Many advanced cancers are incurable, but they are typically treatable. You should understand whether the purpose of treatment is to cure the cancer, slow its growth and extend your life, or alleviate symptoms. Even if the goal is not to cure the cancer, the majority of the time physical symptoms can be managed.
Over time, treatments for advanced cancer have vastly improved. Some patients have access to new treatments, such as immunotherapy and targeted therapies, and the delivery of other treatments, such as chemotherapy, radiation, and surgery, has been improved. During and after treatment, supportive care therapies may help patients manage side effects and improve their quality of life.
However, treatment for advanced cancer is frequently complicated, and patients may be required to make challenging decisions regarding their cancer care. Some individuals are diagnosed with advanced-stage cancer. Despite treatment, some patients’ cancer continues to progress. Some cancer patients experience a variety of symptoms or side effects, while others experience very few, depending on the type of cancer they have, its progression, and their response to previous treatments.
The term “advanced cancer” is ambiguous. Advanced cancer is defined by the National Cancer Institute as “cancer that is unlikely to be cured or controlled with treatment.” Patients and physicians frequently use this term to describe cancer that has advanced beyond its initial stages. Cancer that has continued to grow despite treatment, spread to other parts of the body, caused secondary tumours, or recurred after a period of remission is considered advanced. In such cases, the cancer may have progressed after standard treatment options or conventional therapies have been utilised. Other patients with advanced cancer may not require initial treatment for a protracted period.
However, some patients may initially be diagnosed with what is regarded as advanced cancer. This may include cancers diagnosed at stages 3 or 4 or when there is evidence that cancer cells have spread to other parts of the body prior to diagnosis.
Some patients with advanced cancer may experience few symptoms and feel relatively well despite the progression of their disease, whereas others may experience symptoms that have a significant impact on their quality of life. It frequently depends on the patient’s cancer type. Patients with indolent (slow-growing) non-Hodgkin lymphoma, for instance, may have very few symptoms despite having cancer in multiple organs, and may not require immediate treatment. Others with less advanced forms of cancer may experience severe side effects and feel quite ill.
As important as a patient’s clinical status may be how he or she is physically feeling and coping with the situation.
The treatment options for advanced cancers depend on the type of cancer, where the cancer originated, and how far it has spread. In general, cancer that has spread will require systemic therapies, such as chemotherapy, targeted therapy, immunotherapy, and hormone therapy. These treatments are administered orally or intravenously. Therapies, such as surgery or radiation, treat only a limited portion of the body, but they can prevent or alleviate certain symptoms. In addition, alleviating symptoms such as pain, constipation, stomach upset, and vomiting can help you feel better. There is almost always something that can be done to maintain or enhance one’s quality of life.
The purpose of cancer treatment is to improve patients’ quality of life. You desire to feel as good as possible for as long as possible. Communicate with your cancer care team about what matters most to you. Tell them what you wish to continue doing. You have the right to make decisions regarding your treatment plan.
Some individuals may wish to continue cancer treatment if there is a possibility that the treatments will be beneficial. Others may conclude that the side effects and other burdens of cancer treatment, such as cost, travel, and time away from home, do not justify the potential benefits. Consequently, some individuals may decide that they no longer desire this type of treatment. Some of your loved ones may find this difficult to accept, but you have the right to make this choice. It is often beneficial to include loved ones in these difficult decisions. In any case, you should be able to make the best decisions for yourself.
The goal of treatment for advanced cancer is to keep the disease under control for as long as possible. This could involve shrinking the size of the cancer or stifling its growth for months or even years. If this is no longer possible, cancer treatment focuses on relieving the disease’s physical and emotional symptoms.
Ask your doctor about other treatment options, including clinical trials, if your current medication ceases to be effective or if you find it difficult to manage the side effects.
The treatment for advanced cancer depends on the cancer’s origin and its spread. You will be treated by a multidisciplinary team (MDT) comprised of a variety of health professionals specialising in various aspects of your care. The team may include, among others, a surgeon, dietician, pharmacist, and occupational therapist.
Chemotherapy is the most common treatment for metastatic cancer. The drugs kill or slow the growth of cancer cells. There are numerous types of chemotherapy drugs, which are frequently administered in various combinations and dosages.
The duration of treatment is typically a few hours or days, followed by a rest period of 1–4 weeks. Most patients undergo multiple treatment cycles. The majority of chemotherapy drugs are administered by injection or intravenous drip, but some can also be taken orally (orally). Ask your doctor about the optimal drug combination and the duration of your treatment.
