Treating Cancer
By Rear Adm. Joyce Johnson, D.O., M.A.

Surgery, radiation, chemotherapy—Rear Adm. Joyce Johnson, D.O., explains how these treatments work and describes the factors that determine what’s best for each patient.

Cancer treatment is available in three basic forms—surgery, radiation, and chemotherapy—that are used separately and in combination. The choice of cancer therapy depends on which organs are affected; what type of cancer it is, how aggressive, and how far advanced; and the patient’s overall medical condition and preferences.

Surgery involves removal of a tumor. Surgery typically is indicated when the tumor can be removed completely and there is a low probability of recurrence. Also, a tumor must be in a location where a surgeon can remove it without seriously damaging surrounding tissue. For example, some brain tumors can be removed, but others are in areas where surgery would cause too much damage. Surgery also might be used to reduce a particularly large tumor’s mass to increase a patient’s comfort. For example, if a tumor is causing a bowel obstruction, removing all or part of the tumor will resolve the immediate emergency of the obstruction.

Radiation is an increasingly popular therapeutic option. It is safer and more effective than in the past. Radiation often is an adjunct to surgery—used either before surgery, to shrink a tumor’s size and make surgery safer, or after surgery to kill any tumor cells that have remained. Radiation also might be used to shrink inoperable tumors to make a patient more comfortable. Radiation frequently is used to treat prostate cancer. In some cases, a machine is used to beam rays at the prostate (typically on an almost daily basis for about two months); in other cases radioactive “seeds” are implanted in a patient’s body to kill the cancer cells.

Chemotherapy attacks growing cancer cells and reduces their growth. Chemotherapy drugs also affect healthy cells, causing many side effects. Chemotherapy often is used after surgery to kill any tumor cells that remain in the blood or lymph, though it also might be used in conjunction with radiation or alone.

Different organs have different types of cancer that respond to different treatment regimens. More aggressive cancers generally require a combination of surgery, radiation, and chemotherapy. Often a pathologist can identify the type of cancer, how quickly it will grow and spread, and other features.

Side effects or underlying health conditions might make someone a poor candidate for a particular therapy. A patient’s preferences and goals are a critical factor in determining the best approach. Some patients don’t want to undergo the complications of surgery; others prefer to receive every possible treatment. Patients should have realistic expectations and enough information to make an educated decision. In the meantime, ongoing research in experimental cancer treatments could lead to other approaches, such as vaccines.