Cancer Treatment: A Guide to the Different Types
Each type of cancer, at different stages, is treated differently with different people. What is cancer treatment and how do cancer treatments differ from one another? How are surgery, chemotherapy, hormone therapy, immunotherapy, and targeted therapies used? What about angiogenesis inhibitors, symptom control, and palliative care? What are tips to help get through cancer treatment?
What is cancer treatment?
The type of cancer treatment(s) that you will receive depends on the type of cancer, how much it has spread and to where, as well as if you have any other health problems. Each cancer treatment carries with it different processes and side effects along with the effects of cancer that the patient is already experiencing.
What is cancer?
Cancer is a condition that develops when normal, healthy cells in a specific part of the body begin to grow and multiply out of control. Although there are many types of cancer, all types of cancer cells grow, multiply, divide, re-divide, and multiply rather than dying and forming new abnormal cells. That said, some types of cancer cells can sometimes travel to other parts of the body through lymph vessels, a process is known as metastasis, or through blood circulation. The cells then begin to grow and multiply. Generally, cancerous cells develop and come from normal, healthy cells due to damaged DNA. Often when the DNA is damaged, the body can repair it. Sadly, that’s not always the case because in cancer cells, damaged DNA isn’t repaired.
Cancer is the second leading cause of death, behind cardiovascular diseases, in the world. One-third of women and half of the male population in the United States will develop cancer in their lifetimes.
Although cancer isn’t uncommon, many people are able to extend their lives with cancer treatments. Cancer treatments have an interesting history. The world’s oldest case of breast cancer cam from 1500 BC in ancient Egypt. It was recorded with the breast cancer case that there were no cancer treatments- only treating the symptoms using palliative care. That said, ancient inscriptions recorded that surface tumor was surgically removed in a similar way as they are surgically removed today.
Other early cancer treatments were either too awful to door too fanciful. Surgeons undertook mastectomies without anesthetic with unsanitary conditions and apothecaries stocked up on things like ground white coral, boar’s tooth, tincture of lead, and fox lungs. In the 18th century, one of the founders of modern surgery, Scot John Hunter, said that if a tumor was movable and hadn’t yet invaded nearby tissue, “there was no impropriety in removing it.” When general anesthetic was discovered in the 19th century, surgery was changed forever. Surgery was used to treat solid cancers, but the impact was limited until it was able to be used with drugs and radiation. Radiation was discovered in 1896 by Emil Grubbe, a medical student. Although Grubbe didn’t understand why radiation worked, they knew that it would kill and/or damage the tumors. Anticancer drugs came into play in the 1940s which helped treating cancer even more effective.
Cancer Treatment- Surgery
It’s not uncommon for people with cancer to be treated with surgery. It works best for solid tumors that are in one area alone because surgery is a local cancer treatment. Sometimes, surgery is all you need. However, that’s uncommon and often the cancer treatment will consist of surgery and another cancer treatment such a chemotherapy. Surgery isn’t useful as a cancer treatment for people with leukemia (a type of blood cancer) or for any types of cancer that have spread throughout the body. However, it was found that some surgeries may actually cause the cancer cells to spread faster than if the patient hadn’t had surgery.
There are two types of cancer surgery- open and minimally invasive. It all depends on how much tissue and tumor needs to be removed.
Open surgery requires the surgeon to make a large cut, remove the tumor, possibly some healthy tissue, too, and some nearby lymph nodes.
Minimally invasive surgery requires the surgeon to make small cuts and insert a long, thin tube with a tiny camera, known as a laparoscope, into one of the cuts. Using the camera and teeny tiny tools, the surgeon is able to remove the tumor and some healthy tissue via the small cuts. Minimally invasive surgery takes less time to recover from compared to open surgery.
There are some surgical options that don’t involve a scalpel but are considered surgical such as:
- Lasers. Lasers are a cancer treatment in which powerful beams of light, lasers, are used to cut through tissue. Technology these days now allows for a tight focus on tiny areas as well as shrink and/or destroy growths and tumors that turn into cancer. Most often, lasers are used to treat tumors that are on the inside lining of internal organs such as the liver or kidney, or on the surface of the body. Cancers that involve lasers can be cervical, vaginal, esophageal, basal cell carcinoma, and non-small cell lung cancer.
