Overview of Cancer Therapy
Curing cancer requires eliminating all cancer cells. The major modalities of therapy are
Other important methods include
Hormonal therapy (for selected cancers, eg, prostate, breast, endometrium)
Immunotherapy (monoclonal antibodies, interferons, and other biologic response modifiers and tumor vaccines—see Immunotherapy of Cancer)
Differentiating drugs such as retinoids
Targeted drugs that exploit the growing knowledge of cellular and molecular biology
Overall treatment should be coordinated among a radiation oncologist, surgeon, and medical oncologist, where appropriate. Choice of modalities constantly evolves, and numerous controlled research trials continue. When available and appropriate, clinical trial participation should be considered and discussed with patients.
Various terms are used to describe the response to treatment (see Defining Response to Cancer Treatment). The disease-free interval often serves as an indicator of cure and varies with cancer type. For example, lung, colon, bladder, large cell lymphomas, and testicular cancers are usually cured if a 5-yr disease-free interval occurs. However, breast and prostate cancers may recur long after 5 yr, an event defining tumor dormancy (now a major area of research); thus, a 10-yr disease-free interval is more indicative of cure.
Defining Response to Cancer Treatment
Treatment decisions should weigh the likelihood of adverse effects against the likelihood of benefit; these decisions require frank communication and possibly the involvement of a multidisciplinary cancer team. Patient preferences for how to live out the end of life should be established early in the course of cancer treatment despite the difficulties of discussing death at such a sensitive time (see Advance Directives).