Understanding Cancer Treatment Options

Local and Systemic Therapies for Cancer Treatment

Chemo Day
Photo by Selina Boertlein c/o SBPhotography/Getty Images

If you've been diagnosed with cancer you're probably feeling not only frightened but overwhelmed. There are so many different types of treatment for cancer, and many of them have names that sound like a foreign language. It's helpful to start by simply breaking these treatments down into two types: local and systemic.

Local vs. Systemic Treatments for Cancer

All cancer treatments can be essentially broken down into two approaches.

For some cancers, one of these may be used, and for others, both will be needed.

Local Treatments: Local treatments are those that are designed to remove cancer cells where they originated. An example would be doing a lumpectomy to remove a lump in the breast. Surgery is a local treatment. It is helpful for removing a primary cancer, and perhaps lymph nodes, but would not work to treat cancer that has spread to the liver or elsewhere. Radiation therapy is also a form of local treatment.

Systemic Treatments: Systemic treatments are designed to treat cancer cells wherever they may be in the body. For example, if any breast cancer cells from the cancer mentioned above had traveled to another region of the body, systemic therapy would be needed to reach those cells. Systemic treatment may also treat a cancer locally in some cases, though surgery is a better option for removing an operable tumor quite often.

Types of systemic treatments include:

For cancers that are fairly small and haven't spread (either in ways that can be seen on imaging, or microscopic spread that cannot yet be seen) local therapies may be enough to clear a cancer. If a cancer has spread beyond its initial site, or if there is a possibility it has spread, systemic therapies will be needed to make sure all cancer cells—even microscopic cancer cells—have been removed.

Addressing Your Treatment Options

When initially diagnosed with cancer, it is most often a medical oncologist who will work with the other doctors in your cancer care team, and coordinate the treatments you will be having. There are a few important points to mention right away.

One is that medicine is changing. Patients and physicians now work side by side in formulating a treatment plan that is best for your particular type of cancer, the size and how far it has spread, and other important factors such as your age and general health. For many cancers, there are a variety of different treatment options, and choosing these will often depend on your preference and what side effects you are willing and/or able to tolerate

Taking time to get a second opinion can be very helpful, and most oncologists not only do not mind, but expect that patients will get a second opinion. Even if the opinion is the same as your first opinion, this can give you more reassurance down the line that you've chosen the right path.

Many people consider getting extra opinions at one of the larger National Cancer Institute-designated cancer centers. Centers like this are often more likely to have a surgeon or oncologist who specializes in your particular type of cancer.

Studies tell us that taking time to learn about your diagnosis is important not only in feeling in control, but in that it may even improve outcome. Check out these tips on how to find good cancer information online.

Methods of Treatment for Cancer

To understand how different methods of treating cancer work, some people find it helpful to understand how cancer cells are different from normal cells, as treatments often "target" some of those differences. We'll begin with the local treatments and then discuss systemic treatments.

Surgery as an Option for Cancer Treatment

Surgery can be used to prevent, treat, stage (determine how advanced the cancer is), and diagnose cancer. In relation to cancer treatment, surgery is often done to remove tumors or as much of the cancerous tissue as possible. 

Surgery is an "ideal" treatment for many cancers, especially those that are caught early, because it is often the best method of curing the disease. Some people find it confusing that surgery may not be done on very large tumors. If a tumor has spread, chemotherapy and other systemic therapies are often the best options for getting rid of cancer cells that surgery cannot reach.

Sometimes surgery is combined with chemotherapy or radiation therapy.  This is often done in one of two ways:

  • Neoadjuvant chemotherapy refers to chemotherapy that is given before surgery to try and reduce the size of a tumor and make surgery easier.
  • Adjuvant chemotherapy is often done after surgery, and is a way to get rid of cancer cells that may have spread beyond the site of surgery, but can't yet be detected on imaging studies we have.

There are a number of other ways in which surgery is combined with other treatments, but your surgeon will talk about these in reference to your specific cancer.

Radiation Therapy

Radiation therapy as noted above is also a local therapy. It works to get rid of cancer cells in the field at which it is directed. Radiation therapy uses certain types of energy to shrink tumors or eliminate cancer cells, by damaging a cancer cell's DNA so it is unable to multiply. Cancer cells are highly sensitive to radiation. Nearby healthy cells may be damaged as well, but are in general more resilient to the effects of radiation than are cancer cells.