- Cryosurgery, also called cryotherapy, is a type of surgical cancer treatment that uses extreme cold produced by argon gas or liquid nitrogen to destroy any abnormal tissues. It can be used in early-stage skin cancer, precancerous growths, and retinoblastoma.
Cancer Treatment- Chemotherapy
Chemotherapy is a cancer treatment that works by stopping or at least slowing down, the growth of cancer cells. It’s used to treat cancer but also ease cancer symptoms. While widely used to treat a multitude of cancers, chemotherapy is often used in conjunction with other cancer treatments such as surgery. Chemotherapy is able to:
- Kill cancerous cells that have spread or returned to (other parts) in your body.
- Make a tumor smaller before radiation therapy or surgery- a process known as neoadjuvant chemotherapy.
- Destroy the cancer cells that remain after other cancer treatments such as radiation therapy or surgery. This is known as adjuvant chemotherapy.
Sadly, chemotherapy carries with it some major side effects. The most cliche being hair loss. Hair loss from chemotherapy is due to cells that line the intestines and mouth which cause your hair to grow are damaged. Luckily, the side effects from chemotherapy often go away once the cancer treatment is done.
Chemo is given by a thin needle that is placed in a vein on your lower arm or hand. At each cancer treatment session, the needle is inserted and removed. People undergoing chemotherapy can have a catheter (to give drugs, and draw blood with one end inside the body and the other end outside), a port (a round, small disc that is placed under the skin during a minor surgery), and a pump. The catheter connects the port to a large vein in the chest. The pump attaches to the port or catheter in order to control how fast and how much chemotherapy goes into the port or catheter. Chemo is given in several forms:
- Oral. Chemo can come in the forms of liquids, capsules, and pills that are swallowed.
- Injection. Chemo can be given by a shot in a muscle in the hip, thigh, arm, or under the fatty part of the belly, leg, or arm.
- Intravenous (IV). The chemo is injected directly into a vein.
- Topical. The chemo comes in a cream form that is rubbed into the skin.
- Intra-arterial (IA). The chemo is injected into an artery that leads to cancer.
- Intrathecal. The chemo is injected into space between layers of tissue that cover the spinal cord and brain.
- Intraperitoneal (IP). The chemo is put directly into the peritoneal cavity- the part of the body that contains the organs such as the liver, stomach, and intestines.
Cancer treatment- Hormone Therapy
Hormone therapy, also known as endocrine therapy, hormonal therapy, and hormone treatment is a cancer treatment that helps stop, or at least slow, the growth of cancers that use hormones to grow. Hormone therapy is used to both treat cancer and ease the cancer symptoms. For example, it is used in men with prostate cancer who can’t have surgery or radiation therapy. Hormone therapy is used to treat specifically breast and prostate cancers and is often used in conjunction with other cancer treatments such as surgery.
Hormone therapy falls into two categories- blocking hormones and interfering hormones. The blocking category involves blocking the body’s ability to produce hormones. The interfering category involves interfering with how hormones are able to behave in the body.
When hormone therapy is used with other cancer treatments, it can:
- Destroy all cancer cells that have returned and/or spread to other parts of the body.
- Make a tumor shrink and smaller before radiation therapy or surgery. This process is known as neoadjuvant therapy.
- Lower the risk of cancer returning after the main treatment which is a process known as adjuvant therapy.
Hormone therapy has been found to make prostate cancer worse, but improve the quality of life in breast cancer patients after 10 years after cancer treatment.
Cancer Treatment- Radiation Therapy
Radiation therapy whose goal is to slow down or completely kill the cancerous cell growth by damaging DNA. When cancer cells whose DNA has been damaged, they stop multiplying and die off. When the cells die, they are broken down naturally and removed by the body. However, the radiation therapy doesn’t kill off the cancer cells immediately- it can take days or weeks of radiation treatment before the DNA in the cancer cells are damaged enough to die. However, once the cells begin to die, the therapy continues for weeks or months in order to kill off all cancer cells. It’s a therapy used to ease symptoms and treat cancer. When radiation therapy is used to treat cancer, it can actually cure it, prevent it from coming back, stop the growth, or at least slow it down.
