Diagnosed

Treatment Types

Different treatments for cancer are used alone or in combination. Most cancers are treated with surgery, chemotherapy and/or radiotherapy (x-ray treatment). Other treatments, such as hormone therapy, can also be used for some types of cancer.

Sometimes drugs known as targeted therapies are used instead of or with chemotherapy.
Your treatment depends on several factors, including:
  • the type of cancer you have
  • where it began
  • whether it's spread to other parts of your body
  • your general health and your age
  • what treatment you want or are prepared to have


Chemotherapy
What is chemotherapy?
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Chemotherapy drugs are also called cytotoxics, which means poisonous (toxic) to cells (cyto). Many of these drugs are obtained from natural sources such as plants, while others are completely developed in the laboratory. There are many types of chemotherapy drugs, which are often used in different combinations and at different strengths.
How does it work?
Most chemotherapy drugs enter the bloodstream and travel throughout the body to reach cancer cells in different organs and tissues.
 
Chemotherapy drugs target and injure rapidly dividing cells, but because they're not cancer specific, both cancer cells and some normal cells are affected. When normal cells are damaged, this can cause side effects.
 
Cancer cells don't repair easily, so they recover more slowly than normal cells. By the time your next treatment starts, your body's normal cells have recovered but the cancer cells haven't. This means that more cancer cells are destroyed with every treatment.

Some chemotherapy is delivered directly into a tumour rather than travelling through the bloodstream. Examples are chemotherapy wafers for brain cancer and chemoembolisation for liver cancer. Because the chemotherapy is localised, side effects are less common.
Why have chemotherapy?
Chemotherapy can be used for different reasons:
  • Cure: Some cancers can be cured by chemotherapy on its own or in combination with other treatments, such as surgery or radiotherapy. The aim of the treatment is to destroy all cancer cells.
  • To help other treatments: Chemotherapy can be given either before or after other treatments. Used beforehand, its purpose is to make the cancer smaller so your main treatment is more effective (neo-adjuvant therapy). If chemotherapy is given after your main treatment, its aim is to get rid of any remaining cancer cells (adjuvant therapy).
  • To control the cancer: If the cancer is too large and can't be cured, chemotherapy can be used to control the cancer's growth for an extended period of time.
  • Symptom relief: When the cancer can't be cured but causes symptoms such as pain, treatment – such as chemotherapy – can provide relief. This is called palliative treatment.
How is chemotherapy given?
Chemotherapy can be given in a variety of ways. Most people have chemotherapy through a vein (intravenously). It can also be prescribed orally (tablets or capsules), as a cream, or as injections into different parts of the body. 
Does chemotherapy hurt?
Having intravenous chemotherapy may feel like having your blood taken.
 
If you have a temporary tube (cannula) in your hand or arm, only the initial injection should hurt.
 
If you have a central venous access device, it shouldn't be painful.
 
Some treatments will cause side effects. However, chemotherapy drugs are constantly being improved to give you the best possible results and to reduce side effects.
 
If you feel burning, coolness, pain or any other unusual sensation where a cannula or central venous access device enters your body, or if you have tenderness or redness over the injection site, tell your doctor or nurse immediately.
Where will I have treatment?
Most people have chemotherapy on an outpatient basis during day visits to a hospital or clinic. Sometimes an overnight hospital stay may be needed. Some people can have chemotherapy at home if they use a portable pump or have oral chemotherapy.
How long does treatment last?
How often and how long you have chemotherapy depends on the type of cancer you have and the drugs used. You may have treatment daily, weekly or monthly for several months to a year.
 
Chemotherapy is commonly given in courses (cycles), with rest periods in between. This allows normal cells to recover and your body to regain its strength. If your body needs more time to recover, your next cycle may be delayed.
 
Your doctor will discuss your treatment plan with you. Many people have chemotherapy over 6 to 12 months, but you may have it for a shorter or longer period.
 
Some people who have chemotherapy to control the cancer or to relieve symptoms (palliative treatment) may have regular treatment for many months or years.
Can chemotherapy be given during pregnancy?
Being diagnosed with cancer during pregnancy is rare – about one in 1,000 women are affected.
 
