Editing Cancer (section)

== Management ==
{{Main|Treatment of cancer|Oncology|}}

Many treatment options for cancer exist. The primary ones include surgery, [[chemotherapy]], [[radiation therapy]], [[hormonal therapy (oncology)|hormonal therapy]], [[targeted therapy]] and [[palliative care]]. Which treatments are used depends on the type, location and grade of the cancer as well as the patient's health and preferences. The [[therapy#By treatment intent|treatment intent]] may or may not be curative.{{citation needed|date=March 2024}}

=== Chemotherapy ===
[[Chemotherapy]] is the treatment of cancer with one or more [[Cytotoxicity|cytotoxic]] anti-[[neoplastic]] drugs ([[list of chemotherapeutic agents|chemotherapeutic agents]]) as part of a [[chemotherapy regimen|standardized regimen]]. The term encompasses a variety of drugs, which are divided into broad categories such as [[Alkylating antineoplastic agent|alkylating agents]] and [[antimetabolite]]s.<ref name="Lind2008">{{cite journal | vauthors = Lind MJ |title=Principles of cytotoxic chemotherapy |journal=Medicine |year=2008 |volume=36 |issue=1 |pages=19–23 |doi=10.1016/j.mpmed.2007.10.003 }}</ref> Traditional chemotherapeutic agents act by killing cells that divide rapidly, a critical property of most cancer cells.

It was found that providing combined cytotoxic drugs is better than a single drug, a process called the [[combination therapy]], which has an advantage in the statistics of survival and response to the tumor and in the progress of the disease.<ref>{{cite book | vauthors = Frei III E, Eder JP |title=Combination Chemotherapy |date=2003 |url=https://www.ncbi.nlm.nih.gov/books/NBK13955/ |access-date=4 April 2020 |language=en}}</ref> A Cochrane review concluded that combined therapy was more effective in treating metastasized breast cancer. However, generally it is not certain whether combination chemotherapy leads to better health outcomes, when both survival and toxicity are considered.<ref>{{cite journal | vauthors = Dear RF, McGeechan K, Jenkins MC, Barratt A, Tattersall MH, Wilcken N | title = Combination versus sequential single agent chemotherapy for metastatic breast cancer | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD008792 | date = December 2013 | volume = 2021 | pmid = 24347031 | doi = 10.1002/14651858.CD008792.pub2 | pmc = 8094913 }}</ref>

[[Targeted therapy]] is a form of chemotherapy that targets specific molecular differences between cancer and normal cells. The first targeted therapies blocked the [[estrogen receptor]] molecule, inhibiting the growth of breast cancer. Another common example is the class of [[Bcr-Abl tyrosine-kinase inhibitor|Bcr-Abl inhibitors]], which are used to treat [[chronic myelogenous leukemia]] (CML).<ref name=TCT2018/> Currently, targeted therapies exist for many of the most common cancer types, including [[bladder cancer]], breast cancer, [[colorectal cancer]], [[kidney cancer]], [[leukemia]], [[liver cancer]], lung cancer, [[lymphoma]], [[pancreatic cancer]], [[prostate cancer]], [[skin cancer]], and [[thyroid cancer]] as well as other cancer types.<ref name=TCT2018/>

