Cancer - also known as a tumor in medicine - can be treated in very different ways. The type of cancer therapy depends primarily on the type and stage of the disease. For example, surgical procedures, chemotherapy, radiation or modern immunological treatment methods are used. In this overview, we have compiled a list of the cancer therapies available today and the oncology experts you can turn to as a patient.
In addition to the type, i.e. the genetic make-up of a tumor, the stage, its grading and the general condition of the patient also play a role in the choice of cancer therapy.
In addition to the most suitable cancer therapy, good side-effect management is particularly important for all therapeutic steps in oncology. This is because many of the methods used in cancer therapy - e.g. chemotherapy and radiotherapy - destroy cancer cells as well as some of the healthy cells. It is therefore not uncommon for these cancer therapies to cause side effects such as fatigue, anemia or nausea and even vomiting.
However, because cancer therapy can depend so much on cancer- and patient-related factors, more and more efforts are being made today to individualize cancer treatment. These different cancer treatment methods are used for this purpose:
In the case of breast cancer and various types of skin cancer in particular, it usually makes sense to remove the tumors surgically. However, the cancer must not be advanced and no metastases must have formed. In the case of a narrowly localized tumour, however, the chances of success of cancer surgery are often good. Where possible, keyhole surgery is performed, i.e. the surgeon only makes a small incision through which the tumor is operated on and removed. In the skin, this is often achieved in the form of a punch excision.
In the case of early-stage tumors, the cancer therapy may even be completed with the operation, so that no further follow-up treatment is necessary. In other cases, treatment is usually continued with chemotherapy or radiotherapy. After a period of around 5 years without recurrence of the cancer (relapse), patients are considered medically cured.
In other cases, it is not possible to cure cancer with surgical measures alone. For example, a tumor may be inoperable or the tumor has already spread to other organs or it is a blood cancer (leukemia). In these cases, cancer therapies are often used in which the growth of the cancer cells can be influenced with the help of radiation or chemotherapeutic drugs (e.g. docetaxel, cisplatin, etc.). However, radiation and chemotherapy not only affect the tumors, but also damage healthy body cells. These cancer therapies are often also used after tumor surgery to destroy residual tumor tissue or to prevent possible metastasis.
As both radiotherapy and chemotherapy cause cell damage, possible germ cell damage must be considered, especially in young cancer patients. It may then no longer be possible to have children naturally after the therapy. However, the healthcare system now offers the option of cryopreserving sperm and eggs for patients with potentially germ cell-damaging cancer therapies. Advice on this topic should of course be given before starting therapy.
As chemotherapy in particular is systemically effective and in principle affects all cells in the body, there are sometimes considerable side effects associated with this cancer therapy. Although radiotherapy has a more localized and limited effect, it can also cause more severe side effects.
In order to reduce the risk of side effects, so-called targeted cancer therapies have been investigated and further developed in recent years. These intervene directly in cancer cell metabolism, signaling or their growth and blood supply with the help of drugs or inhibitors. Important signaling pathways for cell growth or cell division are blocked in this way and the cancer cells are killed. Blocking certain hormonal signaling pathways - such as in breast cancer or prostate cancer - is also a targeted cancer therapy in the broader sense.
Immuno-oncology is a relatively new form of cancer therapy. The aim is to enable the body's own immune system to recognize the cancer cells and fight them (again).
Cancer cells have often found ways to hide from the immune system and become practically "invisible". For example, they form receptors on the cell surface that tell an immune cell that everything is OK and switch it off. If such a receptor is blocked from the outside with the help of an antibody, the immune cell remains active after binding to the cancer cell and kills it. In medical terms, this mechanism of action in cancer therapy is known as checkpoint inhibition. Well-known antibodies include nivolumab, pembrolizumab and atezolizumab. Some of these are already being used very successfully for melanoma, lung cancer and urological tumors.
Immuno-oncological cancer therapies also include various cell-based procedures, such as CAR-T cells, which are effective in selected leukemias. These are usually the body's own T cells, which are obtained and whose receptor set is genetically modified outside the body in order to specifically attack cancer cells after being returned to the blood.
The trend in cancer therapies today is very much in the direction of individualized treatment with therapy approaches that have fewer side effects. The "one-fits-all" principle is increasingly being abandoned. Molecular tumour characterization and genetic analyses enable new personalized treatments.
Tumor surgery and radiotherapy and/or chemotherapy remain important for cancer therapy. However, targeted therapies and immuno-oncology offer further alternatives, often with fewer side effects.
At the same time, the medical spectrum within the tumor centers is expanding. In addition to radiology, surgery and oncology, human genetics, molecular biology, pathology, immunology, nutritional medicine and psycho-oncology are also involved. In many cases, cancer treatments are already being carried out in oncology practices in private practice, which work closely with the local hospitals.
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