Cancer develops by a sequence of genetic alterations/mutations. These genetic changes are different in tumors from different organs. Even in the tumors affecting the same organ, the genetic changes leading to cancer in different individuals are often different, leading to differences in the rate of growth, the pattern of spread (metastasis), and drug/treatment sensitivity. Your Medical Oncologist is trained to understand these differences in the biology of your cancer.

Your Medical Oncologist is trained to assess your tumor using the latest imaging and diagnostic tests. He/she will also make whatever assessments are necessary for determining if your heart, lung, kidney or liver function(s) are appropriate for certain forms of therapy. Using this information about your specific tumor and organ function in conjunction with his/her knowledge of cancer biology, the proper treatment “modality” will be selected: chemotherapy, radiotherapy, surgery, immunotherapy, monoclonal antibody therapy, or anti-anglogenesis agents. Your Medical Oncologist will organize the team of your other physicians or personnel needed to treat disease.

Most treatments (>90) are delivered to on an outpatient basis in the office. Advances in the treatment have made the side effects of treatment much more manageable. There is no longer a reason to fear treatment because of the uncontrolled nausea or other similar problems.

In general, cancer therapy can be divided into local therapies (those that only treat a certain area of the body, for example: surgery or radiation) and systemic therapies (those that can go widely through the body, killing cancer cells that may have spread from the original tumor, for example: chemotherapy). “Adjuvant” chemotherapy improves survival and reduces the chance of disease recurrence after local therapy in a number of cancers, especially breast and colon cancer.

Chemotherapy may also be applied before local therapy (for example, “pre-op” or “neoadjuvant” therapy). It can shrink or “downstage” a tumor significantly, often allowing for a reduction in the extent of surgery required. This is an underutilized technique, particularly in breast cancer. Successful pre-operative chemotherapy can in many circumstances allow for breast conservation therapy, which might otherwise not be possible if surgery is used primarily. In fact, European studies have conclusively shown that 2/3 or more breast tumor cases can be managed with breast conservation after preoperative chemotherapy.

Cancer treatment is always with “curative” intent, if that is possible. Treatment is more likely to achieve that goal if the tumor is sensitive to the drug therapy selected and if a maximal dose of that drug is given over the shortest possible time period. Careful monitoring of the disease response during treatment is always performed.

When “cure” is not possible, our main objective is a good symptom control and optimizing quality of life. Chemotherapy and radiation may control disease and extend life significantly, even under those circumstances. When the disease is not controlled or when treatment side effects are not tolerated, we work in conjunction with several hospice agencies to keep our patients comfortable at home.

Visit the National Cancer Institute website for more in depth knowledge of What You Need to Know About Cancer. This site also provides details on many different types of cancer types.