What are some words you associate with cancer? Chances are “chemotherapy” is one of the first that comes to mind. But chemo is not always the first course of treatment.
“These days, a cancer diagnosis doesn’t have to mean chemo — and the nausea, vomiting and hair loss most people think of,” says Susan Budds, NP, a nurse practitioner who specializes in cancer at Rush.
In fact, sometimes chemo takes a back seat to other treatments that may have milder side effects. Thanks to new treatments and advances in personalized care, oncologists are now better able to tailor cancer treatment to each individual patient and the type of cancer they have.
Treatment 1: Surgery
Surgery is an option for most cancers other than blood cancers, with specialized cancer surgeons attempting to remove all or most of a solid tumor. It is an especially effective treatment for early stage cancers that haven’t spread to other parts of the body.
“While it depends on the size of the tumor and other factors, many patients with stage 1 cancers don't need any other treatment except for surgery,” says Marta Batus, MD, a medical oncologist at Rush.
And surgery can play a role in cancer treatment even when a tumor has spread beyond its original site.
“Our options for treating cancer — even at later stages — have grown, and surgery is a big part of that,” Budds says. “The role of surgery has expanded, and it’s very encouraging.”
Depending on the cancer and the stage, minimally invasive surgery may be an option. For example, thoracic surgeons at Rush often use video-assisted thoracoscopic surgery (VATS), a minimally invasive procedure, to remove early stage lung cancer tumors. VATS uses smaller incisions than open surgery and typically offers patients less pain, shorter hospital stays after surgery and fewer complications.
Treatment 2: Immunotherapy
Immunotherapy, a relatively newer type of cancer treatment, uses medications to rev up the patient’s own immune system to fight cancer. Immunotherapy treatments can work across different cancer types and may be effective in treating even the most advanced and hard-to-treat cancers.
Researchers continue to look into the potential of immunotherapy, but several effective, FDA-approved drugs are now commonly used to treat certain cancers.
“Immunotherapy has definitely opened up more options for a lot of patients, and it is now the frontline treatment for certain patients,” Batus says. “Patients don’t lose their hair. They don't have nausea or vomiting. Most of the time, they experience minimal side effects, if any.”
Some patients, though, may experience side effects, depending on the drug administered and the type of cancer being treated.
Immunotherapies are administered through an IV infusion.
And immunotherapy gives some patients with late-stage cancers a treatment option they previously didn’t have, sometimes allowing them to live longer than they would have been expected to live otherwise. For example, immunotherapy has redefined how doctors are treating melanoma, the most dangerous and deadly form of skin cancer. Five years ago, overall survival for a person diagnosed with metastatic melanoma (cancer that has spread to other parts of the body) was about nine months. Today, thanks to combination immunotherapies, the majority of patients with metastatic melanoma are alive and doing well at least one year later — and many are living many years beyond that.
Treatment 3: Targeted therapies
Oncologists use targeted therapies, also known as precision medicine, to tailor medications for each individual patient and cancer. A tumor or blood sample is tested to identify a genetic profile. That allows clinicians to administer medication that targets the genes that are causing the cancer.
“There could be five or six gene processes that turn a cancer on or off,” Budds says. “With genetic testing, we can find out which medicines to use and which ones not to use.”
Medications, delivered in pill or IV form, either destroy cancer cells or stop the cancer from continuing to grow. Like immunotherapy, targeted therapies can be used at any stage: as a first treatment, to keep the cancer from coming back or if a cancer returns.
For instance, patients with breast cancer are typically tested to see if they carry the HER2 gene, which can play a role in causing breast cancer cells to grow. If a patient tests positive for HER2, oncologists at Rush use a medication or a combination of medications developed to target the gene, such as trastuzumab or pertuzumab. These medications help stop the growth of the cancer cells, often without harming healthy cells.
These days, a cancer diagnosis doesn’t have to mean chemo — and the nausea, vomiting and hair loss most people think of.
Treatment 4: Active surveillance
Active surveillance (also called watchful waiting) may be all that’s needed for certain types of cancers. Your doctor may recommend this approach if the cancer is at an early stage and is growing slowly or not at all.
For example, doctors often recommend active surveillance for prostate cancer, which tends to grow very slowly. Doctors monitor patients’ prostate-specific antigen (PSA) with blood tests and monitor symptoms. If or when symptoms worsen or tests show that the cancer is growing more rapidly, they then begin discussing additional treatments.
“Often, patients who are receiving active surveillance have no symptoms and go on living their lives as usual,” Batus says.
Surveillance may also be an option for patients who want a break from treatment side effects or for those who have exhausted all other treatment options.
Treatment 5: Supportive care
Supportive cancer care can be an effective complement to standard treatment, helping to minimize the physical and emotional stress of cancer treatment.
For example, psychotherapy and massage therapy can help ease patients’ anxiety as they cope with a diagnosis; acupuncture can be beneficial for pain relief; and nutrition counseling can keep a patient from losing too much weight during treatment and keeping their body as healthy as possible.
Other types of integrative medicine include the following:
• Fitness classes
• Mindfulness meditation
“Anything you can do to keep a patient mentally and physically well while they handle the stress of having cancer is beneficial,” Budds says. “It’s just one of the growing set of tools we have to help our patients deal with cancer. We’ve come a long way in recent years.”