Overview of Hereditary Cancer Treatment

Cancer Treatment

This section covers the following topics

planning for treatment	weighing your options
timing of treatment	second opinions
local and systemic treatments	information by treatment type

Your treatment plan

Oncologists use the following information to develop a patient's treatment plan:

• Cancer site or organ where the tumor originated (e.g., breast, colon, pancreas, etc.)
• Cancer subtype based on additional testing or microscopic examination of the tumor (e.g., triple-negative breast cancer, serous ovarian cancer, etc.)
• How fast the cancer is growing or how likely it is to spread.
• Cancer stage; tumor size, and presence of spread to other areas of the body.
• Whether the cancer is sensitive or resistant to certain treatments (e.g., platinum-sensitive ovarian cancer, castration-resistant prostate cancer, etc.)
• Results from genetic testing for inherited mutations and tumor biomarker testing. 
• Your overall health, including other diseases or conditions that may affect treatment or prognosis.
• Your preferences and choices regarding your care.

People diagnosed with advanced cancer often receive more than one course of treatment. Doctors may refer to a treatment regimen based on the number of previous treatment courses a patient has received:

• First-line or front-line therapy is the first treatment given for a disease such as cancer.
• Second-line treatments are used if the cancer doesn’t respond to first-line treatment or if the cancer returns.  
• If the cancer does not respond to second-line therapy or it comes back again, the next treatment regimen is called third-line, and if necessary, fourth-line, and so on.

Timing of surgery and treatment 

• Adjuvant treatment is given to patients after the tumor is removed and when there is no longer evidence of disease. It is used to destroy any hidden cancer cells that may still remain somewhere in the body after the cancer is removed.
• Neoadjuvant treatment is given to shrink a tumor before surgery. 
• Maintenance therapy is given after chemotherapy has been completed to reduce the chance of the cancer returning. The goal of maintenance therapy is to extend the length of time before a recurrence or to turn a temporary remission into a long-term cure.
• Treatment for advanced cancer is often ongoing. It focuses on shrinking tumors, preventing further spread, reducing symptoms and maintaining quality of life. 

Local and systemic therapies

Cancer treatment can be categorized based on where it works in the body.

Local therapy treats the tumor and the surrounding area. Examples include radiation therapy, creams used to treat skin cancer or chemotherapy injected directly into the abdomen to treat ovarian cancer.

Systemic therapy treats the entire body to halt further growth or spread of the cancer to distant organs. Examples include intravenous  chemotherapy, hormone therapy, targeted therapy and immunotherapy.

Weighing your treatment options

Some cancer diagnoses come with clear guidance, but you may have more than one treatment option. It's important that you understand your diagnosis, test results and treatment plan, so that you can take an active role in your medical decision making. Ask your doctor or nurse to explain any parts of your medical record that you do not understand.

Information that may be found in your medical record includes:

• type of cancer
• subtype and stage of cancer
• results from lab tests and body scans
• results from tumor biomarker testing
• results of genetic testing for an inherited mutation
• notes from office visits
• surgical reports
• treatment plan

It's helpful to have a copy of your medical records in case you decide to get a second opinion or enroll in a clinical trial at another facility. 

Getting a second opinion

At any time during your care, you may want a second opinion from another doctor or facility. Second opinions are a normal and expected part of cancer care. People often seek another opinion when their situation or treatment plan changes, including:

• at initial diagnosis
• after receiving a treatment plan
• after completing treatment
• when a cancer recurs or progresses
• to address a complication, symptom or treatment side effect

You may have concerns about a second opinion, including:

• it may delay care too long
• it may be expensive
• your current doctor may be disappointed

Many treatment decisions can wait until you get another opinion. Large comprehensive cancer centers routinely provide second opinions and can often hasten the process, especially for urgent situations. Having copies of your medical records and lab reports on hand can speed up the process. Many health plans will cover the cost of a second opinion, but deductibles, coinsurance and copays may apply. Most doctors will understand and support your decision to get a second opinion. A second opinion doesn't mean you need to change doctors. Sometimes a second opinion can provide piece of mind that your current health care team and treatment plan is the right one for you.