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treatment options

Learn about your treatment options

Occasionally people will only have one treatment option available, however most will have a combination of treatments, like surgery along with chemotherapy and radiation therapy. There are a number of established and emerging treatments that may be used in your care.

Treatment types

What is chemotherapy?

Chemotherapy is a type of cancer treatment that uses cytotoxic drugs in order to kill or damage cancer cells. Chemotherapy works by damaging healthy and cancerous cells in the body which are growing quickly, causing many side-effects.

What is hormone therapy?

Hormone therapy is a cancer treatment that slows or stops the growth of types of cancers that use hormones to grow, including some prostate and breast cancers. Hormone therapy can lessen the chance of a cancer returning, or stop or slow its growth. It may also be used to reduce or prevent symptoms, for example in men with prostate cancer who are not able to have surgery or radiation therapy. Hormone therapy falls into two broad groups, those that block the body's ability to produce hormones and those that interfere with how hormones behave in the body.

What is immunotherapy?

Your immune system helps your body fight infections and other diseases, including cancer. Your immune system is made up of white blood cells, organs and the tissues of the lymph system. Immunotherapy is a type of biological therapy that makes your immune system more efficient and effective at fighting your cancer by using substances made from living organisms to enhance your body's natural immunity, and help it battle against the disease.

What is radiotherapy?

Radiation therapy (also called radiotherapy) is a cancer treatment that uses radiation to kill cancer cells and shrink tumors. At high doses, radiation can either kill cancer cells or slow their growth by damaging their DNA. If the DNA of a cancer cell is damaged beyond repair, it will stop dividing or die, before breaking down and being excreted by the body. Radiation therapy doesn't have an immediate effect, it can takes days or weeks of treatment before cell DNA is damaged enough for cancer cells to die. Once that stage is reached, cancer cells will continue to die for weeks or months after a course of radiotherapy is complete.

What is a stem cell transplant?

A bone marrow transplant (or haematopoeitic stem cell transplant) is a medical procedure done to replace damaged or diseased bone marrow cells with the healthy equivalent. Haematopoeitic stem cells (the basic start up cells in the bone marrow that develop into the blood cells and some of the cells of the immune system) can be harvested/collected from the bone marrow, peripheral blood or from an umbilical cord.

What is surgery?

Surgery is a key component of cancer care and is used in a variety of ways:

  • Prevention and screening. Evidence shows that the early removal of pre-cancerous lesions may prevent the tumors from developing into invasive cancers.
  • Diagnosis of cancer. A sample of suspicious tissue can be biopsied and sent for further investigations in order to get a diagnosis.
  • Treatment of cancer. Primary treatment involves the removal of the tumor with an adequate margin of surrounding healthy tissue in order to reduce the amount of cancer in the body. Sometimes the tumor as well as the regional lymph nodes and lymph vessels need to be removed.
  • Palliative treatment is used to relieve distressing symptoms and to make the patient more comfortable for example removal of life-threatening obstructions.
  • Reconstruction surgery may be necessary to improve function and cosmetic appearance post extensive surgery.
  • Insertion of supportive devices. There are a number of devices that can be surgically placed to assist with safe treatment delivery, for example placement of a chemotherapy port.

What is targeted therapy?

Targeted therapy can help the immune system destroy cancer cells by stopping the cancer cells from growing, killing the cancer cells or even starving them of the hormones needed to reproduce and spread.

How Chemotherapy Is Given

Your chemotherapy can be administered in a number of different ways:

  • Oral
    It can be taken via pills, capsules, or liquids that you swallow
  • Intrathecal
    Chemotherapy can be injected into the space between the layers of tissue that cover the brain and spinal cord
  • Topical
    Chemotherapy sometimes comes in a cream that you can rub onto your skin
  • Intravenously (IV)
    Chemotherapy may be given directly into a vein
  • Intraperitoneal (IP)
    Chemotherapy may go directly into your peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
  • Injection
    It may be given by injection, into a muscle in your arm, thigh or hip, or right under the skin in the fatty part of your arm, leg, or belly
  • Intra-arterial (IA)
    Chemotherapy can be injected directly into the artery that leads to the cancer

