Cancer patients often experience confusion and lack understanding about treatment methods. Sometimes, patients may face questions from themselves and those around them. Therefore, understanding the principles of cancer treatment is important because after a cancer diagnosis, additional tests are required to determine the stage of the disease in order to plan further treatment.
Understanding Cancer Treatment at Each Stage
To understand the goals of cancer treatment, if a patient has early-stage cancer, it means the cancer is localized and has not spread to nearby organs or metastasized. Disease control treatment can be provided. However, in cases where the cancer has advanced and surgery is not initially possible, other treatments may be needed first to shrink the tumor, inhibit, and control its spread before surgery can be performed.
If the cancer has spread to other organs, the goal of treatment for metastatic cancer is mostly to control, inhibit, and reduce the cancer burden, allowing patients to live longer with a good quality of life. It is clear that accurate cancer diagnosis and appropriate additional testing are very important for patients to ensure treatment meets its goals.
What Types of Cancer Treatments Are There?
- Surgery
Surgery is a localized cancer treatment. Most early-stage cancers require surgery, such as head and neck cancer, breast cancer, lung cancer, and abdominal cancers like stomach and colorectal cancer. Nowadays, surgical techniques have advanced significantly, allowing many organs to be operated on without deformity or loss of the organ. For example, breast cancer surgery can be limited to removing only the tumor (Lumpectomy) without removing the entire breast (Mastectomy). For bone cancer in the thigh bone, surgeons can perform limb-sparing surgery without amputation.
There are also minimally invasive surgeries, such as laparoscopic surgery, which can be used for colorectal cancer treatment, and robotic-assisted laparoscopic surgery for prostate cancer treatment.
- Radiotherapy
Radiotherapy, commonly known as radiation treatment, is a localized cancer treatment that uses high-dose radiation targeted at the cancer site to control the disease. The radiation passes through the skin to the targeted area, which can cause side effects. Radiation oncologists plan the radiation dose to minimize effects on surrounding organs by controlling the depth and area of radiation. In some cases, brachytherapy is used, where a radioactive source is placed close to the tumor (e.g., cervical cancer). Modern radiotherapy technology has advanced to reduce complications, shorten treatment duration, and improve precision with 3D and 4D radiation techniques.
How Is Radiotherapy Administered?
- For Curative Treatment
Radiation is the main treatment for some cancers, such as early-stage head and neck cancer. Radiation alone may be sufficient for treatment. If the cancer is more advanced, combined radiation and chemotherapy can also cure the disease. For some patients who cannot undergo surgery, radiation is the primary treatment instead of surgery.
Adjuvant radiotherapy after surgery, such as breast-conserving surgery for breast cancer, requires radiation to the breast area post-surgery. Organ-preserving therapy uses radiation to treat the organ instead of surgery.
- Palliative Radiotherapy
When cancer progresses and causes symptoms in affected organs, such as pain, radiotherapy can help relieve these symptoms, for example:
- Radiation to relieve cancer pain, especially when cancer has spread to the bones.
- Radiation to control bleeding from tumors, which may have abnormal blood vessels causing continuous bleeding, such as bladder cancer with persistent blood in urine. Radiation can stop the bleeding.
- Emergency radiotherapy when cancer compresses critical areas, and delayed treatment could affect quality of life or cause disability, such as spinal cord compression causing weakness and numbness in both legs.
Chemotherapy
Chemotherapy uses chemical agents that destroy cancer cells more than normal cells. The mechanism involves disrupting cell division, affecting cancer cells that divide faster than normal cells.
How Is Chemotherapy Administered?
- Main Treatment
Many cancers, even when metastatic, can be treated with chemotherapy, such as testicular cancer, lymphoma, and leukemia.
- Adjuvant Treatment
Adjuvant chemotherapy after surgery is used to prevent cancer recurrence, reducing the chance of relapse and prolonging life compared to surgery alone, such as in breast and colorectal cancer. Neoadjuvant chemotherapy is given before surgery to shrink tumors and improve surgical outcomes, such as in breast and bone cancers.
- Concurrent Chemo-radiotherapy
This enhances the effectiveness of radiotherapy.
- Palliative Chemotherapy
Chemotherapy is used to control and inhibit cancer spread to other organs, allowing patients to live longer with better quality of life compared to no chemotherapy. Medical research supports chemotherapy regimens for patients suitable for this treatment, showing evidence-based benefits.
Therefore, patient readiness for treatment outcomes is very important. If a patient is not suitable for chemotherapy, side effects can be severe and dangerous. Each patient’s chemotherapy regimen differs because different cancers respond differently to drugs. Some patients receive expensive chemotherapy drugs, while others receive less costly ones. A higher price does not always mean better efficacy. In some cancers, cheaper drugs can be as effective as expensive ones and remain standard treatment.
Hormonal Therapy
Hormonal therapy works by inhibiting cell function through hormone receptors or enzymes related to hormones. This is especially important in breast and prostate cancers.
Targeted Cell Therapy
Targeted therapy uses drugs specific to cancer cells to inhibit cellular signaling pathways, thereby inhibiting cancer cell growth and division. These drugs may target molecules outside the cell, on the cell surface, or inside the cell. Since different cancers use different growth pathways, each targeted therapy drug has a different mechanism of action, such as antibodies that stimulate immune destruction of cancer cells, inhibitors of signaling pathways that promote cancer growth, or receptor blockers on the cell surface. These therapies provide better treatment outcomes and disease control than traditional chemotherapy.
Immunotherapy
Immunotherapy is a new cancer treatment that stimulates and enhances the body’s immune system to effectively fight cancer cells. Normally, abnormal cells like cancer cells arise daily but are destroyed by the body’s mechanisms or immune cells. However, cancer cells can produce proteins to hide and evade the immune system, allowing cancer to develop. Current research continuously supports the effectiveness of immunotherapy for various cancers, making it a standard treatment for many cancer patients.
It is evident that cancer treatment has advanced significantly in all aspects. Surgical techniques have improved to increase disease control with smaller incisions and faster recovery. Modern radiotherapy machines are more effective with fewer side effects. New chemotherapy and anti-cancer drugs are being developed, providing more treatment options tailored to the disease and patient.
All of the above represent part of the current advances in cancer treatment. Therefore, consulting with a specialist physician is crucial for making the best treatment decisions, enabling cancer patients today to fight and overcome cancer.
Dr. Winai Paul
Oncologist
Cancer Center, Phyathai 3 Hospital