The efficacy of chemotherapy depends on the type of cancer and the stage. In combination with surgery, chemotherapy has proven useful in cancer types including breast cancer, colorectal cancer, [[pancreatic cancer]], [[osteosarcoma|osteogenic sarcoma]], [[testicular cancer]], ovarian cancer and certain lung cancers.<ref name=HollandTx40/> Chemotherapy is curative for some cancers, such as some [[leukemias]],<ref>{{cite journal |vauthors=Nastoupil LJ, Rose AC, Flowers CR |title=Diffuse large B-cell lymphoma: current treatment approaches |journal=Oncology |volume=26 |issue=5 |pages=488–95 |date=May 2012 |pmid=22730604}}</ref><ref>{{cite journal |vauthors=Freedman A |title=Follicular lymphoma: 2012 update on diagnosis and management |journal=American Journal of Hematology |volume=87 |issue=10 |pages=988–95 |date=October 2012 |pmid=23001911 |doi=10.1002/ajh.23313|s2cid=35447562 |doi-access=free }}</ref> ineffective in some [[brain tumors]],<ref>{{cite journal |vauthors=Rampling R, James A, Papanastassiou V |title=The present and future management of malignant brain tumours: surgery, radiotherapy, chemotherapy |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=75 |issue=Suppl 2 |pages=ii24–30 |date=June 2004 |pmid=15146036 |pmc=1765659 |doi=10.1136/jnnp.2004.040535}}</ref> and needless in others, such as most [[non-melanoma skin cancer]]s.<ref>{{cite journal |vauthors=Madan V, Lear JT, Szeimies RM |title=Non-melanoma skin cancer |journal=Lancet |volume=375 |issue=9715 |pages=673–85 |date=February 2010 |pmid=20171403 |doi=10.1016/S0140-6736(09)61196-X|pmc=3339125 }}</ref> The effectiveness of chemotherapy is often limited by its toxicity to other tissues in the body. Even when chemotherapy does not provide a permanent cure, it may be useful to reduce symptoms such as pain or to reduce the size of an inoperable tumor in the hope that surgery will become possible in the future.{{Citation needed|date=January 2025}}

=== Radiation ===
[[Radiation therapy]] involves the use of [[ionizing radiation]] in an attempt to either cure or improve symptoms.<!--<ref name=H41/> --> It works by damaging the DNA of cancerous tissue, causing [[mitotic catastrophe]] resulting in the death of the cancer cells.<ref>{{cite journal | vauthors = Vitale I, Galluzzi L, Castedo M, Kroemer G | title = Mitotic catastrophe: a mechanism for avoiding genomic instability | journal = Nature Reviews. Molecular Cell Biology | volume = 12 | issue = 6 | pages = 385–392 | date = June 2011 | pmid = 21527953 | doi = 10.1038/nrm3115 | s2cid = 22483746 }}</ref> To spare normal tissues (such as skin or organs, which radiation must pass through to treat the tumor), shaped radiation beams are aimed from multiple exposure angles to intersect at the tumor, providing a much larger dose there than in the surrounding, healthy tissue. As with chemotherapy, cancers vary in their response to radiation therapy.<ref>{{cite book | vauthors = Bomford CK, Kunkler IH, Walter J | title = Walter and Miller's Textbook of Radiation therapy | edition = 6th | page = 311 }}</ref><ref>{{cite web |url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=2060451853 |title=tumour radiosensitivity – General Practice Notebook | vauthors =  McMorran J, Crowther D, McMorran S, Youngmin S, Wacogne I, Pleat J, Clive P |url-status=live |archive-url=https://web.archive.org/web/20150924023421/http://www.gpnotebook.co.uk/simplepage.cfm?ID=2060451853 |archive-date=24 September 2015}}</ref><ref>{{cite web |url=https://patient.info/doctor/radiotherapy-pro |title=Radiotherapy |publisher=[[Patient UK]] | vauthors = Tidy C |date=23 December 2015 | url-status = live |archive-url=https://web.archive.org/web/20170709084620/https://patient.info/doctor/radiotherapy-pro |archive-date=9 July 2017}} Last Checked: 23 December 2015</ref>

