Treating Advanced Cancer

Advanced cancer that can’t be cured, often still can be treated. The physical symptoms it causes almost always can be managed. At any stage of cancer, the treatment goal should be clear. You should know if the goal is to cure the cancer, slow its growth and help you live longer, or relieve symptoms. This can sometimes be confusing because some treatments used to cure cancer are also used to slow its growth or relieve symptoms.

This is a review of common treatments used for advanced cancer. More details on treating certain types of advanced cancer can be found in our information on that specific cancer type.

Making treatment choices

Treatment choices for advanced cancer depend on where the cancer started and how much it has spread. As a general rule, cancer that has spread will need systemic therapy like chemotherapy or hormone therapy. Systemic therapy is treatment that’s taken by mouth or put into the blood to reach cancer cells throughout the entire body. Local therapies such as surgery or radiation, only affect a certain part of the body. Still, they might also be needed to help prevent or relieve certain symptoms.

Some people believe that nothing more can be done if the cancer can’t be cured, so they stop all treatment. But radiation, chemotherapy (and other drugs), surgery, and other treatments can often slow cancer growth and help control symptoms. And relieving symptoms like pain, constipation, upset stomach, and vomiting can help you feel better. Something can almost always be done to help maintain or improve your quality of life.

The goal of any cancer care is to give you the best possible quality of life. You want to feel as good as possible for as long as possible. This is a very personal issue. Talk to your cancer care team about what’s important to you. Tell them what you want to be able to continue to do. You have the right to be the decision-maker in planning your treatment.

Some people might want to continue cancer treatments as long as there’s a chance they may help. Others might decide that the side effects or other burdens of aggressive cancer treatments outweigh the possible benefits, so they may no longer want this type of treatment. This may be hard for some of your loved ones to accept, but you have the right to make this decision. It often helps to include your loved ones in these tough choices. Either way, you should make the decisions that are best and most realistic for you and your situation.

Surgery for advanced cancer

Surgery isn’t often used to treat advanced cancer, but can help in some cases.

Surgery to relieve symptoms and improve your life

Surgery can help you feel better and do more. It may help you live longer, even when cancer has spread too far to be cured. For instance, cancer can sometimes block the bowel (intestine). This can be very painful and can be dangerous if the bowel is blocked completely. Surgery may be done to bypass the blockage or put a tube through it so the bowel can work again. Another option is surgery to let the bowel drain outside the belly into a bag (called a colostomy).

Sometimes, simple surgery is used to put in feeding tubes or to put small tubes into blood vessels for giving medicines to relieve pain.

Surgery to stop bleeding

Surgery may be done if the cancer is causing bleeding from the stomach, bowel, or airways. Often, the doctor will first look for the source of bleeding with an endoscope (a thin flexible tube that has a camera inside). The scope can be put in through the mouth or the rectum. (The patient is given drugs to sleep while this is done.) The doctor may be able to stop bleeding by burning the bleeding vessel closed with a tool passed through the scope. If this can’t be done, surgery to stop the bleeding may be an option.

Another way to find out where the bleeding is coming from is to use angiography. For this test, a long, thin tube called a catheter is put into a large artery (such as the one in the groin) and threaded up to the arteries of the intestines or lungs. A dye is put in through the tube. It allows the doctor to pinpoint the blood vessel that is bleeding. Often, substances can be put in through the catheter and to stop the bleeding.

Surgery to stop pain

Sometimes a tumor may be pressing on a nerve and causing pain. Either injecting something into the nerve to kill it, cutting the nerve, or taking out the tumor may relieve the pain.

Surgery to prevent or treat broken bones

Cancer that spreads to the bones may weaken them, causing breaks (fractures) that tend to heal very poorly. If a bone looks weak on an imaging test, surgery may be done to put in a metal rod to support it and help keep it from breaking. This is most often done in the thigh bone. If the bone is already broken, surgery can relieve pain and help the person be more active.

