At Kansas City Urology and Oncology, we fight cancer every day. Luckily, with today’s medicine, we have multiple ways to do it. If we were to break it down into categories, there would be 4 types of treatment for cancer:
- Chemotherapy, or “chemo”, uses special drugs to shrink or kill cancer cells.
- Radiation therapy, or “radiation”, kills cancer cells at a specific site in the body with high-energy beams such as X-rays or protons.
- Immunotherapy uses the power of the body’s immune system to prevent, control, and eliminate cancer.
- Surgery physically removes as much of the cancerous tumor or tissue as possible from the body.
Let’s go a little deeper into each type of these 4 types of treatment for cancer to help you understand the differences.
Chemotherapy – a Systemic Approach
Chemotherapy targets cancer cells throughout the body with medications typically given intravenously, occasionally orally. These drugs circulate in the bloodstream and can attack cancer cells anywhere in the body. Chemotherapy is a comprehensive, broad-based way to attack cancer cells, while radiation is a more targeted approach which specifically focuses on the area where the tumor or cancer resides. Because chemotherapy drugs pass through your entire body, or system, this therapy is referred to as a “systemic” treatment. Chemotherapy side effects can include nausea, fatigue and hair loss.
Radiation – a Local Treatment Aimed Directly at Cancerous Tissue
Radiation therapy uses invisible bursts of energy instead of drugs. Radiation damages the DNA of the tumor, making the tumor unable to repair itself or grow new cells. Because the beams of energy are aimed specifically at the area where the cancer is in the body, it is called a “local” type of treatment. There are several types of radiation treatments:
Photon Therapy
This type of radiation therapy uses x-rays that come from a machine called a linear accelerator. The linear accelerator produces electrons (tiny charged particles), accelerates the electrons to a very high velocity, then directs the electrons at a heavy metal target inside the accelerator. The collision between the electrons and the target creates a high energy x-ray beam. The x-ray beam is then shaped by metal apertures as it exits the linear accelerator and is directed toward the patient. The x-ray beams can be shaped with great precision. X-ray radiation is highly penetrating, allowing it to attack tumors deep inside the body with very little effect on superficial tissues when that is the goal. Alternatively, beams can be designed to treat tumors located in or near the skin when it is necessary. X-ray radiation has been used to treat cancer since 1896. The first linear accelerators went into service in the mid-1950s.
Proton Therapy
This type of radiation therapy uses proton beams instead of photon rays. Protons are charged particles which are found in the nucleus of atoms. Protons have mass, unlike x-rays which are beams of energy without any mass (much like microwaves and sunlight). Because protons have mass, accelerating them to high speeds is more challenging than creating x-ray beams, but there are unique advantages to the mass characteristics of protons when it comes to treating cancers. When directed into the body, protons give up very little energy as they enter, but as the particles begin to ‘slow down’, they do so quite abruptly. The energy of the protons is then deposited into a rather tightly confined area, and there is no ‘exit radiation’ extending past the target point (the location of the tumor).
As such, protons can be used to deliver very high doses of radiation to very tightly conformal targets, while sparing the surrounding tissues in ways which cannot be accomplished with x-rays. As such, the biggest advantage compared to traditional or photon therapy is that proton therapy focuses more energy on the tumor itself with less radiation to surrounding tissue. Protons were first used to treat cancer in 1954 in California. Today, it is becoming more popular and well-known, with 41 regional proton therapy centers in the U.S. and more under construction. The Kansas City Proton Institute is scheduled to open in the Winter of 2023/2024.
Radiation treatments themselves are painless, but side effects can include fatigue, skin redness and hair loss around the part of the body being treated.
Immunotherapy – Enhances the Body’s Natural Defense System
Immunotherapy is a type of cancer treatment that uses the body’s immune system to help it fight cancer. It can involve substances naturally made by the body or created in a laboratory. These specific cells or proteins are added back to the body to boost the immune system and help the body find and destroy cancer cells. There are several different types of immunotherapy:
Immune Checkpoint Therapy
This type of therapy enhances cancer-fighting immune cells (T cells) to enable them fight the cancer more effectively.
Adoptive Cellular Therapy
This type of therapy increases the number and/or effectiveness of immune cells (usually T cells). The four main types of adoptive cellular therapy include:
Chimeric Antigen Receptor (CAR) T cell therapy gives patients large amounts of T cells that are all genetically engineered to find and fight the cancer.
Tumor infiltrating lymphocyte (TIL) therapy increases the amount of a patient’s T cells in a lab (collected from a tumor) to recognize the cancer, and fight it.
Endogenous T cell (ETC) therapy increases the number of T cells collected from a patient’s blood to fight cancer cells.
Chimeric Antigen Receptor (CAR) natural killer (NK) cell therapy – NK cells (that identify and then kill abnormal cells) are engineered to better recognize cancer, boosting their ability to find and kill cancer cells. (This therapy is still in the clinical trial stage.)
Cancer Vaccines
These vaccines help the body recognize cancer cells and stimulate the immune system to destroy them. These vaccines usually contain cancer cells taken from the patient’s tumor, proteins designed to attach themselves to cancer cells, or proteins specific to a patient’s tumor.
Monoclonal Antibodies
These antibodies attach to specific proteins on the surface of cancer cells or immune cells and either mark the cancer as a target for the immune system, or boost the ability of immune cells to fight the cancer
Cytokine Therapy
This type of therapy relies on proteins called interferons and interleukins to trigger an immune response.
Surgery – Removes Cancerous Tissue from the Body
Surgery is the oldest kind of cancer treatment. It works well to treat many types of cancer. It can also be used in combination with other types of cancer treatments. There are many different types of cancer surgery:
Curative Surgery – removes the cancerous tumor or growth from the body.
Preventive Surgery – used to remove pre-cancerous tissue that may develop into a malignant tumor. An example would be the removal of polyps in the colon.
Diagnostic Surgery – removes a tissue sample for testing to determine whether the cells are cancerous. Tissue samples can help to confirm a diagnosis, identify the type of cancer, or determine the stage of the cancer.
Staging Surgery – performed to determine the extent of cancer.
De-Bulking Surgery – removes a portion, but not all, of a cancerous tumor when removing the entire tumor could cause damage to the body.
Palliative Surgery – does not work to cure cancer, but to relieve discomfort or other problems created by the cancer or cancer treatment.
Supportive Surgery – does not work to cure cancer. Instead, it helps other cancer treatments work effectively. For example the insertion of a catheter to make chemotherapy more convenient.
Restorative Surgery – used to restore a person’s appearance or the function of a body part. For example, breast reconstruction surgery to restore the physical shape of the affected breast(s).
There are also various ways to perform the different types of surgery:
Laparoscopic Surgery – the surgeon manipulates small instruments and a tiny camera through small incisions to eliminate the need for large incisions and longer recovery times.
Robotic Surgery – a type of laparoscopic surgery that uses an instrument with mechanical arms equipped with surgical instruments and a camera that are controlled by the surgeon through a computer console.
Cryosurgery – a type of surgery that destroys cancer cells by freezing them.
Laser Surgery – uses a focused, high-powered beam of light to destroy cancer cells. Lasers may also be used to turn on a cancer-killing chemotherapy medicine.
Microsurgery – used when work must be done on a very small scale.
Electrosurgery – uses high-frequency current to burn away (cauterize) cancerous or precancerous cells.
Every Cancer Diagnosis Is Unique
Every case is unique and will require a specific type of treatment, or perhaps treatments, over a predetermined amount of time. All four treatment types can be used independently or in concert with each other. It all depends on what your doctor decides is the best approach for your particular situation.