Radiation therapy is used in about half of cases. The radiation can be either from internal sources ([[brachytherapy]]) or external sources. The radiation is most commonly low energy X-rays for treating skin cancers, while higher energy X-rays are used for cancers within the body.<ref>{{cite journal |vauthors=Hill R, Healy B, Holloway L, Kuncic Z, Thwaites D, Baldock C |s2cid=18082594 |title=Advances in kilovoltage x-ray beam dosimetry |journal=Physics in Medicine and Biology |volume=59 |issue=6 |pages=R183–231 |date=March 2014 |pmid=24584183 |doi=10.1088/0031-9155/59/6/r183|bibcode=2014PMB....59R.183H }}</ref> Radiation is typically used in addition to surgery and/or chemotherapy. For certain types of cancer, such as early [[head and neck cancer]], it may be used alone.<ref name=H41/> Radiation therapy after surgery for brain metastases has been shown to not improve overall survival in patients compared to surgery alone.<ref>{{Cite web |date=13 August 2019 |title=Radiation Therapy for Brain Metastases: A Systematic Review |url=https://www.pcori.org/research-results/2019/radiation-therapy-brain-metastases-systematic-review |access-date=10 October 2023 |website=PCORI |language=en}}</ref> For painful [[bone metastasis]], radiation therapy has been found to be effective in about 70% of patients.<ref name="H41">Holland Chp. 41</ref>

=== Surgery ===
Surgery is the primary method of treatment for most isolated, solid cancers and may play a role in palliation and prolongation of survival. It is typically an important part of the definitive diagnosis and staging of tumors, as biopsies are usually required. In localized cancer, surgery typically attempts to remove the entire mass along with, in certain cases, the [[lymph node]]s in the area. For some types of cancer this is sufficient to eliminate the cancer.<ref name=HollandTx40>Holland Chp. 40</ref>

=== Palliative care ===
[[Palliative care]] is treatment that attempts to help the patient feel better and may be combined with an attempt to treat the cancer. Palliative care includes action to reduce physical, emotional, spiritual and psycho-social distress. Unlike treatment that is aimed at directly killing cancer cells, the primary goal of palliative care is to improve [[quality of life (healthcare)|quality of life]].

People at all stages of cancer treatment typically receive some kind of palliative care. In some cases, [[Specialty (medicine)|medical specialty]] [[professional organizations]] recommend that patients and physicians respond to cancer only with palliative care. This applies to patients who:<ref name="ASCOfive">{{Cite journal |author1=American Society of Clinical Oncology |author1-link=American Society of Clinical Oncology |title=Five Things Physicians and Patients Should Question |journal=Choosing Wisely: An Initiative of the ABIM Foundation |url=http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Clin_Onc.pdf |access-date=14 August 2012 |archive-url=https://web.archive.org/web/20120731073425/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Clin_Onc.pdf |archive-date=31 July 2012}}<br/>* The American Society of Clinical Oncology made this recommendation based on various cancers.</ref>
* for lung cancer, see {{cite journal |vauthors=Azzoli CG, Temin S, Aliff T, Baker S, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pao W, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G |title=2011 Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer |journal=Journal of Clinical Oncology |volume=29 |issue=28 |pages=3825–31 |date=October 2011 |pmid=21900105 |pmc=3675703 |doi=10.1200/JCO.2010.34.2774 | author20 = American Society of Clinical Oncology}} and {{cite journal |vauthors=Ettinger DS, Akerley W, Bepler G, Blum MG, Chang A, Cheney RT, Chirieac LR, D'Amico TA, Demmy TL, Ganti AK, Govindan R, Grannis FW, Jahan T, Jahanzeb M, Johnson DH, Kessinger A, Komaki R, Kong FM, Kris MG, Krug LM, Le QT, Lennes IT, Martins R, O'Malley J, Osarogiagbon RU, Otterson GA, Patel JD, Pisters KM, Reckamp K, Riely GJ, Rohren E, Simon GR, Swanson SJ, Wood DE, Yang SC |title=Non-small cell lung cancer |journal=Journal of the National Comprehensive Cancer Network |volume=8 |issue=7 |pages=740–801 |date=July 2010 |pmid=20679538| doi = 10.6004/jnccn.2010.0056 |doi-access=free }}
* for breast cancer, see {{cite journal |vauthors=Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, Erban JK, Farrar WB, Goldstein LJ, Gradishar WJ, Hayes DF, Hudis CA, Jahanzeb M, Kiel K, Ljung BM, Marcom PK, Mayer IA, McCormick B, Nabell LM, Pierce LJ, Reed EC, Smith ML, Somlo G, Theriault RL, Topham NS, Ward JH, Winer EP, Wolff AC |title=Breast cancer. Clinical practice guidelines in oncology |journal=Journal of the National Comprehensive Cancer Network |volume=7 |issue=2 |pages=122–92 |date=February 2009 |pmid=19200416 |author29=NCCN Breast Cancer Clinical Practice Guidelines Panel| doi = 10.6004/jnccn.2009.0012 |doi-access=free }}
* for colon cancer, see {{cite journal |vauthors=Engstrom PF, Arnoletti JP, Benson AB, Chen YJ, Choti MA, Cooper HS, Covey A, Dilawari RA, Early DS, Enzinger PC, Fakih MG, Fleshman J, Fuchs C, Grem JL, Kiel K, Knol JA, Leong LA, Lin E, Mulcahy MF, Rao S, Ryan DP, Saltz L, Shibata D, Skibber JM, Sofocleous C, Thomas J, Venook AP, Willett C |title=NCCN Clinical Practice Guidelines in Oncology: colon cancer |journal=Journal of the National Comprehensive Cancer Network |volume=7 |issue=8 |pages=778–831 |date=September 2009 |pmid=19755046 |author29=National Comprehensive Cancer Network|doi=10.6004/jnccn.2009.0056 |doi-access=free }}
* for other general statements see {{cite journal |vauthors=Smith TJ, Hillner BE |title=Bending the cost curve in cancer care |journal=The New England Journal of Medicine |volume=364 |issue=21 |pages=2060–5 |date=May 2011 |pmid=21612477 |doi=10.1056/NEJMsb1013826|pmc=4042405 }} and {{cite journal |vauthors=Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH, Schnipper LE |title=American society of clinical oncology statement: toward individualized care for patients with advanced cancer |journal=Journal of Clinical Oncology |volume=29 |issue=6 |pages=755–60 |date=February 2011 |pmid=21263086 |doi=10.1200/JCO.2010.33.1744 | author10 = American Society of Clinical Oncology|s2cid=40873748 }}
* Display low [[performance status]], implying limited ability to care for themselves
* Received no benefit from prior [[Evidence-based medicine|evidence-based treatments]]
* Are not eligible to participate in any appropriate [[clinical trial]]
* No strong evidence implies that treatment would be effective