Surgery to treat cancer that’s pressing on the spinal cord

If a tumor is pressing on the spinal cord, it can lead to a loss of muscle control and function below the level of the tumor and sometimes paralysis. Surgery may be needed to remove the tumor and stabilize the bones in the spine so that a person can continue to walk and function.

Ablative techniques for advanced cancer

Putting a needle or probe right into a tumor and using heat, cold, or a chemical to destroy it is called ablation. It’s used most often for cancer that has spread to the bone or liver, but may be used in other areas, too. It’s most often used when only a few tumors are causing problems.

A common type of ablation called radiofrequency ablation (RFA) uses a needle that carries an electric current. The tip of the needle is put into the tumor. Ultrasound or CT scans may be used to be sure the needle is in the right place. An electric current passed through the needle heats the tumor to destroy it. RFA is usually done while the patient is under general anesthesia (deeply asleep and not able to feel pain).

In another type of ablation, called cryoablation, a probe put into the tumor is used to freeze it, killing the cancer cells. Other methods may use alcohol to kill the cells or other ways to heat the tumor (such as laser-induced interstitial thermotherapy).

Radiation therapy for advanced cancer

Radiation therapy uses high-energy x-rays or particles to kill cancer cells and shrink tumors. In advanced cancer, radiation therapy is often used to shrink tumors to reduce pain or other symptoms. This is called palliative radiation.

Different types of radiation therapy are sometimes used together.

Radiopharmaceuticals

Radiopharmaceuticals are a group of drugs that contain radioactive materials (like radium-223 or strontium-89) that have been dissolved into liquids and can be put into a vein. They travel through blood and are drawn to areas of bones that have cancer. The radiation given off by the drug kills cancer cells and relieves bone pain, but it does not cure the cancer.

If the cancer has spread to many bones, this type of treatment may work better than using external beam radiation, which only treats a small area. For more on this, see Treating Bone Metastasis.

Other radiopharmaceuticals aren’t only attracted to bones, but can be used to treat certain types of cancer, even when it has spread to other places. For instance, radioactive iodine (I-131) can be used to treat most types of advanced thyroid cancer.

Drugs used to treat advanced cancer

This is general information about the types of drugs that can be used to treat advanced cancer. To learn more about drugs used to treat your type of cancer, see our information on that specific type of cancer.

Chemotherapy

Chemotherapy (chemo) uses drugs to kill cancer cells. Usually the drugs are put into a vein or taken by mouth. Once the drugs get into the bloodstream, they go throughout the body. This treatment is often useful for cancer that’s widespread. By shrinking the cancer, it can relieve symptoms. It can even prolong life for some people with advanced cancer.

To learn more about chemo and dealing with side effects, see Chemotherapy.

Targeted therapy

Targeted therapy drugs attack specific parts of cancer cells or other cells or proteins that help cancer cells grow. These drugs work differently from standard chemo drugs. They can be used alone or along with other treatments.

To see what targeted drugs can be used to treat your cancer, see our information about that specific type of cancer.

Hormone therapy

Hormone therapy drugs block the actions of certain hormones or reduce how much hormone is made. This treatment is most often used for breast and prostate cancer, but it can be used for some other cancers as well.

For instance, estrogen is a hormone that causes many breast cancers to grow. Drugs can lower estrogen levels or block the effect that estrogen has on breast cancer cells. This may stop growth and even make tumors shrink. Likewise, male sex hormones, called androgens, make most prostate cancers grow. Drugs that lower androgen levels or block their effect can help stop or slow growth of these cancers.

Immunotherapy

Immunotherapy boosts the body’s immune system or uses man-made versions of immune system proteins to kill cancer cells. Many types of immunotherapy are used to treat patients with advanced cancer.

To see if immunotherapy is used to treat the cancer you have, see our information about that kind of cancer.

Drugs to treat cancer that has spread to the bones

Some types of drugs can be especially helpful if cancer has spread to the bones. For more on these drugs, see Treating Bone Metastasis.

Clinical trials

Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691.

Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the only way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.

For more information see Clinical Trials.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 16, 2016 Last Revised: December 16, 2016

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