Cancer treatment: chemo, hormone, radiotherapy…

List of cancer treatments

Cancer is an umbrella term that groups together several subgroups based on the type of tissue affected. For example :

• carcinomas : cancers develop in the tissues that surround the organs or in the cells of a gland, its lining or a mucous membrane
• sarcomas : these cancers affect supporting tissues, bones, fat, muscles
• hematopoietic cancers : lymphomas – cancers affect the lymphoid organs – and leukemias – cancers affect the blood
• embryonic tumors (in children)
• brain tumors

The different types of treatment currently available are:

• surgery
• radiotherapy
• chemotherapy
• immunotherapy
• hormone therapy
• targeted therapy

Several criteria are taken into account by clinicians before choosing one treatment over another:

• The type (which organ is affected) and the cancer subtype (small cell, large cell, adenocarcinoma, squamous cell carcinoma, etc.)
• The stage of the disease : Is the cancer localized, locally advanced or metastatic?
• The general condition of the patient : “it will be a question of evaluating the foreseeable toxicity of the treatments according to the profile of the patient so that we can adapt our therapeutic project“.

“For example, when the cancer is localized, if the patient’s general condition allows it, more aggressive treatments are usually used to try and destroy the tumor permanently. For metastatic disease, the goal is to contain the progression of the cancer as long as possible, with long-term treatments that the patient must be able to endure over the long term without this affecting their quality of life too much. If the patient is too fragile, “light” treatments are used adapted to each person“, illustrates Dr. Pernelle Lavaud, medical oncologist at the Gustave-Roussy cancer center. “Lymphomas, leukaemias, localized tumors… children are cured today in the majority of casesbut you have to be able to live well afterwards. The current challenge is to opt for treatments that will leave the least possible sequelae, especially in adulthood. A child is a developing being: his organs and his immune system are immature. We therefore think in terms of sequelae, essentially for chemotherapy, which is very toxic, and radiotherapy, which has a high cardiac toxicity in young children.“says Dr. Véronique Minard, pediatric oncologist at Gustave Roussy.

Surgery is not an option for all cancers

How long does cancer treatment last?

This depends on several parameters, in particular the stage of disease, type of treatment and response to treatment. “For example in the metastatic phase, for targeted therapies, we continue as long as the treatment works. For immunotherapy, discontinuation of treatment will be proposed after two years. For the chemotherapy, more toxic, it usually lasts 4 to 6 months before a break. A lighter protocol can also be put in place“, notes Dr. Pernelle Lavaud. Treatment with radiation therapy will usually not last longer than 8 weeks, it could be shorter. She adds : “Chemotherapy is sometimes used before or after surgery to shrink the tumor or to ensure that no cancer cells can settle elsewhere. In this case, it usually does not last more than three to four months”.

When do we operate or not for cancer?

Solid cancerous tumors are operated on as soon as possible and available. “When the tumor is operable, it is removed during surgery. We can then decide whether or not to prescribe adjuvant treatment, such as chemotherapy“, specifies Dr. Pernelle Lavaud. Surgery is not an option for all cancerssuch as against lymphomas and blood cancers.

When is radiotherapy offered?

“Radiation therapy consists of locally deliver rays, or ionizing radiation, which cause major damage at the DNA level. Since cancer cells fail to repair these lesions as well as healthy cells, they can no longer multiply and/or die“, explains theCurie Institute on its website. Radiation therapy can be used for the following purposes:
► Curative : “It is used in this case at high doses, for example in a patient with breast cancer, or against lung cancer when the tumor is not operable. The goal is to cure the patient.“, specifies the oncologist.
► Workaround: “it is then a question of relieve the patient in the case of bone metastases For example. In this case, the symptoms of the disease are taken care of“, she adds.

When is chemotherapy offered?

Chemotherapy is a systemic treatment, administered intravenously or orally. These are chemical substances, drugs that pass through the blood, and which aim to eliminate cancer cells, regardless of their location in the body. “It can be administered before surgery or radiotherapy to reduce the size of the tumour, or after to ensure that no tumor cells remain in the body. It also affects metastases (multiplications of cancer cells away from the primary site of the tumor, editor’s note). Chemotherapy uses toxic products that kill tumor cells but also “good” cellshence the known side effects of chemotherapy such as hair loss, digestive disorders, etc.)“, specifies Dr. Lavaud.