Palliative care may be confused with [[hospice]] and therefore only indicated when people approach [[End-of-life care|end of life]]. Like hospice care, palliative care attempts to help the patient cope with their immediate needs and to increase comfort. Unlike hospice care, palliative care does not require people to stop treatment aimed at the cancer.{{Citation needed|date=January 2025}}

Multiple national [[medical guideline]]s recommend early palliative care for patients whose cancer has produced distressing symptoms or who need help coping with their illness. In patients first diagnosed with metastatic disease, palliative care may be immediately indicated. Palliative care is indicated for patients with a prognosis of less than 12 months of life even given aggressive treatment.<ref>{{cite web |url=http://www.nccn.org/professionals/physician_gls/default.asp |title=NCCN Guidelines |url-status=live |archive-url=https://web.archive.org/web/20080514153600/http://www.nccn.org/professionals/physician_gls/default.asp |archive-date=14 May 2008}}</ref><ref>{{cite web |url=http://www.nationalconsensusproject.org/guideline.pdf |title=Clinical Practice Guidelines for Quality Palliative Care |publisher=The National Consensus Project for Quality Palliative Care (NCP) |archive-url=https://web.archive.org/web/20110516082645/http://www.nationalconsensusproject.org/Guideline.pdf |archive-date=16 May 2011}}</ref><ref>{{cite journal |vauthors=Levy MH, Back A, Bazargan S, Benedetti C, Billings JA, Block S, Bruera E, Carducci MA, Dy S, Eberle C, Foley KM, Harris JD, Knight SJ, Milch R, Rhiner M, Slatkin NE, Spiegel D, Sutton L, Urba S, Von Roenn JH, Weinstein SM |s2cid=44343423 |title=Palliative care. Clinical practice guidelines in oncology |journal=Journal of the National Comprehensive Cancer Network |volume=4 |issue=8 |pages=776–818 |date=September 2006 |pmid=16948956 |doi= 10.6004/jnccn.2006.0068}}</ref>