Radiation therapy is used depending on the type of cancer, the size of the tumor, its location in the body, the patients health and general medical history, the other types of cancer treatment the patient has/is undergoing, and most importantly, how close the tumor is to other normal tissues that are too sensitive for radiation.
Radiation therapy is often used in conjunction with other cancer treatments such as chemotherapy, surgery, or immunotherapy. However, the timing of when radiation is used with other cancer treatments depends on whether the patient is being treated to stop cancer or simply ease the symptoms. It’s important to continue with radiation therapy as much as possible without interruption because it was found that people who had interrupted their radiation treatments had a higher risk of cancer recurrence.
There are two types of radiation therapy- internal and external beam.
Internal radiation therapy is a radiation treatment that involves a source of radiation being put into the body via a solid or liquid form. It’s often used to treat head, neck, eye, thyroid, breast, prostate, and cervical cancers.
External beam radiation therapy comes from a large, noisy machine whose goal is to point radiation at cancer. The machine never touches the person physically, but it moves around them while radiation into the part of the body with cancer from many different directions. It’s a local treatment which means it only treats a specific part of the body. For instance, if you have lung cancer, your radiation therapy will be directed at your chest, not the whole body. It’s used to treat many different types of cancer.
No one can withstand large amounts of radiation and each of us has a limit of radiation they can safely take within a lifetime. Depending on how much radiation one area of the body has already been treated with, the patient may not be able to have a second round of radiation therapy- ever. That said, just because one area of the body has received its lifetime amount and dose of radiation, another part of the body might still be able to be treated with radiation therapy if the distance between the treated area and the to-be-treated area are far enough apart.
Cancer Treatment- Targeted Therapies
Targeted therapies are the foundation of precision medicine. So, what is a targeted therapy? It’s a type of cancer treatment that targets the changes in cancer cells that help the cells grow, divide, multiply, and spread. Most often, targeted therapies are either monoclonal antibodies or small-molecule drugs. Monoclonal antibodies are drugs that attach to specific targets on the outer surface of cancer cells because they aren’t able to enter the cancer cells easily. Small-molecule drugs are used to enter the inside of the cancer cells since they can easily enter the cells.
The majority of targeted therapies help to treat cancer by interfering with specific proteins that help tumors spread and grow through the body. They are able to treat cancer in a variety of ways, such as:
- Stopping cancer cells from growing. When healthy cells in the body divide and multiply, they do so from signals to do so. These signals attach to proteins on the cell surface which tells the cells to then divide. However, some cancerous cells have changes in their proteins on their surfaces that tell them to divide whether the signal is there to tell them to multiple or not. Some targeted therapies can interfere with these proteins in order to prevent cells from dividing. This slows cancer’s growth.
- Destroy cancer cells via the immune system. Cancer can thrive because it can live in the immune system. Some targeted therapies can mark the cancer cells which makes it easier for the immune system to not only find but also to destroy the cancer cells. Other targeted therapies also work to help boost the immune system which helps everything work better and cancer easier to find.
- Stop the signals that help form blood vessels because tumors need to form new blood vessels in order to grow- a process known as angiogenesis. Targeted therapies, known as angiogenesis inhibitors, are made to interfere with the signals that the tumors use to make more blood vessels which prevent a blood supply from forming. With no blood supply, tumors stay small and are unable to grow. If the tumor has already grown and has a solid blood supply, the angiogenesis inhibitors cause the blood vessels to die which, in turn, causes the tumor to shrink.
- Cause cancer cell death. Cancer treatments are so rough for some people because in order to kill off the cancer cells, often times some of the healthy cells have to die, too. However, the healthy cells have an orderly process when they are no longer needed or damaged. Cancer cells, on the other hand, are able to avoid this dying process. Thus, the targeted therapies cause the cancer cells to go through the cell-dying process.
- Deliver cell-killing substances to the cancer cells. Some monoclonal antibodies combined with chemotherapy drugs, toxins, and radiation. Once the antibody is able to attach to the targets on the surfaces of the cancer cells, the cells die. Luckily, the cells that don’t have a target won’t’ be harmed.
- Starve the cancer of the hormones that it needs to be able to grow in prostate and breast cancers. Hormone therapy is a type of targeted therapies that work in two ways- prevent the bodies from making specific hormones, or prevent the hormones from using cells to act- including cancer cells.