When is targeted therapy offered?

It is now possible to make a molecular profiling of tumor cells. Their DNA and RNA are studied in search of mutations or other abnormalities that could be taken as therapeutic targets. “For some of these mutations, targeted therapies are available (intravenously or in tablets) which recognize the mutated cancer cells and specifically target them.“, explains the specialist. To date, there is no no targeted therapy available for all tumor mutations. The possibility of this type of therapy will therefore depend on the mutation. “It’s a revolution, especially in the treatment of fibrosarcoma, a cancer that affects the muscles, in young children. In 90% of cases, a response to targeted therapy is obtained“, adds Véronique Minard.

When to consider hormone therapy?

Hormone therapy is also one of the systemic treatments. It is used against hormone-dependent cancers, tumors that feed on hormones to grow. These cancers mainly concern breast cancer in women and prostate cancer in men. The treatment blocks the hormone to stop feeding the cancer and prevent it from growing.

When to consider immunotherapy?

This time, it is not a question of directly attacking the tumor cells but of boost the patient’s immune system so that it is able to target the tumour. “Tumor cells put the immune system to sleep, which fails to recognize them. The goal of immunotherapy is to wake it up so that it’s lymphocytes that kill cancer cellsas it would for a bacterium for example“, illustrates Pernelle Lavaud. “In the child, whose immune system is still very immature, the figures concerning the success of treatments based on immunotherapy are poor. They work in only 5% cases“adds Véronique Minard.

Can natural treatments accompany the patient?

“What matters most to us is that there is no no drug interaction with the patient’s treatment, in terms of toxicity and efficacy. For example, we know that antioxidants sold in pharmacies can protect the good cells but also the bad ones, which is therefore counterproductive, especially since there may be interactions with our treatments. If the patient wants it, we ask for all the components and we see with our pharmacist if he can take this natural treatment.“, says Pernelle Lavaud. However, some natural products can relieve symptoms. of the patient. “THE cannabis-derived drugs can for example reduce nausea in some patients, infusions or others can also act on this or that symptom. There is no strict prohibition but all this must be well known and supervised by the healthcare team“, continues our expert.

“Metastatic cancer usually does not operate : the goal of treatment will no longer be to cure but to delay the progression of the disease as long as possible. The patient will have to keep treatment all his life. One cannot therefore have recourse to overly aggressive treatments which will quickly exhaust it and no longer allow it to withstand other treatments thereafter. He will be prescribed less aggressive treatments to slow the disease and maintain the best possible quality of life“, notes the clinician. The healthcare team will then use a systemic treatment to treat the whole body and destroy the cells that have detached from the tumor, circulate in the blood and cause metastases.

What treatments in case of cancer relapse?

There resuming a treatment already tried or introducing a new treatment can be offered. “If the period without recurrence has been long then the same treatment can sometimes be used because it had worked for a certain time. If, conversely, we had good results only for a short time, there is usually no point in trying the same treatment again, we suspect that the treatment will not work. We therefore choose on a case-by-case basis, depending on the initial sensitivity to the treatments. and according to the different molecules available“, answers Dr. Pernelle Lavaud.

The earlier the cancer is diagnosed, the more likely the patient is to be cured.

What treatments or drugs in the terminal phase?

“We decide to stop the treatments based on two criteria: is there a potentially effective treatment that we have not yet tried? And if so, will the patient be able to tolerate this treatment? If you answer no to one or other of these questions, the proposed treatments will only be for symptomatic purposes.“. It will then be a question of to relieve the patient, to maintain as much as possible his quality of life and his comfort through the management of pain, respiratory symptoms, psychological symptoms…

How effective are cancer treatments?

The earlier the cancer is diagnosed, when it is still localized, the more likely the patient is to recover. It will also depend on the chemosensitivity of the cancer: “Some tumors are very sensitive to chemotherapy, such as blood cancers or testicular cancers, others much less, such as pancreatic cancers, for example“. It is not never possible to predict with certainty who will or will not respond favorably to the treatments, or for how long.

Thanks to Dr. Pernelle Lavaud and Véronique Minard, oncologists, for their expertise.