Some cancers proliferate in response to specific hormones. These tumours are referred to as hormone-dependent tumours. Hormone therapy blocks the effect of the body’s natural hormones with synthetic hormones. The objective is to reduce the amount of hormones the tumour receives, which can help slow the cancer’s spread.
If you have breast or uterine cancer, you may be recommended hormone therapy. The treatment for prostate cancer is known as androgen deprivation therapy (ADT).
This is a type of drug treatment that employs molecular targets to inhibit the growth and spread of cancer by attacking specific characteristics of cancer cells.
Chemotherapy drugs function differently than targeted therapy drugs. Chemotherapy drugs circulate throughout the body, but they affect rapidly dividing cells in particular. Targeted therapy drugs are used to control the progression of cancer. They frequently reduce or eliminate the signs and symptoms of cancer, allowing patients to resume their normal activities. The medications may need to be taken for an extended period of time, and you will need to undergo regular tests to monitor the cancer.
Certain targeted therapy drugs for certain cancers are subsidised by the Pharmaceutical Benefits Scheme (PBS). Therapies not covered by the PBS are typically costly, but you may be eligible to receive them through a clinical trial.
This type of drug therapy employs the body’s immune system to combat cancer.
Different forms of immunotherapy operate in various ways. Some work by allowing the immune system to bypass cancer-established ‘checkpoints’ that block the immune system. Some types of cancer are currently treatable in Australia with checkpoint immunotherapy. It has been effective for some individuals, but not everyone.
Even if immunotherapy is recommended, its efficacy is difficult to predict. New immunotherapy drugs are being developed rapidly; consult your physician to determine if any are suitable for you.
Radiation therapy may be used as a primary treatment alone or in conjunction with other treatments to kill or slow the growth of cancer cells and shrink tumours.
Radiation may also be used to alleviate the pain of patients with advanced cancer. A metastatic prostate cancer patient, for instance, may experience bone pain if a tumour presses on the spinal cord. Targeted radiation to the tumour may alleviate the pressure and alleviate the pain.
Radiation oncologists can deliver a more precise dose of external beam radiation to cancerous tissues using sophisticated equipment designed to spare healthy tissue as a result of technological advancements. This more precise delivery may reduce radiation therapy’s toxicity and side effects. Internal radiation therapy enables radiation to be administered to a tumour using a catheter or device implanted inside or near the tumour. This method typically requires only a few treatments, as opposed to weeks for conventional radiation therapy.
Cancer clinical trials investigate the safety and efficacy of new and experimental cancer treatments, drugs, and technologies. Before the government approves a new cancer treatment, it is necessary to conduct clinical trials. During the course of clinical trials, patients undergo newly proposed treatments, which may provide advanced cancer patients with treatment options not previously available.
The CTCA research staff only participates in clinical trials after weighing the relative benefits to our patients. We are involved in a large number of clinical trials. In the United States, CTCA is one of the largest contributors to the Targeted Agent and Profiling Utilization Registration (TAPUR) study. The purpose of the study is to enhance our understanding of how commercially available anti-cancer drugs perform on a wider variety of cancers by matching the drugs to tumours with specific genomic mutations that the drugs are designed to target.
Not all patients with advanced cancer qualify for participation in a clinical trial. In addition to a number of trial-specific requirements, you may need to have a specific type or subtype of cancer, be within a specific age range, have a cancer with a specific genomic mutation, and/or have exhausted all other treatment options. However, it is worth asking your oncologist about, particularly if he or she has run out of standard treatment options to recommend. You and/or your physician can search the ClinicalTrials.gov database for clinical trials.
Sometimes cancer can limit your activities. Rehabilitation is a means of enhancing your quality of life during or after treatment. Rehabilitation may help restore physical functioning through physiotherapy, occupational therapy, speech therapy, or artificial body parts (prostheses). It may also include emotional support, such as counselling.
Reintegration into the workforce is another form of rehabilitation. You may find that you must return to work with reduced hours. If you are unable to work or choose not to, you may need to engage in activities that make you feel engaged in life and connected to others.
For most individuals, rehabilitation is coordinated by their treatment centre. If you have been treated in a private hospital, ask your doctor if these services are available. Your primary care physician or palliative care service can also coordinate your rehabilitation.