The most common types of cancer treatment include surgery, radiation therapy, and chemotherapy. These therapies may be used either alone or in combination with other therapies. More recent treatment options include targeted therapies and biologic treatments. The first treatment that a person is given is called first-line therapy. Adjuvant therapy is treatment that is given after the first treatment (such as chemotherapy after surgery). Neoadjuvant therapy is treatment that is given before the primary treatment (such as hormone therapy before surgery). Most experimental therapies are tested in clinical trials.

As cancer care becomes more specialized, many people are now treated by a team of doctors, nurses, and other health-care specialists. Usually one doctor, often the medical oncologist, will help coordinate the person's care. Learn more about the Oncology Team.

Before beginning treatment, people should consider asking the doctor about the goals of treatment, how long the treatment will take, and the potential side effects. Read more Questions to Ask the Doctor.

It is also important that people with cancer and their families feel comfortable about their doctor and his or her recommended therapy. It is always appropriate to ask for a second opinion. Read more about Seeking a Second Opinion.

Surgery

Surgery involves the removal of cancerous tissue from the body. It is the primary treatment for many types of cancer, and some cancers can be cured with surgery. Surgery can also confirm a diagnosis (biopsy), determine how far a person's cancer has advanced (staging), relieve side effects (such as an obstruction), or ease pain (palliative surgery).

Some types of surgery can be performed in a clinic or doctor's office instead of the hospital. This is called outpatient surgery. Most cancer surgeries, though, will be performed in a hospital. Before surgery, consider preparing a list of questions for the surgeon. Carefully review with your doctor any preparation you may need before surgery.

The side effects of surgery depend on the type of surgery and the health of the person before surgery. One of the more common side effects is pain, which can be successfully treated in most people. Refer to individual Cancer Type sections for more information about surgical procedures for specific cancers.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy drugs fight cancer by interfering with the growth process of cancer cells, eventually causing the cells to die. Chemotherapy is used to shrink or eliminate the tumor, keep the tumor from spreading, destroy any cancer cells that have spread to other areas in the body, or relieve symptoms. Chemotherapy is called a systemic treatment, because it affects the entire body.

Chemotherapy is given by a medical oncologist, which is a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor's office; others may go to the hospital. A chemotherapy regimen usually consists of a specific number of cycles given over a period of time. Some drugs are given continuously over several days; some are given several times a week.

Side effects of chemotherapy

Chemotherapy can damage healthy cells along with cancer cells, which may cause side effects, including nausea, vomiting, and fatigue. Depending on the drug, some people may also experience tingling or numbness in the arms and legs, hair loss, and mouth sores. Because some drugs can damage blood cells, a person may experience anemia (low red blood cell counts) and/or an increased risk of infection (low white blood cell counts). Side effects can usually be treated and go away once treatment is finished. The occurrence of side effects is not related to whether the cancer drug is working or not.

During chemotherapy, a person may lose his or her appetite or develop an aversion to the taste or smell of food. Consider talking to a registered dietitian who can give suggestions about meal planning and managing side effects through simple diet changes.

Many people are concerned about the side effects of chemotherapy, and children and young adults should ask about long-term side effects of chemotherapy. Fortunately, many new drugs do not cause the same, severe side effects as some older chemotherapy drugs. And, there are many effective medications that help reduce side effects, caused by chemotherapy. Read more about Managing Side Effects.

Radiation treatment

Radiation therapy uses high-energy x-rays to destroy cancer cells. Radiation therapy is considered a local treatment, as it only affects one part of the body. The goals of radiation therapy include shrinking the tumor before surgery, keeping the tumor from returning after surgery, eliminating cancer cells in other parts of the body, and relieving pain (palliation).

Radiation therapy can be given two ways: externally and internally. With external-beam radiation therapy, a machine directs the radiation at the tumor from outside the body. With internal radiation therapy, also called brachytherapy, small tubes or implants (also called seeds) containing radioactive materials are placed in the body near the tumor. With internal radiation therapy, the person does not need to come to the hospital every day to be treated, and the doctor can use a higher dose of radiation. However, internal radiation therapy can only be used if the tumor is in a location where the doctor can place the implant.

Before beginning external-beam radiation therapy, the doctor will plan where to aim the radiation. The goal is to hit as much of the tumor as possible, while minimizing the exposure of healthy tissue. A person's skin may be marked to show where the radiation will be directed. New computerized techniques help pinpoint the best place to give the radiation.

For more information on the use of radiation in cancer treatment, read the Cancer.Net Feature: Frequently Asked Questions about Radiation Therapy or see the American Society for Therapeutic Radiology and Oncology's (ASTRO) website, www.rtanswers.org.