It's possible for some pregnant women to have chemotherapy. Your medical team will discuss all of the available treatment options with you. Their recommendations will be based on the type of cancer you have, its stage, the other treatment options, and how to avoid harming your developing baby. Sometimes chemotherapy or other treatment can be delayed until after the baby's birth.
 
Most pregnant women with cancer will feel very anxious and afraid about what will happen to their unborn child. Being well informed about your diagnosis, possible treatments and side effects can make it easier to make decisions and cope with what happens.
 
If you have chemotherapy during pregnancy, your doctor will probably advise you to stop having it at least 3 to 4 weeks before your delivery date. This is because chemotherapy increases your risk of bleeding or getting an infection during the birth. Stopping chemotherapy allows your body time to recover from the side effects.
 
Researchers are currently doing long-term studies on women and children to explore this issue further. It's known that giving chemotherapy in the first trimester (12 weeks) increases the risk of birth defects. However, some studies on children who were exposed to chemotherapy in the womb during the second and third trimesters show that chemotherapy didn't affect their development.
 
Different chemotherapy drugs may affect a developing baby in different ways. For example, chemotherapy may cause premature delivery. Pre-term babies often have other health problems, such as respiratory problems and delayed development.
 
Your doctor can talk in detail about your specific situation and what is best for your health and your unborn baby.
Information Reviewed By:
Dr Mark Wong, Staff Specialist, Medical Oncology, Westmead Hospital, NSW; Annie Angle, Oncology Nurse, Cancer Council Victoria; Karen Hall, Clinical Nurse, Cancer Services Division, Flinders Medical Centre, SA and Helpline Consultant, Cancer Council South Australia; Ann Hobday, Consumer; and Cecilia van Raders, Helpline Consultant, Cancer Council Queensland.


Radiation Therapy
What is radiotherapy?

Radiotherapy uses radiation, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells and stop them from growing and multiplying. It is a localised treatment, which means it generally only affects the part of the body where the radiation is directed.
How does radiotherapy work?
Radiotherapy damages cancer cells in the region being treated. Although the radiation can also damage normal cells, they can usually repair themselves. During this repair process, you may experience some side effects, depending on the part of your body being treated.
Why have radiotherapy?
Many people diagnosed with cancer will have radiotherapy as part of their treatment. Research shows that at least one in two people recently diagnosed with cancer would benefit from radiotherapy. It can be used for several reasons:
  • Cure: Radiotherapy given with the aim of curing the cancer on its own or combined with other treatments, such as surgery or chemotherapy. This may be called curative treatment.
  • Control: Radiotherapy used to control the cancer by making it smaller or stopping it from spreading.
  • Help other treatments: Radiotherapy is used before (neoadjuvant) or after (adjuvant) other treatments. The aim is to make the main treatment more effective.
  • Symptom relief (palliative treatment): Radiotherapy is often able to relieve symptoms, such as pain or bleeding, to help you to feel as well as possible.
How is radiotherapy given?
It can be given in two ways.

External radiotherapy
You will lie on a treatment table underneath a machine, which aims radiation beams towards your body. The machine remains outside of your body and doesn’t come into contact with you. Radiation beams are directed towards the cancer and surrounding tissues where the cancer may have spread.

Internal radiotherapy
A radiation source is put inside the body on or near the cancer. This includes brachytherapy, where a temporary or permanent radiation source is put inside the body on or near the cancer, or radioisotope treatment, where a radioactive isotope is given as a capsule.
 
Depending on the type and size of the cancer, and where it is in your body, you may have one or both types of radiotherapy. The different types of radiotherapy are described in more detail in the following pages.
Where will I have treatment?
Radiotherapy is delivered by specially trained staff called radiation therapists.
 
It uses large medical equipment that takes up a lot of space, so treatment is usually given in large hospitals or private clinics, in dedicated rooms.
 