The following devices may be used to deliver the drugs safely:


  • Pump
    Pumps are often attached to catheters or ports
  • Catheter
    A catheter is a thin, soft tube A doctor or nurse places one end of the catheter in a large vein, often in your chest area, and administers chemo via that tube
  • Port
    A small, round disc that is placed under your skin during minor surgery, containing a 'reservoir' of chemo

Side effects of Chemotherapy

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that are fast-growing such as the cells that line your mouth. This can cause adverse effects including:

  • Fatigue
     
  • Mouth sores
     
  • Constipation
     
  • Hair loss
     
  • Nausea
     
  • Reduced ability to fight off infections
     
  • Diarrhoea
     
  • Eating problems
     

Side Effects of hormone therapy

Hormone therapy can cause unwanted side effects, depending on the type of treatment you receive and how your body responds to it. People can respond differently to the same treatment, so not everyone gets the same side effects at the same level. Some side effects also differ between men and women.

common side effects for women

  • Hot flashes
     
  • Nausea
     
  • Vaginal dryness
     
  • Loss of interest in sex
     
  • Mood changes
     
  • Enlarged and tender breasts
     

common side effects for men

  • Hot flashes
     
  • Diarrhea
     
  • Nausea
     
  • Loss of interest in or ability to have sex
     
  • Fatigue
     

How hormone therapy is given

Hormone therapy may be given in many ways. Some common ways include:

  • Oral
    Hormone therapy comes in pills that you swallow.
  • Surgery
    You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.
  • Injection
    The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.

Side effects of immunotherapy

Immunotherapy can cause side effects, depending on the type of treatment you receive and how your body responds to it.

  • Fever
     
  • Chills
     
  • Dizziness
     
  • Weakness
     
  • Fatigue
     
  • Hair loss
     
  • Nausea or vomiting
     
  • Muscle or joint aches
     
  • Low or high blood pressure
     

Who is part of the treatment team?

The delivery of radiation therapy requires a treatment team, including a radiation oncologist, medical physicist, and radiotherapist.

  • Radiation oncologist
    A radiation oncologist is a physician who evaluates each patient to determine the appropriate therapy or combination of therapies for them. They determine which area to treat and what dose to deliver.
  • Medical physicist
    The medical physicist, radiotherapist and oncologist determine what techniques to use to deliver the radiation. The medical physicist and the radiotherapist then make detailed treatment calculations using treatment planning computers.
  • Radiotherapists
    Radiation therapists deliver daily treatments and have additional training in radiotherapy and patient care.

Types of stem cell transplants

In a stem cell transplant, you receive healthy blood-forming stem cells through a needle in your vein. Once they enter your bloodstream, the stem cells travel to the bone marrow, where they take the place of cells that were destroyed by treatment.

  • Autologous
    This means that the stem cells come from you, the patient
  • Allogeneic
    This means the stem cells come from someone else. The donor may be a blood relative, but can also be someone who is not related

How surgery works against cancer

Depending on your type of cancer and how advanced it is, surgery can be used to:

  • It removes the entire tumor. Surgery can remove cancer that is contained in one area
  • It can ease cancer symptoms. Surgery may be used to remove tumors that cause pain or pressure
  • Surgery may be performed to debulk a tumor. The surgery removes some, but not all, of a tumour. Debulking is used in cases where removing an entire tumour might damage an organ, or the body. Removing part of a tumor can help other treatments work better

Side effects of surgery

  • Pain
    After surgery, most people will have pain in the part of the body that was operated on. How much pain you feel will depend on the extent of the surgery, the part of your body where you had surgery, and how you feel pain.
    Your doctor or nurse can help you manage pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain. After surgery, tell them if your pain is not controlled.
  • Infection
    Infection is another problem that can happen after surgery. To help prevent infection, follow your nurse's instructions about caring for the area where you had surgery. If you do develop an infection, your doctor can prescribe a medicine (called an antibiotic) to treat it.

    Other risks of surgery include bleeding, damage to nearby tissues, and reactions to the anesthesia. Talk to your doctor about possible risks for the type of surgery you will have.

Types of targeted therapy

Most targeted therapies are either monoclonal antibodies or small-molecule drugs.