Side effects of radiation treatment

Like chemotherapy, radiation therapy can also damage normal cells, causing side effects. These include tiredness (fatigue), swelling, redness or irritation of the skin, hair loss, cough or shortness of breath (if the radiation is given to the neck or chest area), mouth sores (if the radiation is given to the head), and digestive problems (if the radiation is given to the abdominal area). These side effects go away once treatment is finished. Internal radiation therapy may cause bleeding, infection, or irritation after the implant is removed. Radiation treatment does not make a person radioactive. Read more about Managing Side Effects.

External-beam radiation therapy may have long-term side effects that can affect a person for many years. For this reason, children and young adults who receive radiation therapy should keep a record of their radiation treatment schedule (including the dose and location of the radiation) and report it as part of their medical history. Long-term side effects can include the risk of a second cancer, the inability to have children (infertility), heart problems (from radiation to the chest), gastrointestinal problems (from radiation to the abdominal area), lung fibrosis (scarring or thickening of the lung tissue), neurologic problems, thyroid problems, or osteoporosis. Also, people who have had previous radiation to the chest should be aware that they are at higher risk of developing breast and lung cancers. Today, most people who receive radiation therapy now receive smaller doses than what was given in years past. Each individual considering radiation therapy should discuss the risks versus benefits of the treatment with his or her doctor.

Hormone therapy

Several types of cancer, including some breast and prostate cancers, can only grow and spread in the presence of natural chemicals in the body called hormones. Hormone therapy fights cancer by changing the amounts of hormones in the body, and is used to treat cancers of the prostate, breast, and reproductive system. For example, tamoxifen (Nolvadex) is an anti-estrogen drug used to treat some hormone-responsive breast cancers.

Hormone therapy does have potential side effects, but most side effects go away once treatment is finished. The side effects depend on the drug and affect men and women differently. Refer to individual Cancer Type sections for more information about hormone therapy and specific side effects.

Biologic therapy

Biologic therapy, also called immunotherapy, stimulates the disease-fighting mechanisms within the body to fight the cancer. Interferon and colony-stimulating factor are two examples of biologic therapy. These substances help restore functioning of the immune system. Researchers are developing specific types of biologic therapy, such as monoclonal antibodies and vaccines. The side effects of biologic therapy generally include flu-like symptoms, such as chills, nausea, and fever.

Monoclonal antibodies. Monoclonal antibodies are laboratory-produced substances that find and attach themselves to specific places on the surface of cancer cells. When they attach to a protein, they effectively stop the protein from doing its job (such as making cancer cells grow). For example, trastuzumab (Herceptin) is a monoclonal antibody therapy for breast cancers that have too much of a protein called HER2/neu. The antibody binds, or attaches to, the HER2/neu protein on the outer surface of tumor cells, preventing the growth and division of cancer cells. Other examples of monoclonal antibody therapies include cetuximab (Erbitux), rituximab (Rituxan), and bevacizumab (Avastin). Monoclonal antibodies can be used alone, in combination with other therapies, or to deliver drugs, toxins, or radioactive material.

Cancer vaccines. Cancer vaccines are another specific type of biologic therapy. Unlike vaccines that can prevent diseases such as chicken pox, cancer vaccines attempt to treat the cancer by training the immune system to recognize cancer cells and attack them. In some cases, doctors take tumor cells from the patient to make a vaccine. Cancer vaccines are being tested for many types of cancer, but are still highly experimental.

Targeted treatments

This general term describes drugs that "target" various proteins that can contribute to cancer. Unlike chemotherapy drugs that kill both healthy and cancerous cells, these drugs selectively kill cancer cells, which helps to reduce side effects. For example, imatinib mesylate (Gleevec) selectively blocks a protein that helps cancer cells grow. Other targeted treatments include gefitinib (Iressa) and erlotinib (Tarceva). Most targeted treatments are still experimental and are used along with other types of therapy. The benefits of these drugs can vary depending on a person's response to previous treatment and overall health. Generally, targeted treatments do not have the same side effects as traditional chemotherapy. Depending on the drug and the dosage, a person may experience nausea, vomiting, muscle cramps, rash, and/or diarrhea.

Anti-angiogenesis drugs. The formation of new blood vessels that feed tumors is known as angiogenesis. Some scientists think that by cutting off a tumor's blood supply, it may be possible to starve the tumor, and prevent it from growing and spreading. Anti-angiogenesis drugs are considered experimental at this time.

Antisense therapy. This therapy utilizes small, chemically-modified strands of DNA that block gene expression by binding to messenger RNA before it can produce a protein. Essentially, the technology acts to selectively "knock out" the production of a single protein.

Gene therapy. This therapy is used to repair or replace damaged genetic material or add new genetic material.

Read more about Understanding Targeted Treatments.

Progress in cancer treatment continues to be made every day. Refer to individual Cancer Type sections for more information.

More Information

NexProfiler Tool for Cancer: Interactive tools to help patients make informed treatment decisions from NexCura and The Lance Armstrong Foundation.