Advanced cancer is a term used to describe cancer that is unlikely to be cured. It may be primary or secondary cancer. Primary cancer refers to the first mass of cancer cells (tumour) in an organ or tissue.
The aim of treatment for advanced cancer is to control the cancer for as long as possible. Controlling the cancer might mean shrinking the size of the cancer or stopping it growing for a while. In some cases, this may be months or years. If treatment is no longer controlling the cancer, the aim of treatment is to relieve symptoms.
New drugs are constantly becoming available, so if your current treatment stops working or you are finding it hard to cope with the side effects, ask your doctor about other options. Also, ask if you are eligible to join a clinical trial.
Treatment choices for advanced cancer will depend on where the cancer started and how much it has spread. Usually cancer that has spread needs systemic treatment. This means treatment is taken by mouth or injected into the blood to reach cancer cells throughout the body. Examples include chemotherapy, immunotherapy or hormone therapy. Treatment that affects only a certain part of the body might also be used to relieve some symptoms. Examples include surgery or radiotherapy. Palliative treatment can also help to maintain or improve quality of life.
Chemotherapy is the most commonly used treatment when cancer has spread. The drugs kill cancer cells or slow their growth. There are many types of chemotherapy drugs, which are often used in different combinations and strengths. Treatment is usually given over a few hours or days, followed by a rest period of 2–3 weeks. Most people have several cycles of treatment.
The chemotherapy drugs are usually given by injecting the drugs into a vein (intravenously), but can also be taken as tablets or capsules (orally). Ask your doctor which combination of drugs is best for you, and how long your treatment will last.
Surgery can remove tumours from affected areas, such as the bowel or lymph nodes. It can also relieve discomfort caused by tumours that obstruct organs or cause bleeding, such as unblocking the bile duct to relieve jaundice in pancreatic cancer.
Some organs release hormones that stimulate tumour growth, so your doctor might suggest surgery on these – for example, removing the testicles will reduce testosterone levels and can slow the growth of prostate cancer.
Also known as radiation therapy, radiotherapy uses radiation, such as x-rays, to kill cancer cells or injure them so they cannot multiply. Radiotherapy can be precisely targeted at cancer sites in your body. Treatment is carefully planned to have the greatest effect on the cancer cells and to limit damage to the surrounding healthy body tissues.
Radiotherapy can shrink tumours or stop them from spreading further. It can also relieve some symptoms, such as pain from secondary cancer in the bones. External beam radiotherapy or internal radiotherapy (brachytherapy) may be offered.
Cancer that grows in response to hormones can often be slowed by taking drugs to suppress the body’s production of the hormone. If you have prostate, breast or uterine cancer, you may be offered hormone therapy. This treatment may cause some side effects.
Targeted therapy may be used instead of, or together with, chemotherapy. This treatment uses drugs that work in a different way to chemotherapy drugs. While chemotherapy affects all rapidly dividing cells and works by killing cancerous cells (cytotoxic), targeted therapy affects specific molecules within cells and often works by blocking cell growth (cytostatic).
This is the use of drugs to alter the immune system’s response. New immunotherapy drugs are being rapidly developed, and several of these are approved for the treatment of some cancers. These new drugs work by permitting the immune system to bypass ‘checkpoints’ set up by the cancer that block the immune system.
Palliative care allows people with advanced cancer to maintain their quality of life. It also provides support to families and careers.
Many people think that palliative care is just for people who are dying, but it is appropriate at any stage of advanced cancer. Some people live comfortably for months or years after their diagnosis of advanced cancer, and they can be supported by palliative care services throughout this time.
The role of palliative care is to:
• help you achieve a good quality of life for as long as possible
• make sure your physical, practical, emotional and spiritual needs are catered for
• help you feel in control of your situation and make decisions about your treatment and ongoing care
• make the time you have as valuable as it can be for you and your family.
Your palliative care may be coordinated by your GP or community nurse or by the specialist palliative care team in your area. These different professionals work together to give you relief from pain and other symptoms of cancer. They will also try to help you live your life as fully as possible.
Contacting the palliative care team early in your illness means that you can find out what the different team members do and see which services might be useful now or in the future. This will vary according to how you feel, what problems you have, and how your careers are managing. If you are not linked in with a palliative care service and would like to be, speak to your doctor or nurse.
MBBS (Gold medalist), MS (Gold medalist), DNB (All India Gold medalist), MNAMS (IND), MRCS (UK), FICS (USA), DNB (SGE & HPB), FMAS (AMASI), Fellow HPB & Liver Transplant (Sir Gangaram, Apollo, Del), CC Lap Solid Organ Surgery (Ethicon), CC Endohernia (Ethicon), CC Lap Colorectal (Galaxy, Pune) / Lap UGI surgery and VATS (Calicut), OB. Fellow HPB & GIS (SGPGIMS, Lucknow / GB Pant, Del).