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There are numerous types of cancer treatments. The type of treatment you receive will depend on the type of cancer you have, your preferences and options offered and discussed with your physician, and how advanced the disease is.
Some individuals will have only one treatment, while many others will have combination treatments. These treatment regimens may include surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, and hormone therapy. These are discussed in more detail below in the “Treatment” section.
When you need treatment for cancer, there is often a lot to learn and a lot to think about. According to the National Cancer Institute, it is quite normal to feel overwhelmed and confused. However, learning about your cancer and discussing your specific diagnosis with your physician can help alleviate much concern. In addition, there are numerous support groups, forums, and other advocacy organizations that can help you cope with your condition. Finally, family and friends offer a wonderful source of love, compassion, and sources of strength to help you endure this trying time.
It is not clear what exactly causes cancer. However, certain risk factors have been identified for numerous types of cancer, which are discussed below in the “Risk Factors” section.
It is known that cancers are a disease characterized by uncontrolled cellular growth. Normally, specific genes within the DNA (genetic material) of cells have functions to regulate cell division. Genes involved in cell replication, or division, cellular growth, and cellular survival are called oncogenes, while those involved in limiting cell growth and division and inducing cell death when necessary are called tumor suppressor genes (such as TP53 and RB1 genes).
When cell DNA is damaged, these genes may be altered and the oncogenes are turned on and the tumor suppressor genes are turned off. As a result, there is uncontrollable cell growth and possible cancer. These changes to cellular DNA can be caused by environmental factors, but they can also be inherited.
Although the cause of cancer is still largely unknown, there are some genetic conditions and environmental factors, which may contribute to the development of this disease. Specific cancers have specific risk factors, but the conditions below will increase your risk of developing cancer in general.
Environmental, or modifiable, risk factors for cancers include:
Genetic and non-modifiable risk factors:
A diagnosis of cancer will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination.
In addition to the history and physical, he or she will then utilize any of the following tools to arrive at a diagnosis:
A CT scan also uses x-rays to generate an image, but it has several advantages compared to the chest x-ray. It will show the precise location, shape, and size of masses. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will have CT scans of the chest, abdomen, brain, and extremities. A CT scan may also be used to obtain biopsies of masses or cancers what lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.
A magnetic resonance imaging (MRI) study also provides detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images. A specific MRI scan called an MRA uses contrast to assess blood vessels, which may be supplying nutrients to the cancerous tissue.
Ultrasound imaging may also prove useful in the diagnostic process. By utilizing sound waves, ultrasound generates images of the organs. To take a sonogram, your doctor or sonographer will place a transducer on the abdomen and evaluate the image on the screen. There is no radiation with ultrasound imaging.
PET scans, also known as positron emission tomography, are especially useful to look for cancer spread. This study involves injecting a special radioactive sugar (flourodeoxyglucose, or FDP) into the vein. The amount of radioactivity is very low and will not cause you harm. After the injection, a special scanner will pick up areas in your body where the sugar has accumulated. As cancer cells are very active and require a great amount of energy (sugar), the FDP will concentrate in these areas. The PET scan does not produce extremely detailed images, but rather indicates spread of cancer throughout the body.
Bone scans can also be performed to detect spread of cancer to bones. During this procedure, a radioactive dye is injected in the vein, where is it transported to areas of bone with abundant activity, which may occur in cancerous and non-cancerous states.
A simple chest x-ray or radiograph will usually be taken, as it is convenient, cheap, and will reveal if the cancer has progressed to the lungs.
Angiography, which utilizes a specialized intravenous dye to visualize the arteries of the body, may also be used to help demonstrate the blood supply of the tumor and to help the surgeon plan his or her surgery.
If a suspicious mass is identified via the aforementioned tests, a biopsy may need to be performed to ensure proper diagnosis. During a biopsy, a small amount of tissue is removed from the suspicious mass and then assessed under the microscope. A biopsy is commonly performed as a fine needle aspiration, or FNA, which utilizes CT imaging and a long, thin needle to pierce the skin and to obtain a small tissue sample of the mass. A pathologist will then study the biopsy to determine if the mass is benign or malignant and will then identify the exact type of malignancy.
Possible lab tests used to help diagnose cancers include a complete blood count (CBC), basic metabolic panel (BMP), liver enzymes, and substances in blood known as tumor markers, which include CA19-9, CA-125, and carcinoembryonic antigen (CEA).
Symptoms of cancers depend upon the type of cancer, the location, and how advanced it is. Sometimes symptoms may be absent until the disease is advanced. Unfortunately, prognosis declines as the disease progresses.
Common signs and symptoms of cancer include:
Although the above are general signs and symptoms of cancer, there are numerous others that are specific to certain types of cancers. Please review our specific cancer topics for likely signs and symptoms of specific cancers.
Prognosis refers to the likely course of a disease or ailment. To determine the prognosis of cancer, many factors must be considered. For example, the age of the patient and his or her functional status, or level of functioning, also plays a vital role in prognosis. Generally, younger and higher functioning patients will do best. Further, the amount of tumor able to be removed, also known as resected, impacts prognosis. If the entire tumor is removed, prognosis improves, while if only part of the tumor is removed, prognosis will likely deteriorate. If the tumor recurs, or comes back after removal, the prognosis is worse.
