What treatment might you have?

Understanding the aims of treatment

Cancer treatments have improved in recent years. Some cancers that used to be difficult to treat can now be treated or better managed.

Sometimes, treatment can remove the cancer completely. This is called curative treatment.

If the cancer has spread and curative treatment is not possible, treatment may focus on managing symptoms and slowing the spread of the cancer. This is called palliative treatment.

When cancer has responded well to initial treatment, further treatment may be used to stop it from growing. This is called maintenance treatment; it may be used over a long period of time.

Sometimes, only one treatment is used, but often therapies are combined to make them more effective. In some cases, a different type of treatment is given before or after the main treatment. This is called:

• neoadjuvant treatment – given before the main curative treatment such as surgery. For example, chemotherapy may be used to shrink a cancer and make it easier to remove with surgery
• adjuvant treatment – given after main curative treatment to reduce the chance of the cancer coming back.

Making treatment decisions

When test results are ready, you’ll have to make decisions about how the cancer will be treated. 

The doctor will recommend treatments based on several factors, including:

• the type of cancer you have
• where the cancer began
• whether it has spread
• your age and general health
• your preferences.

The doctor will also consider the available treatments and what clinical guidelines suggest. Clinical guidelines recommend tests and treatments for various types of cancer based on evidence. Your doctor may also discuss your treatment plan with other specialists as part of a multidisciplinary team.

Sometimes, it’s difficult to make decisions about treatment. You may feel that everything is happening too fast. Ask your doctor how soon your treatment needs to start, and take as much time as you can to understand your options before making a decision.

You can accept or refuse any treatment offered. Some people with advanced cancer choose treatment that has significant side effects even if it gives only a small benefit. Others choose not to be treated.

Surgery

What it is – Surgery removes cancer from the body or repairs a part of the body affected by cancer. It usually involves one or more cuts in the body (incisions). It may be called a procedure, operation or resection.

How it’s given – Surgery can be done in 3 main ways:

• open surgery – the surgeon removes the cancer through one or more cuts (incisions) in the body
• keyhole surgery – the surgeon makes a few small cuts and inserts a camera to see the cancer and remove it safely. Also called laparoscopic or minimally invasive surgery
• robotic surgery – a type of keyhole surgery where the surgeon uses a robotic system to assist the procedure.

Depending on the type of cancer and surgery, it may be a day procedure or you may need to stay in hospital longer. You may have a general anaesthetic (puts you to sleep) or a local one (numbs part of your body).

Radiation therapy (radiotherapy)

What it is – Radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. It is also called radiotherapy.

How it’s given – Radiation therapy may be given in 2 main ways. For some cancers, both types are used:

• external beam radiation therapy – delivers radiation from outside the body using a machine called a linear accelerator
• internal radiation therapy – delivers radiation inside the body. A source of radiation is placed in the body next to or inside the cancer. This may be temporary or permanent. The most common type of internal radiation therapy is called brachytherapy.

My diagnosis of oesophageal cancer came as a complete shock. I had chemotherapy and radiation therapy to shrink the tumour and then went home to recover for 6 weeks before surgery.

John

Drug therapies

Many types of cancer are treated with medicines that circulate throughout the body. These are also called systemic or drug treatments. The main types are chemotherapy, targeted therapy, immunotherapy and hormone therapy.

Chemotherapy

What it is – Chemotherapy uses drugs that kill or slow the growth of cancer cells. It’s sometimes called chemo.

How it’s given – Chemotherapy is usually injected slowly into the bloodstream using a thin tube inserted into a vein in the arm (intravenous or IV). A central venous access device (CVAD) may be used so the tube can stay in place during the treatment course. This may be a PICC line or port-a-cath (“port”). Chemotherapy is given in cycles. This means you have the treatment, then a break before the next dose. It can also be given as tablets you swallow or as a cream.

Targeted therapy

What it is – Targeted therapy uses drugs that target specific features of cancer cells to stop the cancer growing and spreading. These drugs destroy cancer cells, while limiting damage to healthy cells.

Targeted therapy only works for some cancers with certain gene or cell changes. Tests are usually needed to see if the cancer will respond to targeted therapy. It may be used alongside chemotherapy.

How it’s given – Targeted therapy may be given as tablets or capsules you swallow or through a thin tube inserted into the arm (intravenous or IV). Sometimes, a central venous access device (CVAD) is used. Targeted therapy may also be given as an injection under the skin.

Immunotherapy

What it is – Immunotherapy uses the body’s own immune system to fight cancer. There are several different types of immunotherapy. The main types are called checkpoint inhibitors.

How it’s given – Checkpoint inhibitors are usually given through a thin tube inserted into a vein in the arm (intravenous or IV). These drugs are usually given in cycles. This means you have the treatment, then a break before the next dose.

Hormone therapy

What it is – Hormone therapy may be used to treat cancers that grow because of certain hormones (hormone-dependent cancers). It may be known as androgen deprivation therapy, endocrine therapy or hormone-blocking therapy.

How it’s given – Hormone therapy is usually taken as tablets you swallow or given as injections into the muscle or under the skin.

Tumour ablation

What it is – Tumour ablation destroys the cancer without removing it from the body. Heat is usually used to treat the cancer (called thermal ablation). Sometimes, extreme cold is used instead (called cryotherapy).

How it’s given – In thermal ablation, the heat is delivered to the tumour using radio waves (radiofrequency ablation or RFA) or microwaves (microwave ablation or MWA). A needle is inserted into the cancer and applies heat directly to the tumour, so it can be destroyed without harming healthy tissue. Cryotherapy is given in a similar way.