Is surgery right for you?
Surgery is typically an option for patients with stage 1 or stage 2 cancers, and rarely stage 3.Surgeries have a higher level of risk of infections to your body than non-invasive methods to eliminate tumors. That brings us back to getting more than one opinion then you make the choice.
Sometimes surgical removal in the earlier stages may be the best option. I would be very cautious on any surgery for stages 3 and 4. Once the cancer has advanced to stages 3 or 4 it means that your cancer has spread outside the original site and can potentially to grow anywhere in your body. Surgery in multiple locations drives up the risk and does not solve the overall problem. There are other techniques at these stages that are less risky.
Updated! (7-13-2022) Now the above info is for the majority of tumor based cancers. There are some cases such as gynecologic cancers (uterus) where surgery is the first line of treatment. My point here is that there is no universal answer that covers all types of cancers. Each person is unique, along with their specific cancer and stage. Do your best to get the best treatment possible for your specific case.
A while back I helped a patient whose husband was going to have surgery on his brain to remove a tumor that metastasized there. I told her about a technique which could zap that tumor without surgery called Cyberknife (more on this topic later under “Radiation in cancer care”). I suggested they ask their doctor about that procedure. She did, and he had never even heard of it before. I did help her find a location close to them that offered this procedure. They did go and it ultimately prevented her husband from having brain surgery.
In my case, I currently have 1 tumor in my left lung, 3 tumors in my chest, 5 tumors on my spine, and 8 tumors in my brain. I have never had to undergo one invasive surgery for any of them. These tumors are all still present, but either dead or dormant. I was treated with targeted oral medications, targeted chemo and targeted radiation … with no surgeries.
Chemotherapy options
Chemotherapy should by no means be the “standard” or “go to” procedure for everyone who has cancer. Chemo does kill cancer cells, but it also kills a lot of good healthy cells.
Chemo chemicals are very harmful to your body. It can lower or compromise your immune system, making you much more susceptible to other infections or diseases. However, if there are no other options, this may be the only treatment available to you.
(New 2-1-2023) From MD Anderson: 10 things to avoid while receiving chemotherapy
Targeted chemo is a much better option. These are specific chemotherapy drugs that are targeted to hit cancer cells more than normal cells. Some are also specifically aimed at attacking cells specific to your type of cancer or DNA mutations.
Closing note on chemo: Most all chemotherapy will make you ill to some level. Typically, the first couple rounds are the worst. You could have serious side effects, or very minimal ones. Each person is different. There are numerous types of newer nausea medications available to you, if needed. You know your body best, so you and your oncologist can make this decision better than anyone else.
Targeted Therapies
Without a doubt, targeted therapies are some of the best treatments for cancer patients! Typically, they are the easiest to receive and one of the most successful treatment options to fight your specific cancer. Of course, you need the details related to your tissue and liquid biopsy results (precision medicine tests) to insure you have the targeted information you need. In my case, I originally took an oral pill Tarceva (designed for the EGFR mutation) for approximately 8 years. I am now on a newer medication called Tagrisso (which is designed for EGFR and T790 mutations). I believe this targeted approach saved my life. Use every option available for your specific illness.
Dana-Farber explaining Precision Medicine and Immunotherapy for Cancer: What to Know.
National Cancer Institute (NIH) explaining Targeted Cancer Therapies and treatment options available today that are approved by the FDA.
MD Anderson article describing Targeted Therapy which supports this fantastic direction for cancer patients.
Radiation in cancer care
Radiation oncology is another very important topic. Technology has changed drastically and in the right direction regarding your treatment options here. The latest radiation techniques have been greatly improved. It’s disappointing to hear, but today some doctors get in a rut on radiation oncology and choose the option of the older “standard techniques” or whatever they have locally in their institution.
Today there are many, many options available. With help, try to choose the best option for you. Learn about the top 2 or 3 for your specific case and then make your decision. I cannot express strongly enough the differences and importance of the various treatment options that are available.
Do not always accept “standard” radiation treatment. As I mentioned earlier, when I ask patients to question their doctor about these new techniques, some are unaware of the new technology or know very little about it.
Updated! (11-19-2021) One of the most advanced technologies in radiation therapy today falls into the category of Image Guided Radiation Therapy (IGRT) From the site: IGRT is the use of imaging during radiation therapy to improve the precision and accuracy of treatment delivery. Image Guided means the high intensity beam stays on target even as you breath. My analogy here is think of how a jet fighter locks on to a target no matter how it moves. This is what IGRT does. Two examples of these devices are Cyberknife (listed below) and the new Image Guided Proton Beam. There are some Proton Beam devices that are not image guided. Again, check for what would be best in your particular case.
Below are a few video links that have previously been recorded for local ABC and CBS channels discussing the advanced and effectiveness of the CyberKnife option.
