A Beginner’s Guide to Understanding Cancer Treatment Options

If you or a loved one has received a cancer diagnosis, you're not alone.

With approximately 1.9 million new cancer cases diagnosed annually, according to the American Cancer Society, that's roughly 5,250 new cases every day in the United States.

And after a diagnosis comes treatment decisions.

Here, experts will simplify the most common cancer treatments, including chemotherapy, radiation therapy, immunotherapy, surgery, targeted therapy, hormone therapy, bone marrow/stem cell transplant and clinical trials. This will help you explore your options and empower you with knowledge during this challenging time.

Cancer treatments

Cancer is no longer the unbeatable foe it once was. As of January 2022, there are approximately 18.1 million cancer survivors in the United States, comprising about 5.4% of the population. This number is projected to surge by 24.4%, to 22.5 million by 2032, the National Cancer Institute says.

This progress is attributed to advancements in cancer treatments and a growing emphasis on healthier lifestyles. The following sections will examine the various treatment options contributing to this positive shift in cancer outcomes.

Chemotherapy

Chemotherapy leverages potent chemicals to target and destroy fast-growing cells within your body, as described by the Mayo Clinic. As cancer cells tend to grow and divide rapidly, they are particularly susceptible to these medications.

Despite its effectiveness, chemotherapy can cause significant side effects, which may vary depending on the drugs used and individual responses. Common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Hair loss
• Loss of appetite
• Fatigue
• Fever
• Mouth sores
• Pain
• Constipation
• Easy bruising
• Bleeding

Radiation therapy

Radiation therapy for cancer uses various techniques, the most common being external beam radiation therapy (EBRT) and internal radiation therapy, per the Cleveland Clinic. Your radiation oncologist will carefully assess your condition and cancer type to determine the most suitable approach.

Radiation therapy operates on a simple, yet powerful, principle: it employs radiation, usually high-powered X-rays, to annihilate cancer cells. This is achieved by disrupting the DNA within cancer cells, rendering them unable to grow or multiply. Consequently, the cancer cells perish, and tumors begin to shrink.

While radiation therapy holds promise in cancer treatment, it can cause side effects, which may include:

• Fatigue
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Skin irritation
• Dry, itchy scalp
• Hair loss
• Mouth sores
• Pain when swallowing
• Reduced appetite
• Burning sensation in the throat or chest
• Pain or discomfort while urinating
• Frequent urination (often in small amounts)
• Abdominal bloating or cramps
• Urgency to have a bowel movement

Immunotherapy

In a video on the American Society of Clinical Oncology’s website, Dr. Jyoti Patel, with the oncology department at Northwestern Medical Group, explains that immunotherapy uses your body’s own immune system to fight cancer. “There are a couple of different ways to do it,” she said.

“We can stimulate your immune system or rev it up to recognize and fight cancer. We can also give patients part of the immune system, such as proteins or antibodies that help the system fight the cancer,” Patel added.

Immunotherapy can bring about various side effects. The National Cancer Institute provides the following list of immunotherapy side effects:

• Skin responses near the injection site, possibly causing discomfort, swelling, tenderness, redness, itching or a rash
• Flu-like symptoms, which encompass fever, chills, weakness, dizziness, as well as nausea or vomiting
• Muscle or joint discomfort, fatigue, headaches, breathing difficulties or fluctuations in blood pressure
• Swelling and weight increase due to fluid retention
• Heart palpitations
• Sinus congestion
• Digestive issues like diarrhea
• Increased susceptibility to infections
• Inflammation of organs

Surgery

• Open surgery: In open surgery, a surgeon makes a single large incision to access and remove the tumor, sometimes including adjacent healthy tissue and nearby lymph nodes.
• Minimally invasive surgery: This approach uses a few small incisions instead of one large one. A thin tube with a tiny camera, known as a laparoscope, is inserted through one incision, projecting internal images onto a monitor. Special surgical tools are introduced through other small incisions to remove the tumor and some healthy tissue. Minimally invasive surgery offers a quicker recovery due to smaller incisions.

Like all cancer treatments, surgery carries potential side effects, according to the Mayo Clinic:

• Pain
• Infection
• Loss of organ function
• Fatigue
• Bleeding
• Blood clots
• Altered bowel or bladder function

Targeted therapy

Targeted therapy is designed to attack specific cancer cells with precision. According to the American Cancer Society, these therapies employ drugs or substances that identify and combat particular types of cancer cells, either as a standalone treatment or in conjunction with chemotherapy, surgery or radiation.

Cancer cells often exhibit genetic changes that set them apart from healthy cells, causing abnormal behaviors such as rapid growth and division. Drugs developed for targeted therapy are tailored to intercept these aberrant signals. They can block cancer cells' growth-inducing messages or trigger the cells' self-destruction.