Sadly, cancer cells can become resistant to some targeted therapies which are why many targeted therapies have to work together with other cancer treatments like radiation therapy and chemotherapy.
Cancer treatment- Immunotherapy
Immunotherapy is a kind of cancer treatment whose aim is to help the immune system fight cancer. The immune system plays a larger role in our lives than we realize and is a crucial system to take care of when one has cancer because some cancers target the immune system while other cancer treatments can lower it. Cancer cells can hide from the immune system which helps them thrive. Some immunotherapies help mark and show the cancer cells so the immune system detects them and can fight them and hopefully destroy them. The immune system is made up of organs, tissues from the lymph system, and white blood cells. As a type of biological therapy, immunotherapy tries to treat cancer using substances made from living organisms. Its goal is used to help the immune system attack cancer in a direct way or by stimulating the immune system in a more general manner. Immunotherapy can be given in a variety of ways such as pills, topical, intravenous (IV), intravascular, or directly into the bladder. While immunotherapy has been approved to treat many types of cancer, it’s not yet as widely used as cancer treatments such as chemotherapy, surgery, or radiation therapy. It’s important not to take antibiotics while going through immunotherapy because antibiotics may actually reduce the effectiveness of immunotherapy.
There are different types of immunotherapy of which include:
- Checkpoint inhibitors which are a type of drug that helps the immune system strongly respond to a tumor. Checkpoint inhibitors work by releasing a “brake” that keep the white blood cells and part of the immune system (known as T cells) from killing cancer cells. Rather than target the tumor directly, these inhibitors interfere with the cancer cell’s ability to avoid an attack on the immune system. The process of growing T cells in a lab takes 2-8 weeks. While the cells are growing, the cancer is often treated with radiation therapy or chemotherapy to help reduce the number of immune cells in the body.
- Treatment vaccines work against cancer by boosting the immune system’s response to cancerous cells. They are vaccines that are different from the vaccines used to help prevent diseases such as the flu shot or rabies vaccine.
- Adoptive cell transfer is a cancer treatment that tries to increase the T-cell’s natural ability to ward and fight off cancer. The T-cells, in this treatment, are taking from the tumor and are most active against cancer when they are grown in large batches in the lab.
- Cytokines, proteins made by the body’s cells, are used to help treat bladder cancer- other types of cancer are being looked in to. These proteins are important in the immune system’s ability to fight off cancer. The two types used to treat cancer are interleukins and interferons.
Cancer Treatment- Angiogenesis Inhibitors
The process of forming new blood vessels is known as angiogenesis. It’s a normal process that we all need in order to survive. That said, it’s also a process that helps feed several diseases such as cancer. Tumors need oxygen and nutrients in order to speed up and grow. These nutrients are in the blood which, when there are lots of blood vessels going in to and out of a tumor, help the tumor “sustain life”. A tumor is able to send chemical signals that stimulate the growth of blood vessels which carry blood to the tumor. Angiogenesis inhibitors, also known as anti-angiogics, are the drugs that try to stop, block, and inhibit the process of angiogenesis. By blocking the oxygen and nutrients from a tumor, the tumor is “starved”.
It’s important to use these inhibitors with other treatment methods to best fight cancer. These are some of the angiogenesis inhibitors that are past the testing, clinical trial stages:
- Avastin (Bevacizumab) is used for lung, colorectal, and kidney cancers.
- Everolimus (Zortress, Afinitor) is used for advanced breast cancer, kidney cancer, and pancreatic neuroendocrine tumors (PNETs). This drug has also been proven a viable cancer treatment for a rare type of non-cancerous brain tumor known as a subependymal giant cell astrocytoma.
- Cabozantinib (Cometriq) is used for kidney and medullary thyroid cancers.
- Axitinib (Inlyta) is used for kidney cancer.
- Pazopanib (Votrient) is used for advanced soft tissue sarcoma as well as kidney cancer.
- Lenalidomide (Revlimid) is used for mantle cell lymphoma, multiple myeloma, and tumors that involve cells that normally produce antibodies.
- Sorafenib (Nexavar) is used for liver, thyroid, and kidney cancers.
