Treatment for advanced cancer

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.

Side effects – Some chemotherapy drugs cause nausea, depression, tiredness and hair loss. Many of these are temporary and can be prevented or reduced.

Different types of chemotherapy have different side effects – for instance, not all of them cause hair loss.

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 radiotherapy, radiation therapy uses radiation, such as x-rays, to kill cancer cells or injure them so they cannot multiply. Radiation therapy 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.

Radiation therapy 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 radiation therapy or internal radiation therapy (brachytherapy) may be offered.

Side effects – Common side effects from radiation therapy include fatigue, skin problems or loss of appetite. These may be temporary or longer-lasting.

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.

Side effects – For women, certain hormone drugs will cause menopausal symptoms, regardless of age. If you have been through menopause, hormone drugs called aromatase inhibitors may be used and these may cause thinning of the bones (osteoporosis) and vaginal dryness. For men, hormone drugs can produce hot flushes.

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).

Not all cancers respond to targeted therapy, and the drugs are sometimes hard to access because they are expensive, not yet developed for all types of cancers, and sometimes available only in clinical trials.

Side effects – These vary depending on the targeted therapy used, but may include fevers, allergic reactions, rashes, diarrhoea, blood-clotting problems, and blood pressure changes.

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 enable the immune system to bypass ‘checkpoints’ set up by the cancer that block the immune system.

Side effects – The side effects of immunotherapy drugs are different to chemotherapy. If the drugs inflame organs, it may cause symptoms, for example, in the lungs (shortness of breath), bowel (diarrhoea) or thyroid gland (abnormal thyroid hormone levels).

It is frustrating to find that cancer can limit your activities.

Rehabilitation is a way of improving your quality of life between or after treatments. It may involve restoring physical functioning with the use of physiotherapy, occupational therapy, speech therapy or artificial body parts (prostheses). It can also include emotional support, such as counselling.

Returning to work is another form of rehabilitation. You may find you need to start back at work with reduced hours. If you can no longer work, or choose not to, you may need something to do that helps you feel involved in life and connected with people.

For most people, rehabilitation is organised through their treatment centre. If you have been treated in a private hospital, ask your doctor about the availability of these services. Your GP can also organise rehabilitation for you.

For more information on the availability of rehabilitation services in your area, contact Cancer Council 13 11 20.