Sunday, November 4, 2007

Understanding Cancer Treatment Options

Very few cases of cancer require emergency treatment. Most patients benefit from taking the time to learn about their disease and explore all treatment options. Before choosing a treatment strategy it is important to understand the stage and extent of cancer, the different types of cancer treatment and the goal of treatment. Many patients decide to obtain a second opinion in order to help them make treatment decisions.
After cancer is diagnosed, a physician will perform several tests to determine the stage and extent of disease. Staging is the process of describing the location of the disease at the time of diagnosis. The American Joint Commission on Cancer is the most widely used cancer staging system. The stage is determined by measuring the size of the primary Tumor, the extent of lymph Node involvement, and the absence or presence of Metastases. This is referred to as the TNM staging system.
Staging provides invaluable information about the location and extent of the disease. After determining the stage of the cancer, physicians and patients can begin to explore treatment options. At this point, it is important for patients to gather as much information as possible about the treatment of their cancer.
Understanding the Different Types of Treatment
There are several different types of cancer treatment. One type of treatment may be best for some cancer patients, while another will be more beneficial for other patients. It is up to the individual to determine which course of action is most appropriate.

Conventional Treatment: In the West, methods of cancer treatment traditionally follow the medical, or allopathic, model. The term allopathy derives from two Greek words: allo meaning opposite and pathos meaning suffering. The basis of this medical system is to focus on disease and employ methods that oppose it. In the medical model, treatments are based on evidence, usually gathered in carefully controlled clinical trials that determine whether a new treatment is effective and safe for patients. In the United States, these conventional treatments are approved by the Food and Drug Administration (FDA) before they can be administered to patients. Conventional treatment can be divided into two categories:
Standard Treatment: Standard treatment refers to treatment that has been proven safe and effective in clinical trials and is approved by the FDA for a specific use. Standard treatment is the “accepted” best treatment for a specific type and stage of cancer.
Experimental Treatment: Experimental treatment refers to a potentially encouraging treatment that is under evaluation, but has not yet been approved by the FDA. Experimental treatment is offered through a clinical trial. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Often, clinical trials offer access to the newest and most promising treatment strategies. It is extremely important to decide whether or not to participate in a clinical trial before receiving any treatment from a physician. Once treatment has been initiated, this almost always excludes patients from participating in a clinical trial designed for patients in their circumstance. Even when there is evidence that a new treatment modality may be better than standard treatment, it takes years to change the existing standard treatment.

Complementary/Alternative Treatment: Complementary and Alternative Medicine (CAM) describes medical therapies practiced outside “mainstream” or conventional Western medicine. CAM contains a variety of healing philosophies and medical practices that are not currently accepted or used by conventional medicine, such as acupuncture, aromatherapy, biofeedback, herbal remedies and more.
Complementary medicine consists of medical therapies that are most often used to supplement conventional medical treatments. Because these treatments are utilized in addition to allopathic therapies, they most often focus on promoting wellness or managing symptoms. Most CAM therapies can be used as a complement to conventional medicine. A benefit of complementary therapies is that the patient can use well-researched conventional treatments against cancer while utilizing complementary medicine to reduce stress, enhance their immune system and/or reduce side effects of conventional cancer treatment. The vast majority of CAM practitioners and cancer patients who utilize CAM therapies use complementary medicine as a means of integrating the best of what both types of medicine have to offer.
In contrast to complementary medicine, alternative medicine is used in place of conventional medicine. Alternative medicine attempts to treat disease specifically, without use of any allopathic therapies. Therapies commonly used as complementary medicine are considered alternative medicine when used in place of conventional treatment. For minor health issues, alternative medicine is generally not dangerous. However, most practitioners of conventional medicine, and many who practice complementary medicine, are uncomfortable with the exclusivity of alternative medicine and its failure to utilize treatments that are known to benefit certain diseases when the illness is serious. In such instances, alternative therapies may delay conventional treatment and result in a more serious illness, complications or death. Many patients who do turn to alternative medicine do so only after conventional medicine has nothing more to offer or because they believe the risks of a mainstream treatment outweigh the risks of the alternative therapy they are investigating. In some instances, a very negative experience with conventional medicine leaves a patient in search of alternative forms of medicine.

Goals of Treatment
In order to explore treatment options, it is important to understand the goal of treatment. The ultimate goal of treatment is cure, which requires eliminating all detectable or measurable disease and any undetectable disease. Micrometastases are undetectable areas of cancer that have spread away from the original site of cancer. Primary treatment is an initial approach to remove detectable disease, but may not remove all micrometastatic disease. In many earliest stage cancers, primary treatment is curative if the cancer is limited to detectable disease.
Since there is a potential for micrometastatic disease even after all of the measurable disease is removed, the primary treatment for many stages of cancer is non-curative. When the potential for micrometastatic disease is significant, additional treatment is often necessary to eradicate any remaining cancer cells. Adjuvant therapy is treatment that is delivered following primary treatment and may include chemotherapy, hormonal therapy and/or biologic therapy. Neoadjuvant therapy refers to treatment that is delivered prior to primary treatment. Sometimes, cancer has grown so large that surgical removal of the entire cancer is difficult. The goal of neoadjuvant treatment is to shrink the cancer, thereby facilitating more complete surgical removal.
Sometimes with advanced cancer, primary and adjuvant treatment may not be beneficial because eliminating measurable disease is not possible. In such cases, patients may elect to receive palliative treatment. The goals of palliative treatment are to alleviate pain and side effects from the disease, prolong life and maintain quality of life.
Treatment Modalities
Cancer treatment may consist of one or more treatment modalities, depending on the type, stage and extent of cancer. Some treatment modalities, such as surgery and radiation, are local treatments used to eradicate visible tumors. Other treatment modalities, such as chemotherapy and biological therapy, are systemic treatments that circulate in the blood to eradicate cancer that has spread away from the original site.
Optimal treatment of cancer often requires more than one therapeutic approach. Often, one or more treatment modalities may be used in order to provide the most complete treatment for the patient. Increasingly, it is common to use several treatment modalities concurrently or in sequence, with the goal of preventing both local and systemic cancer recurrence. This is referred to as multi-modality treatment of the cancer. These modalities may include surgery, radiation therapy, chemotherapy and/or biological therapy. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving medical oncologists, radiation oncologists and surgeons.

Surgery: Surgery is a local treatment used to remove visible tumors. In addition, surgeons frequently remove the tissue adjacent to the cancer during surgical resection of a tumor. Information gained about the tumor during surgery is useful in predicting the likelihood of tumor recurrence and the need for other treatment modalities.
Radiation Therapy: Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible tumors. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer.
Chemotherapy: Chemotherapy is the general term for any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs. Chemotherapy can be administered through a vein, injected into a body cavity or delivered orally in the form of a pill. Chemotherapy is different from surgical or radiation therapy because it is considered a systemic treatment. The cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original tumor.
Biological Therapy: Biological therapy is referred to by many terms including immunologic therapy, immunotherapy or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors or cytokines and vaccines.
Hormone Therapy: Hormones are naturally occurring substances in the body that stimulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the body’s own hormones. Therefore, drugs that block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it may affect cancer cells throughout the body.

Choosing the Appropriate Treatment
Appropriate cancer treatment choices vary depending on many factors. What is appropriate for one patient may not be appropriate for another. Patients who understand the specific characteristics of their disease and understand the many different facets of cancer treatment will be able to make informed treatment decisions.

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