While targeted therapy offers promising results, it may yield side effects such as:

• Skin issues, including altered skin texture, photosensitivity, rashes, dryness, itching, changes in nail beds (redness and soreness), and hand-foot syndrome
• Alterations in hair growth and changes in hair or skin color
• Eye-related changes
• High blood pressure
• Bleeding or clotting complications
• Slow wound healing
• Potential heart damage
• Autoimmune reactions
• Swelling
• Nausea and vomiting
• Digestive issues (diarrhea or constipation)
• Mouth sores
• Breathing difficulties
• Cough
• Persistent fatigue
• Headaches
• Hair loss
• Organ damage, such as to the thyroid gland, liver, or kidneys
• Allergic reactions during IV drug administration
• Heightened susceptibility to specific infections
• Increased risk of secondary cancers

Hormone therapy

Hormone therapy is specifically designed to slow or halt the growth of cancers fueled by hormones, the National Cancer Institute says.

• Cancer treatment: It effectively curtails cancer growth.
• Symptom relief: In some cases, hormone therapy can alleviate or prevent symptoms, particularly in men with prostate cancer who may not be candidates for surgery or radiation therapy.

For men undergoing hormone therapy for prostate cancer, potential side effects may include:

• Hot flashes
• Decreased interest in or capability for sexual activity
• Weakened bones
• Diarrhea
• Nausea
• Swelling and tenderness in the breast area
• Fatigue

Conversely, women receiving hormone therapy for breast cancer may experience:

• Hot flashes
• Vaginal dryness
• Altered menstrual patterns (if menopause has not yet occurred)
• Decreased sexual interest
• Nausea
• Mood fluctuations
• Fatigue

Bone marrow/stem cell transplant

A bone marrow transplant, also known as a stem cell transplant, is a treatment for cancer that introduces healthy blood-forming stem cells into the body. This infusion serves to replace bone marrow that isn’t creating an adequate supply of healthy blood cells.

The Mayo Clinic explains that bone marrow transplants are employed for several reasons, including:

• Enabling aggressive treatment: They permit the use of high-dose chemotherapy or radiation, while also rescuing damaged bone marrow.
• Restoring malfunctioning marrow: In cases where bone marrow isn't functioning correctly, new stem cells can rejuvenate it.
• Direct cancer cell attack: The introduction of fresh stem cells can directly combat cancer cells.

The transplant process involves a phase known as conditioning, wherein chemotherapy and sometimes radiation are administered. This stage serves to eliminate cancer cells, suppress the immune system and prepare the bone marrow for the incoming stem cells. The specific approach to conditioning varies based on the underlying disease and overall health.

Side effects of the conditioning process include:

• Nausea and vomiting
• Diarrhea
• Hair loss
• Mouth sores or ulcers
• Infections
• Infertility
• Sterility
• Bleeding
• Anemia
• Fatigue
• Cataracts
• Organ complications (e.g., heart, liver, or lung issues)

Clinical trials

Clinical trials are research studies involving people, offering promising avenues for cancer treatment, diagnosis, prevention and symptom management. Whenever you or a loved one face a cancer diagnosis, considering participation in a clinical trial can open doors to innovative solutions.

Cancer clinical trials are thoughtfully designed to explore novel approaches for:

• Treating cancer
• Detecting and diagnosing cancer
• Preventing cancer
• Managing cancer symptoms and treatment-related side effects

Each clinical trial operates under a detailed study plan called a protocol, outlining the trial's structure, procedures, and objectives. Eligibility criteria are also included, determining who can participate based on factors like cancer type, prior therapies, genetic markers, age, medical history and health status.

The Memorial Sloan Kettering Cancer Center recommends the following steps to be considered for a clinical trial:

• Explore options: Seek clinical trial options that align with your needs. Websites like those at Memorial Sloan Kettering Cancer Center, the National Cancer Institute (NCI), TrialCheck, and ClinicalTrials.gov provide comprehensive databases for trial searches.
• Review eligibility: Ensure you meet the specified criteria for participation.
• Contact organizers: Reach out to the study organizers to express your interest and inquire about participation.
• Study description: Thoroughly review the trial's description, objectives, and potential benefits and risks.
• Informed consent: Understand the informed consent process, which ensures you are fully aware of what participating entails and can make an informed decision.

It’s important to know that in many cases, your cancer care team may share potential clinical trials with you proactively.

References

American Cancer Society Journals: Cancer Statistics, 2022

National Cancer Institute: Statistics and Graphs

Mayo Clinic: Chemotherapy

Cleveland Clinic: Radiation Therapy

American Society of Clinical Oncology: What Is Immunotherapy?

National Cancer Institute: Immunotherapy Side Effects

National Cancer Institute: Surgery to Treat Cancer

Mayo Clinic: Cancer Surgery: Physically Removing Cancer

American Cancer Society: How Targeted Therapies Are Used to Treat Cancer

American Cancer Society: Targeted Therapy Side Effects

National Cancer Institute: Hormone Therapy to Treat Cancer

Mayo Clinic: Bone Marrow Transplant

National Cancer Institute: Clinical Trials Information for Patients and Caregivers

National Cancer Institute: Deciding to Take Part in a Clinical Trial

Memorial Sloan Kettering Cancer Center: How to Join a Clinical Trial