  • Small molecule drugs
    These are drugs that can enter into cells easily because they have a low molecular weight. One inside the cells, they can affect other molecules such as proteins, causing the cancer cell to die.
  • Hormone therapy
    Some breast and prostate cancers require certains hormones to grow. Hormone therapies are a type of targeted therapy that can work in two ways. Some hormone therapies prevent your body from making specific hormones. Others prevent the hormones from acting on your cells, including cancer cells.

Chemotherapy works by stopping or slowing the growth of cancer cells which grow and divide quickly.

Hormone therapy is used to treat cancers that use hormones to grow, such as some prostate and breast cancers.

Immunotherapy is a type of biological therapy that uses substances made from living organisms to treat cancer.

Radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

A stem cell transplant restores your body's ability to create the blood cells it needs.

Surgery works best for solid tumors that are contained in one area. It treats the part of your body with the cancer.

Targeted therapy affects people in different ways. Because it precisely targets cancer cells and doesn't harm nearby normal tissues, targeted therapy often is associated with fewer side effects than chemotherapy.

How will I know if my chemotherapy is working?

Chemotherapy can feel like a long and intense process, and of course you will naturally want to know if it's working as soon as possible.

How will i know if my chemotherapy is working?

Chemotherapy can feel like a long and intense process, and of course you will naturally want to know if it's working as soon as possible.

How will i know if my chemotherapy is working?

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

special diet needs

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian.

Different types of immunotherapy

Several types of immunotherapy are used to treat cancer. These include:

Immune checkpoint inhibitors

These are drugs that block proteins called "checkpoints" which are made by specialised cells of the immune system and some cancer cells. Checkpoints can sometimes prevent our immune system from killing cancer cells. By blocking the action of these checkpoints, these drugs enable your immune cells to respond more aggressively to cancer.

Vaccines

Vaccines are medicines that train the body's immune system to fight disease. Broadly there are two types of cancer vaccines: one type targets the viruses that can cause cancer and is used as a prevention strategy and a second type that is used to treat certain types of cancer. The second type tends to stop the cancer from coming back or from spreading.

Monoclonal antibodies

Monoclonal antibodies are laboratory-made proteins that are made to bind to specific targets in the body, such as targets on the surface of certain cancer cells. They can be used alone or used to carry drugs, toxins or radioactive substances directly to cancer cells.



CAR T-cell therapy

CAR (chimeric antigen receptor) T-cell therapy is a promising treatment that activates a patient's own immune system to attack and destroy cancer cells. The process works by removing a specific type of white blood cell (called a T-cell lymphocyte) and reprogramming/modifying them to recognize specific cancer-identifying proteins on cancer cells, before being returned to your body via an infusion, to fight the cancer.

Immune system modulators

Immune system modulators are agents (like proteins etc.) or drugs that boost the body's immune response against cancer. Some of these agents affect very specific parts of the immune system, whereas others will have an overall impact on the immune system in a more general way.

The process of radiotherapy

Radiotherapy is a complex treatment that happens as a process broken into a number of important steps

CT planning scan

You will have a radiotherapy planning CT scan. This type of scan is a little different to regular diagnostic CT scans, which you might be familiar with. This type of scan allows your radiographer to obtain 3D images of the cancer and the area being treated, so that they can create a specific radiotherapy plan for you and your illness. This part of the process can sometimes be referred to as the 'simulation' stage.

Treatment planning

During treatment planning, your radiation oncologist, radiotherapist, and medical physicist will meet to create the individualised plan for your radiotherapy treatment. They'll use the CT scan images (and any others such as an MRI or PET scan, if necessary), to do this. The idea of planning this is so that they can deliver a high dose of radiation to the tumor while also limiting the dose received by the surrounding 'normal' tissue.



Radiotherapy treatment delivery

Your radiation therapist is responsible for positioning you correctly for treatment, and may use aides to help immobilise you if necessary. Once they're satisfied with your positioning, they will deliver the radiation dose prescribed in treatment planning. They will take images on the first day of treatment and throughout treatment, if necessary, to confirm that the area of treatment has not changed position. You will be alone in the room while treatment is administered, but can talk with the radiotherapist via an intercom system. Treatment sessions typically don't last long – generally no more than 20 minutes, with much of that time used for correct positioning.

