Which Cancer Treatment Is Best? Selecting the Right Tool for the Job

October 7, 2021 – For patients diagnosed with cancer that begins in a solid organ such as the lung, colon, breast, or prostate, oncologists want to determine the best treatment for each patient.

To find out, oncologists must answer an important question: Has the cancer spread to other parts of the body? The process of locating cancer, called staging, gives doctors a clearer sense of and predicts the biological behavior of the cancer, and helps determine the best treatment strategy.

The most common method of staging cancer assesses the size and spread of where the cancer began – the primary tumor – as well as whether cancer cells have spread to the lymph nodes in the area or traveled through the bloodstream to distant sites in the body – advanced or metastatic disease. contributions NShumor, npoems and NSEtastases define the TNM staging system.

Our treatments for cancer tend to work either locally or systemically. Local treatments, such as surgery or radiation, are effective in the specific area they are directed at. Surgery that removes the tumor is effective in eliminating the risk of disease from that site, and the radiation helps kill cancer cells in the “field” where the radiation is directed.

Systemic treatments, such as chemotherapy and immunotherapy, work throughout the body and can be given intravenously (IV), orally, or sometimes by injection. Immunotherapy, usually intravenous therapy, helps stimulate the patient’s immune system to recognize and attack the cancer. The goal of systemic therapies is to treat disease that appears on scans or physical examination as well as any potential microscopic or invisible disease that cannot be detected by examination or examination but may grow over time.

Historically, surgery or radiation has been the cornerstone of managing early-stage cancers, and chemotherapy or other systemic therapies have been the mainstay of advanced cancer care.

Doctors usually use topical treatments when the primary tumor is not too large, has not invaded surrounding tissues, and spread to the lymph nodes is limited. In fact, for early-stage cancers, local treatments such as surgery or radiation can be curative.

However, as the size and number of lymph nodes affected by cancer increases, so does the possibility that the cancer has spread or spread to other areas of the body. Patients with more advanced cancers usually undergo comprehensive treatment to find a broader treatment network and capture not only the disease you see but also the disease you cannot see.

However, we have found over time that systemic treatments can also improve outcomes for many high-risk but early-stage cancers, and local treatments may be beneficial for certain types of metastatic cancer.

For example, in some patients with localized early-stage cancer, chemotherapy may be given before surgery or at the same time as radiotherapy. Combining systemic and local treatments can improve the effectiveness of local treatment against visible disease that we can see and often help invisible disease before it can take hold. For many types of cancer, chemotherapy or immunotherapy has been shown to reduce the size of tumors before surgery or during radiation and increase the chance that patients will be free of cancer after years of treatment.

Local treatments such as surgery or radiation may also be appropriate for patients with advanced cancer. If the cancer has spread to the brain, for example, the patient may benefit from surgery or radiation directed to the tumor site because many systemic cancer drugs cannot reach the brain in concentrations high enough to shrink these tumors. Likewise, when a tumor mass causes symptoms that need treatment right away, such as bleeding or difficulty breathing, a local treatment that targets the problem may do the job better. In addition, patients with metastatic disease may have one or more tumors growing at an alarming rate. This condition is called oligo-metastatic disease.lack means “few”), is unusual but may warrant local treatment directed at this rapidly growing tumor.

This is precision medicine – the concept of identifying the right tools for each individual – in action.

H. Jack West, MD, is Assistant Professor and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, California. West works as a web editor for gamma tumorsHe edits and writes several departments on lung cancer for UpToDate, and leads a wide range of continuing education and other educational programs, including hosting West Wind podcasts.


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