized in 18 states for recreational use, meaning anyone in those states over the age of 18 can purchase marijuana products. Other states do not allow recreational marijuana use, but do allow medicinal marijuana use. In these states, you will have to get a medical marijuana license to legally purchase weed. Finally, there are a small handful of states where weed is completely outlawed, including for medical purposes.

ALTERNATIVE TREATMENTS

When it comes to cancer, most people are willing to do anything to find a cure or limit the side effects they experience from treatment. Unfortunately, this desperation can lead to undergoing a treatment that hasn’t been proven to work. Alternative treatments are unproven or disproven approaches to treating cancer. It can be hard to know how effective an alternative treatment is or if it is safe due to the lack of research around it. If you are interested in an alternative treatment, be sure to look for unbiased and reliable information about it, talk to your doctor, and consider the risks and benefits.

WHAT IF I LIVE FAR AWAY FROM TREATMENT?

If you live in a rural area, you will face unique challenges in diagnosing, treating, and living with cancer because you live far away from oncology providers. After you’ve been diagnosed and decided on your oncology team, you’ll need to figure out how you’ll travel to appointments, where you will stay during treatment, and how you’ll manage follow-up care after treatment. If you need help with any of these things, check out our CareLine patient navigators.

Financial assistance is available for people with cancer who need to travel to access treatment, including airfare, lodging, and local transportation. Once you return home after treatment, there are some programs available to help you manage side effects at home through telehealth or medical providers treating you at home. Your medical team or patient navigator can help you locate these resources.

Source: American Cancer Society; Centers for Disease Control and Prevention; JCO Oncology Practice

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