The treatment plan for cancer in the elderly depends mainly on the type of cancer the person has and the stage of the disease. Doctors also consider the patient's age and general health when formulating a treatment plan. Often, the goal of treatment is to cure the cancer, but in other cases, the goal is to control the disease or to minimize symptoms for as long as possible. Caregivers can work closely with their loved ones' doctor to ensure they are getting the proper treatment.
Cancer treatment plans may change over time. Most plans include surgery, radiation therapy, or chemotherapy. Some involve hormone therapy or biological therapy. In addition, stem cell transplantation may be used so that a patient can receive very high doses of chemotherapy or radiation therapy. Some cancers respond best to a single type of treatment, while others may respond best to a combination of different approaches. Treatments may be focused on a specific area (local therapy) or throughout the body (systemic therapy).
- Local therapy removes or destroys cancer in just one part of the body. Surgery to remove a tumor and radiation to shrink or destroy a tumor are examples of local therapy.
- Systemic therapy sends drugs or substances through the bloodstream to destroy cancer cells all over the body. It kills or slows the growth of cancer cells that may have spread beyond the original tumor. Chemotherapy, hormone therapy, and biological therapy are usually systemic in nature.
Because cancer treatments often damage healthy cells and tissues in the process, side effects are common. Side effects depend mainly on the type and extent of the treatment. They may not be the same for each person, and they may change from one treatment session to the next. Before treatment begins, the health care team will explain possible side effects and suggest ways to help manage them. This team may include an oncologist, nurses, a dietitian, a physical therapist, and others.
Questions to Ask the Doctor
You may want to ask the doctor these questions before treatment begins:
- Has the cancer spread? If so, where? What is the stage of the disease?
- What is the goal of treatment? What are the treatment choices? Which do you recommend? Why?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment?
- How can side effects be managed?
- What can I, as a caregiver, do to prepare my loved one for treatment?
- How often will they receive treatments? How long will treatment last?
- What is the treatment likely to cost? Will my loved one's insurance cover the costs?
- What new treatments are under study? Would a clinical trial be appropriate for my loved one?
Types of Cancer Treatments
In most cases, the surgeon removes the tumor and some tissue around it. Removing nearby tissue may help prevent the cancerous tumor from growing back. The surgeon may also remove some nearby lymph nodes. Possible side effects depend mainly on the size and location of the tumor and the type of operation. It takes time to heal after surgery, and the time needed to recover is different for each type of surgery and varies from person to person. It is common to feel tired or weak for a while. Most people are uncomfortable for the first few days after surgery, however, medicine can help control the pain.
Before surgery, caregivers should discuss the plan for pain relief with the doctor or nurse. The doctor can adjust the plan if additional pain relief is needed. Some people worry that having surgery (or even a biopsy) for cancer will spread the disease, but this seldom happens. Surgeons use special methods and take many precautions to prevent cancer cells from spreading. For example, if they must remove tissue from more than one area, they use different tools for each one. This approach helps reduce the chance that cancer cells will spread to healthy tissue. Similarly, some people worry that exposing cancer to air during surgery will cause the disease to spread. This is not true. Air does not make cancer spread.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Doctors use several types of radiation therapy, and some people receive a combination of these treatments.
- External radiation: Radiation is applied by a large machine outside the body. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
- Internal radiation: Radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes that are put in or near the affected tissue. The patient usually stays in the hospital, and the implants generally remain in place for several days.
- Systemic radiation: The radiation comes from liquid or capsules containing radioactive material that travel throughout the body. The patient swallows the liquid or capsules or receives an injection. This type of radiation therapy can be used to treat cancer or control pain from cancer that has spread to the bone. Only a few types of cancer are currently treated in this way.
The side effects of radiation therapy depend mainly on the dose, the type of radiation received, and the part of the body that is treated. For example, radiation to the abdomen can cause nausea, vomiting, and diarrhea. Skin in the treated area may become red, dry, and tender. Hair loss may also occue in the treated area. Fatigue is very common during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Fortunately, most side effects go away in time. In the meantime, there are ways to reduce discomfort. If your loved one is experiencing a side effect that is especially severe, their doctor may suggest a break in their treatment.
Chemotherapy is the use of drugs that kill cancer cells. Most patients receive chemotherapy by mouth or through a vein. Either way, the drugs enter the bloodstream and can affect cancer cells all over the body. Chemotherapy is usually given in cycles. People receive treatment for one or more days and then have a recovery period of several days or weeks before the next treatment session. Most people receive their treatment in an outpatient part of the hospital, at their doctor's office, or at home. Some may need to stay in the hospital during chemotherapy. Side effects depend mainly on the specific drugs being used and the dosage. These drugs affect cancer cells and other cells that divide rapidly, including:
- Blood cells: When drugs damage healthy blood cells, patients are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
- Cells in hair roots: Chemotherapy can cause hair loss. The hair will grow back, but it may be somewhat different in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Although the side effects of chemotherapy can be distressing, most of them are temporary. The doctor can usually treat or control them.
Some cancers need hormones to grow. Hormone therapy prevents cancer cells from getting or using the hormones they need. It is considered systemic therapy and may use drugs or surgery as the method of delivery.
- Drugs: The doctor gives medicine that stops the production of certain hormones or prevents the hormones from working.
- Surgery: A surgeon removes organs (such as the ovaries or testicles) that procude hormones.
The side effects of hormone therapy depend on the type. They include weight gain, hot flashes, nausea, and changes in fertility. In women, hormone therapy may make menstrual periods stop or become irregular and may cause vaginal dryness. In men, hormone therapy may cause impotence, loss of sexual desire, and breast growth or tenderness.
Biological therapy is another type of systemic therapy that helps the immune system fight cancer. For example, certain patients with bladder cancer receive Bacillus Calmette-Guerin solution (BCG) after surgery. The doctor uses a catheter to put the solution, which contains live, weakened bacteria that stimulate the immune system to kill cancer cells, directly in the bladder. BCG can cause side effects, such as bladder irritation, nausea, low-grade fever, or chills.
Most other types of biological therapy are given through a vein. Some people get a rash at the injection site, and side effects include flu-like symptoms, such as fever, chills, headache, muscle aches, fatigue, weakness, and nausea. More serious side effects include changes in blood pressure and breathing problems. Biological therapy is usually given at the doctor's office, clinic, or hospital.
Stem Cell Transplants
Transplantation of blood-forming stem cells enables patients to receive higher doses of chemotherapy, radiation, or both. The high doses destroy both cancer cells as well as normal blood cells in the bone marrow. After the treatment, the patient receives healthy, blood-forming stem cells through a flexible tube placed in a large vein. New blood cells then develop from the transplanted stem cells. Stem cells may be taken from the patient before the high-dose treatment, or they may come from another person. Patients remain in the hospital for this type of treatment.
The side effects of high-dose therapy and stem cell transplantation include infection and bleeding. In addition, graft-versus-host disease (GVHD) may occur in people who receive stem cells from a donor. In GVHD, the donated stem cells attack the patient's tissues. Most often, GVHD affects the liver, skin, or digestive tract. GVHD can be severe or even fatal and can occur any time after the transplant, even years later. Drugs may help prevent, treat or control GVHD.
The National Cancer Institute supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.