Videos ABC 1 (Dr. Kresl video), ABC 2 (Dr. Kresl & Joe video), CBS (Dr. Kresl & Joe video)
Other radiation techniques to investigate with your doctor are TrueBeam STx , other SBRT options, and Proton Therapy to name a few. The point here is there are many options. Ask your doctor(s) which is best for you, not what they have on hand at their institution.
Immunotherapy: The next wave
Updated (2-23-2022) Immunotherapy — or I/O — is one of the most improved and promising research areas in the fight against cancer. This method uses your body’s own immune system to kill the cancer cells. There are FDA approved immunotherapy drugs today for many cancers, including melanoma and lung cancer. More info from NIH (National Institute of Health)
New (7-5-2022) MSK Study Identifies Biomarker That May Help Predict Benefits of Immunotherapy This article is very important to know if your doctor suggest Immunotherapy in your case. Immunotherapy is great, but make sure though science (above link) that it will help you. If you are not a good candidate, Immunotherapy will not work for you. Check the science with your doctor.
Additional Types of Therapies in use today
There are other techniques like CAR T- cell technologies that were recently approved by the FDA. I believe this is one of the most promising area to watch for us all. For a moment, imagine not having to deal with major chemo. Then imagine the same for radiation therapy. We can get there!
This is another reason to Give It Your All and be there when these promising technologies will be ready. Just recently I watched a show called First in Human on the Discovery channel. This program documents the real life stories that are currently taking place in building #10 of the National Institutes of Health, where the first in-human studies are being conducted with these amazing immunotherapy techniques. More to come here!
There’s more information at these websites:
Dana-Farber – What Types of Cancers Can Be Treated With Immunotherapy? CAR T-Cell Therapy Helps Runner Zoom Past Follicular Lymphoma
Memorial Sloan Kettering (MSK) – Immunotherapy
MD Anderson – Immunotherapy Platform
Columbia University Medical Center – CAR-T therapy
Dana Farber – Cell Therapy
Dana Farber – What are Radiopharmaceuticals and How Are They Used in Cancer?
First Targeted Cancer Drug Approved Based on Mutation Rather than Tumor Type: This is Big Step Forward for Precision Medicine! Please click on the link above for a more detailed explanation from Memorial Sloan Kettering. In the past, you could only get a drug approved for your specific tumor type, i.e. breast, lung, pancreatic, etc. With this new approach based on mutation type, it would not matter where the cancer is in your body. This particular approval is for cancers caused by a mutation called TRK fusion. This could be a life saver. Going forward more approvals using this technique based on mutation type will save many more lives of cancer patients. To know what mutation you may have, you must run the simple liquid biopsy and/or the tissue biopsy test described in the tab above “Precision Medicine” .
Hormonal drugs: Taken from National Institutes of Health website: “Hormones can encourage the growth of some cancers, such as breast and prostate. But, in some cases, they can kill, slow or stop cancer cells from growing. Hormone therapy usually involves taking medications that prevent cancer cells from getting the hormones they need to grow.”
New! (6-16-2022) Cancer Vaccines: Taken from the Dana-Farber Cancer Institute website: What are Cancer Vaccines?
FDA’s (Food and Drug Administration) Project Facilitate Will Assist Requested Access to Unapproved Cancer Therapies. From site – The two-pronged program is called Project Facilitate, run by the FDA Oncology Center of Excellence, and Expanded Access Navigator, which is operated by the Reagan-Udall Foundation for the FDA. I believe this is a great step forward where patients could have access to life saving drugs even if not yet approved for their specific cancer. “The (FDA) Expanded Access (compassionate use) program permits patient access to investigational products outside clinical trials,” the researchers wrote.
Note – Most of these techniques above are not only limited to the institution on the link. Check with your cancer hospital also to see what is offered there. You can also use these techniques to discuss with your oncologist to see which is best for you.
Treatment options will continue to get better. I will try to add significant new options on this site. But also look for your specific/personalized info (cancer type and DNA mutation type) and continue to research new developments pertaining to your case.
Clinical Trials 
Another available option is a clinical trial. When and if needed, you should discuss this option with your oncologist. Typically this happens when existing treatment methods are not working, or your case is very unique, or you are looking for additional options with the latest technology. This is best described in the following two links:
Description of Clinical Trials: A good overview from American Cancer Fund.
NIH database of Clinical Trials: A service from the National Institutes of Health.
Closing comment on all treatment options:
Get all the information you can, but I strongly suggest getting another viewpoint/opinion from another institution. If they match, great. But in some cases they do not. This can be a life and death decision if you choose the wrong treatment plan. There is nothing wrong with validating the first doctor’s opinion on treatment options. Be strong, and be informed! It could save your life.