Radiation may be given in a number of ways, but can basically be broken down into external radiation, which directs radiation to the tumor from outside the body, or internal radiation or brachytherapy, in which radioactive seeds are implanted in the body.

Significant progress has been made in radiation therapy so that healthy cells are not damaged nearly as much as in the past. Newer methods are finding ways to direct a greater amount of radiation to a tumor so that therapy can be accomplished in fewer visits.

As with chemotherapy, radiation can be given alone, or combined with surgery or chemotherapy. For some cancers, newer radiation techniques may be used instead of surgery, especially for those in whom surgery could be dangerous. Radiation may also be used as palliative therapy, that is, therapy to reduce the symptoms of cancer, but without the intent to cure cancer.


Chemotherapy is a type of cancer treatment that uses drugs to eliminate cancer cells. Unlike surgery, chemotherapy affects the entire body, not just a specific part. It works by targeting rapidly multiplying cells. Unfortunately, other types of cells in our bodies also multiply at high rates, like hair follicle cells, cells in our bone marrow, and the cells that line our stomachs. This is why chemo can cause side effects like hair loss and an upset stomach.

Chemotherapy is most commonly given by pill or intravenously (IV), but can be given in other ways. A single type of chemotherapy may be used, but combination chemotherapy is more often prescribed. This involves the use of more than one chemotherapy drug designed to interfere with cell division at different places in the cycle.

Thankfully the side effects of chemotherapy such as nausea are much more treatable than in the past, and many people have little nausea and vomiting.

Targeted Therapies

Targeted therapies are the term used for drugs that target specific characteristics of cancer.  Over the last decade, we've learned that every cancer is different, and has a different molecular profile.  By targeting some of the processes tumors use which allows them to thrive, these treatments are often able to treat a cancer without as many side effects as chemotherapy. Some of these targeted therapy drugs work to block signals which cause the tumor to grow, whereas others work by cutting off the blood supply to a tumor, causing it to basically starve to death. This area of medicine is advancing daily, with many new drugs recently approved, and even more being tested in clinical trials.

In order to determine who would best respond to these treatments, oncologists often do gene profiling (molecular profiling) on a tumor which has been biopsied.


Immunotherapy is an exciting new category of cancer treatment—one which you may have heard about recently on the news. There are several different mechanisms for these drugs, but most of them work simplistically by harnessing our own immune system so that our own bodies can fight off the cancer. These drugs don't work for everyone, but when they do they may result in long-term control of the cancer for some people, even for advanced cancers.

Clinical Trials

According to the National Cancer Institute, people with cancer should consider the option of clinical trials. Unfortunately, the myths about clinical trials often frighten people, and it's thought that only a small number of people who qualify for these trials are currently participating. It may be helpful to realize that every drug and procedure we now have to treat cancer was once studied in a clinical trial. Take a moment to learn about the purpose of clinical trials and how they may not only help you contribute to better cancer treatments, but may offer a superior option for you as well.

Integrative, Complementary, and Alternative Treatments

It's important to be cautious when hearing of "miracle cures" on the Internet.  Unfortunately, anyone can publish anything online. That said, when some complementary alternative treatments are used in an integrative way—along with conventional methods just discussed—they may help people cope with the symptoms of cancer more easily.  Take a moment to learn about some of the integrative cancer treatments such as meditation, massage, acupuncture, and more.

Working as a Team With Your Doctors and Choosing Treatment

Before you sit down with your doctor, check out these questions to ask your doctor about your cancer and add your own thoughts.  Most often cancer does not have to be treated immediately, and you will have time to carefully weigh your options and get a second (or third or fourth) opinion.  We can't stress enough how important it is to learn how to be your own advocate as a cancer patient.

Most importantly, hang on to hope.  Progress is being made with even the most difficult to treat cancers.  If it is your loved one who has been diagnosed, here are some ideas on how to support a loved one with cancer.


National Cancer Institute. Cancer Treatments. Updated 04/29/15. http://www.cancer.gov/about-cancer/treatment

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