Understanding Cancer Treatment
Cancer treatment: neoadjuvant therapy, adjuvant therapy, and surgery
When a relative or close friend receives a diagnosis of cancer, he'll soon be plunging into the complex world of cancer treatment. Typically, his doctor will refer him to an oncologist, who plans a course of treatment. This may be a single process, such as chemotherapy, or more likely it will be a combination of different treatment types, such as surgery followed immediately by radiation, followed later by a course of chemo. Within each of these treatment categories, there are myriad distinctions to understand and decisions to make, which can leave you and the patient feeling overwhelmed.
To help you and him sort through the maze of cancer treatments, here's a guide to the main types and how they work.
Neoadjuvant therapy and adjuvant therapy. Sometimes oncologists prescribe chemotherapy, radiation, or other drugs, such as hormones, to shrink a tumor priorto surgery. This is known as neoadjuvant therapy. Adjuvant therapy is the term for chemotherapy or radiation given after surgery.
Various types of surgery. If the doctor identifies a tumor that's safe for removal, surgery is going to be an important part of the treatment. The oldest form of cancer treatment, surgery is still considered the best way to remove cancerous tissue, particularly when it's localized in one area of the body. The goal in surgery is to remove the entire tumor, including the cancerous cells spreading around the edge, or "margin," of the tumor.
The patient's doctor may discuss one or a number of different types of surgery:
- Laser surgery. Most people picture a scalpel when thinking about surgery, but today some surgeries are performed using lasers to cut tissue. Lasers are typically used for very precise surgeries, such as in the eye or larynx, but they can also be used to vaporize cancers in particular areas, such as the cervix or rectum. Lasers or cryosurgery (freezing) are commonly used to treat skin cancer.
- Surgery on surrounding areas. Sometimes additional surgery is performed on other areas where the cancer is spreading. Breast cancer, for example, is often treated with surgery to remove the tumor in the breast and additional surgery or biopsy to remove the lymph nodes under the arm. The surgeon may also decide to remove blood vessels close to the tumor to prevent the cancer from spreading.
- Diagnostic surgery. Some types of surgery are used to diagnose and "stage" cancer when the doctor can't see what's going on from outside the body.
Biopsies are the most common type of diagnostic surgery. Using a needle, the doctor draws a tissue sample from a tumor. Biopsies can also be done by cutting through the tissue with a knife or laser. An excisional biopsy is one that cuts out the entire tumor, while an incisional biopsy removes a small part of a larger tumor. Unlike regular surgery, biopsies are often outpatient procedures performed using local anesthesia.
Endoscopies often done in tandem with biopsies, use a flexible tube and scope to pass through the throat or colon in order to examine a potentially cancerous area without cutting through the skin. Endoscopies are also usually done on an outpatient basis.
Laparoscopies are similar to endoscopies, but they do require a small incision -- usually in the abdomen -- through which the doctor inserts the scope.
- Prophylactic surgery. This type of surgery is a proactive treatment used to prevent cancer from developing in people who are likely to develop the disease. For example, women with a strong family history of breast cancer may choose to have a prophylactic mastectomy to protect themselves.