The goals of a bone marrow transplant

The goals of a bone marrow transplant are to replace healthy haematopoeitic stem cells into a patient after his/her bone marrow has been treated with high doses of chemotherapy, with or without radiation therapy, regenerate the immune system to fight off any residual cancer remaining and restore normal function of the bone marrow after receiving high dose treatments. Bone marrow transplants are used to treat patients with cancer and non-cancerous conditions such as leukaemia, lymphoma and myeloma and aplastic anaemia, multiple sclerosis and immune deficiency disorders.

The preparation for the transplant includes conditioning treatments given a few days before the transplant, where the patient receives unusually high doses of chemotherapy with or without whole body radiation therapy in order to "make space" in the bone marrow for the healthy incoming donor cells and to treat any residual disease.

What to expect before, during, and after surgery

Surgery can be a frightening prospect, and you may have concerns and questions about how to prepare for and navigate the process

Before surgery

Before surgery, a nurse may call you to tell you how to prepare. They may tell you about tests and exams you need to have before the surgery. Common tests that you may need, if you have not had them lately, are blood tests, chest x-rays and electrocardiogram (ecg).

You may not be able to eat or drink for a certain period of time before the surgery. It is important to follow the instructions about eating and drinking. If you don't, your surgery may need to be rescheduled.

During surgery

Once you are under anesthesia, the surgeon removes the cancer, usually along with some healthy tissue around it. Removing this healthy tissue helps improve the chances that all the cancer has been removed.

Sometimes, the surgeon might also remove lymph nodes or other tissues near the tumor. These tissues will be checked under a microscope to see if the cancer has spread. Knowing if the nearby tissue contains cancer will help your doctors suggest the best treatment plan for you after surgery.

After surgery

Once you are ready to go home after surgery, the nurse will tell you how to take care of yourself. He or she will explain how to control pain, activities you should and should not do, how to take care of your wound and how to spot signs of infection, steps to take if you do and when you can return to work.

You will have at least one more visit with the surgeon a week or two after you go home. For more complex surgeries, you may need to see the surgeon more often. You may have stitches removed, and the surgeon will check to make sure you are healing as you should.

How does targeted therapy work against cancer?

Most types of targeted therapy help treat cancer by interfering with specific proteins that help tumors grow and spread throughout the body. They treat cancer in many ways. They can:

Help the immune system destroy cancer cells

One reason that cancer cells thrive is because they can hide from your immune system. Certain targeted therapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other targeted therapies help boost your immune system to work better against cancer.

Stop cancer cells from growing

Healthy cells in your body usually divide to make new cells only when they receive strong signals to do so. These signals bind to proteins on the cell surface, telling the cells to divide. This process helps new cells form only as your body needs them. But, some cancer cells have changes in the proteins on their surface that tell them to divide whether or not signals are present. Some targeted therapies interfere with these proteins, preventing them from telling the cells to divide. This process helps slow cancer's uncontrolled growth.



Stop signals that help form blood vessels

Tumors need to form new blood vessels to grow beyond a certain size. In a process called angiogenesis, these new blood vessels form in response to signals from the tumor. Some targeted therapies called angiogenesis inhibitors are designed to interfere with these signals to prevent a blood supply from forming. Without a blood supply, tumors stay small. Or, if a tumor already has a blood supply, these treatments can cause blood vessels to die, which causes the tumor to shrink.

Deliver cell-killing substances to cancer cells

Some monoclonal antibodies are combined with toxins, chemotherapy drugs, and radiation. Once these monoclonal antibodies attach to targets on the surface of cancer cells, the cells take up the cell-killing substances, causing them to die. Cells that don't have the target will not be harmed.

Cause cancer cell death

Healthy cells die in an orderly manner when they become damaged or are no longer needed. But, cancer cells have ways of avoiding this dying process. Some targeted therapies can cause cancer cells to go through this process of cell death.

Further information

Contact the central customer service centre on

[email protected] or 0860 NETCARE (0860 638 2273)

Please note that the centre operates on weekdays between 08:00 and 16:00.

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