Surgery

Many people with cancer have surgery. If the cancer appears to be contained in one area (localized), surgery may be used to remove it along with any nearby tissue that might contain cancer cells. Sometimes it is hard to tell how much surgery will be needed until the surgeon sees the extent of the cancer during the operation. Surgery is most successful when the tumor has not spread to other areas. Today, surgery offers the greatest chance of cure for many types of cancer.

Other treatments, such as radiation therapy and chemotherapy, may be used along with surgery. They may be given before or after the surgery.

Radiation therapy

Like surgery, radiation treatment is used for localized cancers. Radiation destroys or damages cancer cells so they cannot grow. It can be used alone or along with surgery or chemotherapy. More than half of all people with cancer have radiation treatment at some point.

Radiation therapy is given 2 ways: either through external high-energy rays or through implants put in the body near the tumor.

External radiation

Getting external radiation therapy is painless, much like having an x-ray taken. It is usually done in an outpatient setting and the treatments take very little time. Treatment is most often given 5 days a week for 5 to 8 weeks, depending on the size, place, and type of cancer being treated.

Radiation seed implants (called brachytherapy)

In some cases, radiation may be given through implants, sometimes called "seeds." These are small containers of radiation placed in or near the tumor while a person is in a deep sleep (under general anesthesia) or with the area numbed (local anesthesia). They allow a person to get a higher total dose of radiation to a smaller area and in a shorter amount of time than with external radiation.

Radiation implants are sometimes used for cancers of the prostate, head and neck, uterus, and cervix. Some implants can be put in place at an outpatient center, while others may require that the person stay in the hospital for a few days. The placement can be permanent or temporary.

• Permanent pellets, seeds, or rods give off radiation for several weeks or months. Because they are so small and cause little discomfort, they are simply left in place after their radioactive material is used up.

• Temporary treatment involves briefly placing hollow needles, tubes, or fluid-filled balloons into the area to be treated. Radioactive material can be put in for a short period of time and then taken out. This process may be repeated over a few days or weeks. Depending on how long the radioactive material is left in place, the person may need to stay in bed and lie fairly still to keep the implant from shifting. Most of the time, implants do not cause severe pain, but there may be some discomfort if the implant is held in place by an applicator. Once an implant is removed, there is no more radiation released in the body.

Side effects of radiation therapy

Side effects vary from patient to patient and depend on the part of the body being treated and the amount of radiation used. The most common side effects are fatigue, skin changes in the area of treatment, and some loss of appetite. Other side effects usually are related to the treatment of specific areas, such as hair loss following radiation treatment to the head. Most side effects go away in time. But be sure to talk to your health care team about any discomfort you are feeling as there are often ways to help.

Fatigue is one of the most common side effects of radiation and chemotherapy. Like most other side effects, it will get better once the treatment is over. You can help yourself by eating a well-balanced diet, drinking plenty of liquids, planning your days to include rest periods, and getting some type of regular exercise.

Chemotherapy

While surgery and radiation therapy are used to treat localized cancers, chemotherapy (often called just "chemo") is used to treat cancer cells that have spread to other parts of the body. Depending on the type of cancer and its stage, chemo can be used to cure cancer, to keep the cancer from spreading, to slow the cancer's growth, to kill cancer cells that may have spread to other parts of the body, or to relieve symptoms caused by cancer.

What is chemo?

Chemo is treatment with strong drugs that are most often given by mouth or by injection. Unlike radiation therapy or surgery, chemo drugs can treat cancers that have spread throughout the body because they travel through the bloodstream. Most often, a combination of chemo drugs is used instead of a just 1 drug.

How is chemo given?

Chemo is given in cycles, each followed by a rest period. A cycle may involve one dose followed by several days or weeks without treatment. This gives the normal cells in the body time to recover from the drug's side effects. Doses may also be given several days in a row, or every other day for several days, followed by a period of rest. Some drugs work best when given non-stop over several days.

Different drugs work best on different schedules. If more than 1 drug is used, the treatment plan will show how often and exactly when each drug should be given. The number of cycles you get may be planned before treatment starts (based on the type and stage of cancer) or may be flexible, in order to see how the treatment affects the cancer and your health.

After a cancer is removed by surgery, chemo can reduce the risk of cancer returning. Chemo can also be given before surgery to shrink a tumor before it is removed.