=== Immunotherapy ===
{{Main|Cancer immunotherapy}}
A variety of therapies using [[Cancer immunotherapy|immunotherapy]], stimulating or helping the [[immune system]] to fight cancer, have come into use since 1997. Approaches include:<ref>{{cite journal |vauthors=Waldmann TA |date=March 2003 |title=Immunotherapy: past, present and future |url=https://zenodo.org/record/1233435 |journal=Nature Medicine |volume=9 |issue=3 |pages=269–77 |doi=10.1038/nm0303-269 |pmid=12612576 |s2cid=9745527 |doi-access=free}}</ref>

* [[Monoclonal antibody therapy]]
* [[Checkpoint therapy]] (therapy that targets the [[immune checkpoint]]s or regulators of the [[immune system]])
* [[Adoptive cell transfer]]

=== Laser therapy ===
{{Main|Lasers in cancer treatment}}
[[Laser]] therapy uses high-intensity light to treat cancer by shrinking or destroying tumors or precancerous growths. Lasers are most commonly used to treat superficial cancers that are on the surface of the body or the lining of internal organs. It is used to treat basal cell skin cancer and the very early stages of others like cervical, penile, vaginal, vulvar, and non-small cell lung cancer. It is often combined with other treatments, such as surgery, chemotherapy, or radiation therapy. [[Laser ablation|Laser-induced interstitial thermotherapy]] (LITT), or interstitial laser [[Laser coagulation|photocoagulation]], uses lasers to treat some cancers using hyperthermia, which uses heat to shrink tumors by damaging or killing cancer cells. Laser are more precise than surgery and cause less damage, pain, bleeding, swelling, and scarring. A disadvantage is that surgeons must have specialized training. It may be more expensive than other treatments.<ref name="NIHlaser">{{cite web|url=https://www.cancer.gov/about-cancer/treatment/types/surgery/lasers-fact-sheet|title=Lasers in Cancer Treatment|date=13 September 2011|publisher=National Institutes of Health, National Cancer Institute|access-date=15 December 2017}}{{PD-notice}}</ref>

=== Alternative medicine ===
[[Alternative cancer treatments|Complementary and alternative cancer treatments]] are a diverse group of therapies, practices and products that are not part of conventional medicine.<ref name="mnalt">{{cite journal |vauthors=Cassileth BR, Deng G |title=Complementary and alternative therapies for cancer |journal=The Oncologist |volume=9 |issue=1 |pages=80–89 |year=2004 |pmid=14755017 |doi=10.1634/theoncologist.9-1-80|s2cid=6453919 |url=http://theoncologist.alphamedpress.org/content/9/1/80.full.pdf }}</ref> "Complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine.<ref>[http://nccam.nih.gov/health/whatiscam/#2 What Is CAM?] {{webarchive|url=https://web.archive.org/web/20051208040402/http://nccam.nih.gov/health/whatiscam/ |date=8 December 2005 }} [[National Center for Complementary and Alternative Medicine]]. Retrieved 3 February 2008.</ref> Most complementary and alternative medicines for cancer have not been studied or tested using conventional techniques such as clinical trials. Some alternative treatments have been investigated and shown to be ineffective but still continue to be marketed and promoted. Cancer researcher Andrew J. Vickers stated, "The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."<ref name="pmid15061600">{{cite journal |vauthors=Vickers A |title=Alternative cancer cures: "unproven" or "disproven"? |journal=CA: A Cancer Journal for Clinicians |volume=54 |issue=2 |pages=110–18 |year=2004 |pmid=15061600 |doi=10.3322/canjclin.54.2.110|citeseerx=10.1.1.521.2180 |s2cid=35124492 }}</ref>