Also very important for prognosis is staging and grading of the cancer. Staging of a cancer is the process of classifying how far a cancer has spread, while grading determines the makeup and characteristics of the cancer’s cells. In addition to prognostic value, staging and grading can help predict what therapy is ideal and the effectiveness of the therapy. The American Joint Committee on Cancer (AJCC) has standardized staging system that employs the size of the tumor (T), the number of involved lymph nodes (N), and the presence of metastasis (M). Thus, it is referred to as the TNM staging system. The more advanced each of these categories, i.e. tumor size, the higher the number that follows the letter. The size of the tumor ranges from 0-4, while the staging of involved lymph nodes varies from 0-2 and the presence of metastases is determined with 0 or 1. A combination of these three variables and numbers then determines the stage of the cancer.
The grade of a cancer cell describes how similar or dissimilar the cell looks compared to a healthy cell observed under a microscope. Healthy tissue will have many different types of cells grouped together. If the tumor has many different types of cells and appears similar to healthy tissue, it is termed differentiated, or a low-grade tumor. Conversely, if the tumor appears very different from the healthy tissue, it is termed poorly differentiated, or a high-grade tumor. In general, the lower the grade of tumor, the better chance of treatment, survival, and prognosis.
Generally, the earlier the cancer is detected, the better the prognosis. However, the type of cancer, location, its stage, and the health status of an individual will all influence a person’s prognosis. Thus, one should seek prognostic information regarding his or her specific cancer and then discuss this information with a physician to determine a more individualized prognosis.
People with cancer not only face physical challenges, but also mental and emotional challenges. It is important to understand your illness and treatment as it can make you feel more in control. Taking care of your emotional health is also vital. Family and friends can be an important source of support for you during this challenging time.
In addition, it is helpful to consider the following:
The U.S. Preventive Services Task Force (USPSTF) is an excellent source of information regarding cancer-screening recommendations. Depending on the type of cancer, the USPSTF may recommend regular screenings or no screenings at all. You can review all of the USPSTF recommendations here.
Unfortunately, there is no guaranteed preventative method to stop cancer from developing. However, cases of cancer that are diagnosed early are less likely to progress and to carry worse a worse prognosis than cases that are diagnosed at later stages. Thus, regular visits to a primary care physician will likely result in an earlier diagnosis.
If you experience any general signs of cancer, contact your physician immediately.
As the definitive treatment for cancer remains chemotherapy, radiation, and surgery, alternative treatments for this condition should only be considered after traditional interventions have been initiated or completed.
Complementary medicine, which refers to interventions performed in addition to traditional or standard treatment, are numerous and may provide additional symptom relief and improved quality of life for many patients. According to the National Center for Complementary and Integrative Health, these include:
Acupuncture. This is particularly effective in alleviating treatment-related nausea and vomiting in cancer patients. It may even help control cancer pain. Although complications from acupuncture are rare, it is important to ensure that the needles are properly sterilized. Many cancer patients have weakened immune systems and more prone to infections.
Ginger. May help to control nausea secondary to cancer chemotherapy, especially when used along with standard anti-nausea medications.
Massage therapy. May help to alleviate symptoms experienced by many cancer patients, such as pain, nausea, anxiety, and depression. However, the massage therapist should be careful to avoid deep or too rigorous massage prior to physician approval, especially directly over a tumor or around sensitive skin, which is common following radiation treatments.
Mindfulness-based Stress Reduction. As a type of meditation, mindfulness-based stress reduction can help cancer patients by relieving anxiety, stress, fatigue, and general mood and sleep disturbances. As a result, this can lead to an overall improvement in quality of life.
Yoga. Preliminary studies suggest that yoga may improve anxiety, depression, and stress in patients with cancer. It may also alleviate fatigue in breast cancer patients. However, additional studies need to be completed for better evidence and conclusions.
If you are experiencing any of the signs or symptoms of cancer (see above), you should seek medical attention as soon as possible. The earlier a diagnosis can be made, the earlier treatment can begin, which generally leads to improved outcomes and better prognosis.
Unless the symptoms are life threatening, you can make an appointment within a reasonable time period and do not need to visit the emergency department.
Your medical team may consist of several healthcare professionals, including your primary care physician, oncologist, and an oncologic surgeon.
The National Cancer Institute offers a website where you can find a cancer center near you.
When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:
Other useful resources to help you learn about cancer and cancer treatment can be found at:
The National Cancer Institute
The American Cancer Society
Sources of Financial Assistance
Patient and Caregiver Resources
Sleep and Cancer: How to Get Quality Rest During Cancer Treatments
Cancer Support Community: Resources
Legal Resources for Cancer Patients
How to Reduce Stress and Boost Your Immune System While Social Distancing
Extreme Exercise and Heart Health
Learning Your Right from Your Left
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