Side effects of chemo

Side effects of chemo depend on the type of drugs, the amounts taken, and the length of the treatment. The most common side effects are nausea and vomiting, short-term hair loss, increased chance of infections, and fatigue. Many of these side effects can be uncomfortable or upsetting. But most side effects can be controlled with medicines, supportive care measures, or by changing the treatment schedule. If you have side effects, ask your doctor or nurse about ways to help ease or prevent them. Also, some side effects may need to be treated right away.

Fatigue is one of the most common side effects of radiation and chemo. Like most other side effects, it will get better once the treatment is over. You can help yourself by eating a well-balanced diet, drinking plenty of liquids, planning your days to include rest periods, and getting some type of regular exercise.

Hair loss can be an upsetting side effect. Most people feel that their hairstyle is a part of who they are, so it is only normal that hair loss is distressing. Some people have hair loss during chemo treatments (and sometimes with radiation treatment to the head) while others do not, even with the same drugs. Not all drugs cause hair loss. When it does happen, the hair almost always grows back after the treatments are over. If hair loss does happen, it usually begins within 2 weeks of the start of treatment and gets worse 1 to 2 months later. Hair often begins to grow back even before therapy is over. Most people are able to find ways to cope with the hair loss until it grows back, usually using hats, scarves, and wigs.

People getting chemotherapy sometimes become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor. There are ways to reduce the side effects or make them easier to manage. Keep in mind that the expected benefits of the treatment should outweigh any problems you might have because of it.

Biologic therapies

The immune system, the body's natural defense system, plays a major role in the body's response to cancer. Some forms of cancer occur when the immune system doesn't destroy cancer cells or prevent their growth. Biologic therapy is an effective treatment for certain cancers. It is sometimes called immunotherapy or biological response modifier therapy. Biologic treatments use the body's immune system to fight cancer or to lessen the side effects of some cancer treatments.

Biologic therapies can act in several ways. They can stop or slow down cancer cell growth, help healthy immune cells control cancer, and help to repair normal cells damaged by other forms of cancer treatment.

There are several kinds of biologic therapy now in use. More than 1 kind of biologic therapy may be used, or biologic therapy may be combined with chemo or radiation to treat cancer.

Complementary and alternative therapy

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that are different from mainstream (standard) medical treatment. These methods can include vitamins, herbs, and special diets, or methods such as acupuncture or massage -- among many others.

Not everyone uses these terms the same way, so it can be confusing. The American Cancer Society uses complementary to refer to medicines or treatments that are used along with your regular medical care. Alternative medicine is a treatment used instead of standard medical treatment.

Complementary methods: Complementary treatment methods, for the most part, are not presented as cures for cancer. Most often they are used to help you feel better. Some methods that can be used in a complementary way are meditation to reduce stress, acupuncture to relieve pain or peppermint tea to relieve nausea. There are others. Some of these methods are known to help, and others have not been tested. Some have been proven not be helpful. A few have even been found harmful.

Alternative treatments: Alternative treatments are those that are used instead of standard medical care. These treatments have not been proven safe and effective in clinical trials. Some of these methods may even be harmful. The biggest danger in most cases is that you may lose the chance to benefit from standard treatment. Delays or interruptions in your standard medical treatment may give the cancer more time to grow.

It is easy to see why people with cancer may think about alternative methods. You want to do all you can to fight the cancer. Sometimes standard treatments such as chemotherapy can be hard to take, or they may no longer be working.

Sometimes people suggest that their method can cure your cancer without having serious side effects, and it's normal to want to believe them. But the truth is that most of these treatments have not been tested and have not been proven to be effective for treating cancer.

As you think about your options, you should talk to your doctor or nurse about any method you are thinking about using. You can also contact the American Cancer Society at 1-800-ACS-2345 to learn more about complementary or alternative methods.

Clinical trials

Clinical trials are carefully controlled research studies that are done with patients. These studies test whether a new treatment is safe and how well it works. Clinical trials may also test new ways to find or prevent a disease. These studies have led to many new ways to prevent, diagnose, and treat cancer.

A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits. If that happens, they may go on to become tomorrow's standard treatment.

Taking part in a clinical trial does not keep you from getting any other medical care you may need. You are free to leave the study at any time, for any reason. To find out more about clinical trials for your type of cancer, talk to your cancer care team. The American Cancer Society also offers a clinical trials matching service that will help you find a clinical trials that is right for you. You can reach this service at 1-800-303-5691 or through our Web site: http://clinicaltrials.cancer.org.

Go back to After Diagnosis: A Guide for Patients and Families

Last Medical Review: 03/19/2008
Last Revised: 05/22/2009