- Thalidomide (Thalomid, Synovir) is used for multiple myeloma.
- Regorafenib (Stivarga) is used for gastrointestinal stromal tumors (GIST) and colorectal cancer.
- Vandetanib (Caprelsa) is used for medullary thyroid cancers.
- Ramucirumab (Cyramza) is used for gastroesophageal junction adenocarcinoma, colorectal, non-small cell, and advanced stomach cancers.
- Ziv-aflibercept (Zaltrap) is used for colorectal cancer.
- Sunitinib (Sutent) is used for kidney cancer.
Cancer treatment- Stem Cell Transplant
Using stem cell transplants are useful in restringing the blood-forming stem cells for people who have had high doses of chemotherapy or radiation therapy and have had their blood-forming stem cells damaged or destroyed. These blood cells are important because they grow into white blood cells (in the immune system), red blood cells (carry oxygen), and platelets (help the blood clot). In order to be healthy, you need all three types of blood cells. As with all cancer treatment options, there are opportunities and challenges.
A stem cell transplant involves receiving healthy blood-forming stem cells via a needle in a vein. Once the healthy cells enter the bloodstream, the cells travel to the bone marrow where they take the place of the cells that were destroyed by cancer and other cancer treatment methods. These cells can come from the bloodstream, bone marrow, or an umbilical cord. While stem cell transplants don’t work against cancer directly, they help recover one’ ability to produce stem cells after a treatment of radiation or chemo in high doses or both. That said, there are certain types of cancer in which stem cell transplants work directly such as some types of leukemia and multiple myeloma. The reason only some cancers can be treated directly with stem cell transplants is that of an effect known as graft-versus-tumor which occurs after allogeneic (from someone else) transplants. This is because the white blood cells from the donor (the graft) attack the cancer cells that are remaining in the body (the tumor) after the previous cancer treatments. Stem cell transplants are most often used to help treat people suffering from cancers such as multiple myeloma, lymphoma, neuroblastoma, and leukemia.
There are several ways that stem cell transplants work.
- Allogeneic. This type of transplant means that the stem cells come from someone else such as a blood relative, although it’s not necessary to be related to the doner.
- Autologous means that the stem cells come from the patient themselves.
- Syngeneic means that the stem cells come from an identical twin if the patient has one.
One study found that the survival rate of women with stage-4 breast cancer went up with stem cell transplants.
Cancer treatment- Palliative Care
Palliative care is a form of cancer treatment that works on preventing, managing, and relieving the symptoms of cancer as well as the side effects. Essentially, it treats the symptoms, not the disease. While it may seem like a waste of time, resources, and energy not to treat the actual problem (cancer), it’s quite beneficial to the patient, according to science, as well. If a tumor is causing a lot of pain, for example, although the tumor is untreatable, the pain isn’t.
Radiation therapy, hormone therapy, and chemotherapy are forms of palliative care because they can ease cancer symptoms. For example, the external beam radiation therapy can shrink tumors in order to treat pain caused by tumors.
Tips to help get through cancer treatment
- Stay in the present tense by being optimistic and living in the moment. Don’t get caught up with your diagnosis and know that your cancer treatments will fight cancer as much as possible.
- Use support. Don’t forget to embrace and use the goodwill and love from others to help support you. There are lots of cancer support groups!
- Chemo Brain is a phenomenon that involves having difficulty in remembering and concentration. It can happen in cancer treatments more than just chemo. Some believe that chemo brain happens due to cancer and it’s toll on the brain and body more than the cancer treatments. Try using things like phone reminders, post-its, lists, and calendars to remember the little things that are easy to forget.
- Take it easy and sleep. Rest when you feel tired. You can’t get over a cold without adequate rest to keep the body’s healing process working- cancer is no different. Many cancer treatments also have a main side effect of fatigue so be sure to take it easy and rest when you need to.
- Take your vitamins… maybe. Cancer treatments aren’t easy and are harsh on the body by taking away lots of good nutrients and vitamins. However, vitamins that contain antioxidants shouldn’t be taken together with chemo or radiation treatment because the antioxidants actually make the cancer treatment less effective.
Have you ever tried one of these cancer treatments before? Let us know what you think in the comments below!
Anna is a freelance writer who is passionate about translation, psychology, and how the world works.