Decoding cancer - treatment options and types of therapy

This blogpost is part of a 2 week series, helping demystify the world of cancer diagnosis and treatment. We all know cancer is a serious, often life-threatening disease, and that it takes many forms. We’ve also probably heard words like ‘grade II’ and ‘radiotherapy’ when talking about it, but do we really know what these terms mean, and if we were told we had cancer, would we know what was to come? It can be hard to go there and think about the unthinkable, but equipping yourself with this knowledge now could help save your life when discussing your diagnosis and treatment options should you get cancer. Likewise, if you have already had a cancer diagnosis, you may be overwhelmed and unsure of the process from this point, so we’ve created a quick overview of cancer terms. The first blogpost last week discussed the diagnostic process and the grades and stages of cancer that medical professionals use. This week, we’re focussing on the treatment of cancer. As different cancers have different treatment plans, it can get confusing very quickly. However, there is some information that can help in understanding the options being presented to you by your doctor or specialist.

Local and systemic therapies

Firstly, let’s talk about the two main types of treatments that you may hear about. There are local therapies, which focus on the specific area where the cancer started, usually aiming to remove or shrink a tumor. Then there are systemic therapies, which affect the whole body, with an effort to prevent or stop the cancer spreading to other parts of the body, or if it already has, to try and attack the cancerous cells throughout. We will explain which treatments are which as we go on, but an example of a local treatment would be surgery, and chemotherapy is an example of a systemic treatment.

Surgery

Where possible, this treatment is often recommended as the first port of call, as surgery could mean complete removal of the cancerous growth, and even the cancer overall in some cases. This is particularly true if the cancer is caught early and has not yet spread anywhere else in the body. Whether this is an option for you, what the surgery entails, and how successful surgery is, varies a lot; different cancers behave in different ways and it will depend what stage your cancer is at, as well as many other factors specific to your cancer. You may have surgery simply to remove a growth such as a cancerous mole, or more invasive surgery, like a mastectomy where a breast or breast tissue is removed, or even brain surgery. Sometimes surgery is not an option because the position of the cancerous tissue makes removal too difficult, or because the cancer has spread to many parts of the body and surgery would not be able to get rid of it all. There are also some types of cancer where surgery is not an option such as leukemia, where there is no growth to be removed as the cancer is in the blood cells.

Radiation therapy

Radiation therapy, or radiotherapy, is another local treatment, and involves using radiation such as x rays to target the area of cancerous cells. The radiation damages the DNA of the cells and destroys them, with the hope that they will not grow back. There is external radiation, where radiation is directed at the affected area, and there is internal radiation, where a source of radiation is placed within the body for a period of time. These treatments can be very intense, have many side effects both in the area and to your overall health, and will damage healthy cells in the area as well as cancerous cells. However, 50% of cancer patients have radiotherapy at some point in their cancer treatment, and it has high success rates for some cancers, such as prostate cancer. All these factors should be considered when weighing up options with your doctor. You may have radiation therapy at different points in your cancer treatment and alongside other therapies, as needed. For example, some have radiation therapy before surgery to try and shrink the size of the cancerous growth before having it removed, while others have radiotherapy after surgery if not all of the growth could be removed and the remaining tissue can be targeted.

Chemotherapy

Chemotherapy is a systemic, drug-based treatment that aims to destroy any fast growing cells in the body. Cancer cells multiply at an accelerated rate to normal cells, and so the chemotherapy medication targets these cells. In some cases, however, it also targets other fast growing cells like the cells in hair, which is why some people lose their hair during chemotherapy. You might only take one type of chemotherapy drug, but you are more likely to take several different drugs at once, and will often taken other medication too such as steroids, to help shrink and destroy cancer cells, as well as control side effects and allergic reactions. You can talk to your doctor about which chemotherapy drugs they are wanting to use, asking why they want to use these ones, so you can understand more about your own treatment. When getting treatment, sometimes the drug is given intravenously through a drip, and sometimes it is taken as a pill.

Hormone therapy

This is another systemic treatment, and hormone therapy can only be used on cancers which use hormones to grow and develop. These differ between men and women but can include breast cancer, ovarian cancer, testicular cancer and prostate cancer. The therapy works by lowering the amount of particular hormones in the body, therefore slowing down or stopping the cancerous cells developing and growing. Because this treatment affects the hormones in your entire body and the hormonal glands, collectively called the endocrine system, the side effects can be significant, particularly at first. Tiredness, breast tenderness, impotence, lowered libido, weight gain, depression, and in some cases lowered fertility are just some of the possible side effects of hormone therapy, and you can discuss the likely side effects of your specific cancer and treatment with your doctor.

Immunotherapy

Immunotherapy is a slightly rarer avenue of treatment in cancer overall, but in some cancers such as skin cancer, it is quite common and can be very effective. Immunotherapy involves medications to help your own immune system to fight the cancerous cells in the body. A normal healthy body with a functioning immune system will notice any abnormal cell growth in the body and send antibodies to the area to destroy the errant cells. Cancer develops when the cells are either missed by the immune system, or are too strong for the immune system to destroy. Immunotherapy then works to help the immune system fight back and this is done in a variety of ways depending on the treatment. There are many different types of immunotherapy, with some only available as clinical trials as they are quite new. A lot of the drugs are made of chemically produced antibodies, which find and attack the cancerous cells, helping the immune system to recognize the cancer and kick into action. Other treatments are synthetic versions of proteins called cytokines that boost the immune system and help it destroy the cancer cells. There are also some newer therapies such as CAR-T therapy, which actually aims to change the genes within white blood cells, enabling them to recognize cancer cells and destroy them.

Cancer treatments are constantly being researched and new treatments are coming out all the time, through clinical trials and on general release, so make sure you ask your doctor about any of the new options if you are interested. As we’ve mentioned, you may have a combination of some or all of these treatment types, and no cancer treatment plan is the same. We’ve also put some website links below, and links to our previous blogposts on specific cancers, that may be helpful if you want to know more about any of these treatments. Most cancers also have their own charity websites with a huge amount of information and research. It can be overwhelming to take in so much information on your cancer diagnosis, but hopefully this blogpost series has helped to set the basics straight so you can continue to learn and take ownership of your cancer diagnosis and treatment.

Useful links

Blood cancers

Bowel cancer

Breast cancer

Cervical cancer

Ovarian cancer

Pancreatic cancer

Cancer Research UK

American Cancer Society