Therapeutic Strategies

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Once a diagnosis of cancer has been established, a plan for treatment is needed. A therapeutic strategy is best achieved by a multidisciplinary team of physicians that includes surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and — depending on the operations planned — plastic and reconstructive surgeons or physical rehabilitation specialists.

Therapeutic strategies must be tested in experimental trials using specific scientific methods and standards before they are proven effective. The largest risk in using unproven approaches is that they may cause a delay in treatment with a proven method.

Surgery, radiation, and chemotherapy alone or in combination are the most common methods used to treat cancer. The specific treatment will vary depending on the kind of cancer, the extent of the disease, its rate of progression, the condition of the patient, and the response to therapy.

Surgery is the oldest form of cancer therapy and was until recently the only method that could actually cure cancer. It is still the principal cure.

Although new advances in surgical techniques have allowed for the successful removal of many cancers, the development of other treatment strategies has reduced the extent of surgical intervention in treating some cancers. And in spite of new surgical techniques, the ability of surgery to control cancer is limited by the fact that, at the time of surgical intervention, two-thirds of cancer patients have tumours that have spread beyond the primary site.

In planning the definitive treatment of an individual with a solid tumour, the surgical oncologist confronts several challenges. One major concern to be addressed is whether the patient can be cured by local treatment alone and, if so, which type of operation will provide the best balance between cure and impact on the quality of life. With many tumours the magnitude of the resection is modified by adjuvant therapies. Therapy also has improved by combining surgery with other types of treatment. For example, survival rates of childhood rhabdomyosarcoma (a type of muscle tumour) were only 20 percent when radical surgery alone was used. However, when adjuvant radiation therapy and later chemotherapy were used in combination with surgery, cure rates rose to 80 percent.

Although surgery often is intended to be curative, it may sometimes be used to assuage pain or dysfunction. This type of surgery, called palliative surgery, can remove an intestinal obstruction or remove masses that are causing pain or disfigurement.

Certain conditions associated with a high incidence of cancer can be prevented by prophylactic surgery. One such condition is cryptorchidism, a developmental defect in which the testes do not descend into the scrotum (which creates a risk of developing testicular cancer). A surgical procedure called orchiopexy can correct this defect and thereby prevent malignant disease from occurring.

Diseases including multiple polyposis of the colon and longstanding severe ulcerative colitis are associated with a high risk for colon cancer, and they can be treated by partial or complete removal of the colon. Individuals with multiple endocrine neoplasia, who are at risk of developing medullary cancer of the thyroid, likewise can be treated by having the thyroid removed.