Advanced Cancer Treatment

The last decades have seen the face of advanced cancer treatment change. With the advancements in immunotherapy, targeted therapy, radiation modalities, and supportive care, patients have more treatment choices than ever before. Although advanced cancer is still a challenging disease to cure, new approaches bring hope, reassurance, and even, on some occasions, long-term control. It is imperative that the patient, along with his or her family, read about advanced cancer and review all the treatment options. 

What is Advanced Cancer?

The phrase “advanced cancer” is most commonly applied to use to explain cancer that has formed and spread from where it initially started to other areas of the body, increased considerably in size, or returned after treatment. It is most commonly stage 4 cancer. The cancer is typically harder to cure or even treat, but not incurable.

Advanced cancer can also be classified as

• Locally advanced: Growth of a tumor has extended to the tissues surrounding it or lymph nodes, but not distant organs.
  
• Metastatic cancer: Cancer cells have invaded organs that are far away from the site of the original tumor.
  
• Recurrent cancer: Cancer has recurred after an interval in remission.

Advanced cancer is typically diagnosed in patients following routine treatment or when cancer is well established at the time of diagnosis.

Goals of Treatment for Advanced Cancer

All individuals with late-stage cancer will be given an individualized treatment strategy based on the exact type and phase of cancer, overall health, and personal preference. The main treatment goals can be

• Halting or slowing cancer growth: Halting or slowing tumor development to prolong life.
• Relieving symptoms: Minimizing pain, tiredness, and other side effects to enhance quality of life.
• Making it more comfortable: Making the patient more comfortable with fewer side effects.
• Extending lifespan: Others will do very well on treatment and live for a few years.
• Meeting emotional and psychological needs: Offering advice and care to fulfill emotional needs.

Among the most important things in finding the correct treatment regimen is knowing a patient’s values and goals. Some would desire aggressive treatment to extend survival, but others would desire to maximize comfort and enjoy time with loved ones.

Standard Treatment Modalities Adopted at Advanced Stages of Cancer

1. Chemotherapy

Chemotherapy employs highly effective drugs that kill or prevent the development of cancer cells. Chemotherapy can be taken orally, by injection, or intravenously. Chemotherapy can be given in advanced cancer.

• As initial treatment
  
• To reduce tumors before surgery or radiotherapy
  
• To manage tumor symptoms

Nausea, weakness, and hair loss may be side effects, but improved tolerance has resulted from advances in anti-nausea medication and other supportive care.

2. Radiation Therapy

Radiation employs high-energy beams to kill cancer cells or shrink tumors. Sophisticated methods like intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) enable the treatment of tumors with sparing of nearby normal tissues.

Radiation is most often employed to:

• Relieve pain caused by the tumor’s compression of nerves or organs
  
• Shrink tumors in sites that are difficult to reach
  
• Cure isolated sites of metastasis

3. Surgery

It is not always feasible to have surgery with advanced-stage cancer, particularly if the cancer has disseminated. In some other instances, however, surgery can be done to

• Remove irritating or painful tumors.
  
• Alleviate symptoms of bleeding or obstruction.
  
• Enhance quality of life in the context of palliative therapy.

Surgical candidacy is taken seriously, particularly regarding recovery time and what benefit can be derived.

4. Immunotherapy

Immunotherapy enables the immune system within the body to recognize and kill cancer cells. Immunotherapy is most effective for some advanced cancers, including melanoma, lung cancer, and bladder cancer. Some examples of immunotherapy are

• Checkpoint inhibitors
  
• Cytokines
  
• Cancer vaccines
  
• Adoptive T-cell transfer (e.g., CAR-T therapy)

A few of the patients on immunotherapy in India, at the behest of experts such as Dr. Vikesh, have entered remission for years, a promising sign in the management of cancer that is advanced cancer. Side effects in the form of inflammation and fatigue can happen and must be watched out for.

Clinical Trials: Testing Experimental Options

Clinical trials are used to test new drugs, combinations, or methods not been commonly done but are new nonetheless. Patients with advanced cancer may be eligible if they’ve already received standard treatment methods or have certain genetic markers.

Participating in clinical trials also has the following advantages:

• Having access to the newest treatments before anyone else
  
• Having close study staff monitoring
  
• Having the ability to be part of bringing advances in cancer treatment to others
  

Not all patients qualify for trials. Talk to your oncologist about open studies or search ClinicalTrials.gov for studies listed during the last week.

Supportive (Palliative) Care: Maximizing Comfort and Quality of Life

Palliative care, inaccurately named, does not take place at the end of life. It is an interdisciplinary approach to symptom and side effect control of cancer and its treatment aimed at maximizing comfort at any point.

Supportive care can include:

• Control of pain
  
• Nutritional counseling
  
• Emotional and psychological support
  
• Physical rehabilitation and physical therapy

• Spiritual and social support

Early incorporation of palliative care has been demonstrated to enhance patient outcomes and quality of life even in those patients that are continued on active treatment.

Making Decisions: Questions to Ask Your Oncologist

Cancer treatment is complicated. Asking the right questions guarantees your decisions are clear and expectations are set. Consider asking your oncologist the following:

• What are the anticipated outcomes from this treatment?
  
• What are the most common and most harmful side effects?
  
• Are there other therapies that will provide a better quality of life?
  
• How will my way of living be influenced?
  
• Can I have a clinical trial?
  
• What will be the result if I discontinue treatment?

Knowledge empowers patients to make the optimal decision in their own best interest.

Taking a Break from Treatment

Sometimes, patients choose to stop treatment temporarily. This may be because of physical or emotional exhaustion, as well as because of other personal priorities. Your care team can help weigh the risks and benefits of stopping treatment temporarily and how to manage symptoms during this time.

It should be remembered that choosing to stop treatment is not a failure. It can be a part of a larger quality-of-life-focused treatment plan.

Finding Specialized Cancer Treatment Centers

Not all hospitals treat cancer, and specialized cancer centers offer multidisciplinary care, innovative therapy, and clinical trials. Such centers usually have:

• Dedicated tumor boards
  
• Special diagnostic facilities (e.g., genetic testing)
  
• Experience with unusual or aggressive cancers
  
• Supportive services are concentrated in one place.

A second opinion at an NCI-designated comprehensive cancer center can bring in new concepts and offer new treatment options.

Final Thoughts: Living with Advanced Cancer

A diagnosis of advanced cancer is uncertain but also an opportunity for reflective, tailored care. With new chemotherapy and immunotherapy, targeted therapy, and palliative care, patients now have more options than ever before to cure them for as long as possible.

Open discussion with your care team, understanding your needs, and being informed about changing treatment are all important. Each patient needs to have a choice to make well-informed decisions based on good information, compassion, and support.

There is no one “right” way to live with late-stage cancer. What is most meaningful is to follow the course that is most meaningful to you and provides the best possible quality of life.

Need More Information or a Second Opinion? If you are being treated for cancer and need professional advice, you can approach Dr. Vikesh Shah or cancer treatment facilities that specialize in treating your condition. They provide the best treatments, access to clinical trials, and empathetic treatment that gives you the best possible care in the process. Contact or visit for more information!