Radiotherapy departments are run in different ways, so procedures may vary slightly. While the information in this booklet will apply in most cases, you may find things are done a little differently at the place where you’re being treated.
Travelling to treatment
While treatment schedules can vary for individuals, most people have radiotherapy on an outpatient basis. This means they do not stay in hospital, but travel to the radiotherapy department for each session.
 
If you are driving to the treatment centre, you may find you feel tired after a few weeks of treatment. At this stage, you may want to arrange for a family member or friend to drive you to treatment.
 
If you have to travel a long way each day to treatment, you may be able to get some financial assistance towards the cost of accommodation or travel. Please speak to your doctor at the hospital to check your eligibility.
How do I know the treatment has worked?
In the weeks and months following your course of treatment, you will talk with your doctor, be examined and have some tests or scans. This will show if the cancer has responded or gone away.
 
Cancer cells begin to die during a course of radiotherapy and this may continue for weeks or months after treatment ends. For this reason, the health professionals treating you can’t give you progress updates on how radiotherapy is going throughout the course of your treatment. However, they can adjust the dose and help you manage any side effects.
 
It may be some time after radiotherapy finishes before the full benefit is confirmed. Follow-up tests will be done periodically to see if the cancer has regrown or recurred.
 
If radiotherapy is given as palliative treatment, the relief of symptoms will tell you if the treatment has worked. This may take a few days or a few weeks.
Which health professionals might I see?
Some health professionals who care for people having radiotherapy are listed in the table below. You will also see other health professionals who specialise in diagnosing and treating the type of cancer you have.
 
Health professional Role
Radiation oncologist A specialist doctor who prescribes and coordinates the course of radiation treatment and advises about side effects
Radiation therapist Plans and delivers radiation treatment
Radiation oncology nurses Help you manage emotional and physical problems, such as side effects that you may experience during treatment
Radiation physicist Ensures that the machines are running correctly in order to deliver treatment accurately and safely
Dietitian Recommends an eating plan to follow while you are in treatment and recovery
Social worker, physiotherapist, clinical psychologist and occupational therapist Advise you on support services and help you get back to your usual activities
Pastoral carer Helps with any religious or spiritual concerns 
Key points
  • Radiotherapy uses radiation to kill or damage cancer cells and stop them from growing and multiplying.
  • Treatment also affects normal cells, but they are better able to repair themselves.
  • Radiotherapy is used to treat cancer, slow its growth or relieve symptoms.
  • You may have treatment in hospital or at a clinic. Most people have outpatient treatment – this means they come to each treatment session without staying in hospital.
  • Radiotherapy can be given by a variety of machines and devices, depending on which part of the body is affected, and the type and stage of the tumour. The two main types are external and internal (brachytherapy or radioisotope) radiotherapy.
  • Most patients will only have one type of radiotherapy.
  • The effects of treatment add up over time. The doctor will know if treatment has worked after the treatment sessions are done, and the full benefit of treatment may be seen in the weeks following treatment.
  • You will be treated by a team of health professionals, including a radiation oncologist, a radiation therapist and radiation oncology nurses. They will work together to ensure you receive the best possible care.
†Radiotherapy in Cancer Care: Estimating the optimal utilisation from a review of evidence-based clinical guidelines. Collaboration for Cancer Outcomes Research and Evaluation CCORE), funded by Commonwealth Department of Health and Ageing. October 2003.
Reviewed By:
Dr Kevin Palumbo, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; A/Prof Michael Jackson, Director, Radiation Oncology, Prince of Wales Hospital, NSW; Amanda Janus, Radiation Therapist, St Andrew’s Toowoomba Hospital, QLD; Page Massey, Consumer; Emma Marafioti, Site Manager, Adelaide Radiotherapy Centre: Calvary Central Districts, SA; Julie Trevanian, Associate Nurse Unit Manager, William Buckland Radiotherapy Gippsland, Latrobe Hospital, VIC; Kathryn Watty, Nurse Unit Manager, Peter MacCallum Cancer Centre, VIC; and Cancer Council QLD Helpline Operators.