Many management options for cancer exist with the primary ones including surgery, chemotherapy, radiation therapy, and palliative care. Which treatments are used depends upon the type, location and grade of the cancer as well as the person's health and wishes.
Patients at all stages of cancer treatment need some kind of palliative care to comfort them. In some cases, medical specialty professional organizations recommend that patients and physicians respond to cancer only with palliative care and not with cancer-directed therapy.[133] Those cases have the following characteristics:[134]
Multiple national medical guidelines recommend early palliative care for people whose cancer has produced distressing symptoms (pain, shortness of breath, fatigue, nausea) or who need help coping with their illness. In people who have metastatic disease when first diagnosed, oncologists should consider a palliative care consult immediately. Additionally, an oncologist should consider a palliative care consult in any patient they feel has a prognosis of less than 12 months even if continuing aggressive treatment.[135][136][137]
Those who survive cancer are at increased risk of developing a second primary cancer at about twice the rate of those never diagnosed with cancer.[143] The increased risk is believed to be primarily due to the same risk factors that produced the first cancer, partly due to the treatment for the first cancer, and potentially related to better compliance with screening.[143]
Predicting either short-term or long-term survival is difficult and depends on many factors. The most important factors are the particular kind of cancer and the patient's age and overall health. People who are frail with many other health problems have lower survival rates than otherwise healthy people. A centenarian is unlikely to survive for five years even if the treatment is successful. People who report a higher quality of life tend to survive longer.[144] People with lower quality of life may be affected by major depressive disorder and other complications from cancer treatment and/or disease progression that both impairs their quality of life and reduces their quantity of life. Additionally, patients with worse prognoses may be depressed or report a lower quality of life directly because they correctly perceive that their condition is likely to be fatal.
Death rate from malignant cancer per 100,000 inhabitants in 2004.[145]
In 2008 approximately 12.7 million cancers were diagnosed (excluding non-melanoma skin cancers and other non-invasive cancers)[6] and in 2010 nearly 7.98 million people died.[146] Cancers as a group account for approximately 13% of all deaths each year with the most common being: lung cancer (1.4 million deaths), stomach cancer (740,000 deaths), liver cancer (700,000 deaths), colorectal cancer (610,000 deaths), and breast cancer (460,000 deaths).[147] This makes invasive cancer the leading cause of death in the developed world and the second leading cause of death in the developing world.[6] Over half of cases occur in the developing world.[6]
Deaths from cancer were 5.8 million in 1990[146] and rates have been increasing primarily due to an aging population and lifestyle changes in the developing world.[6] The most significant risk factor for developing cancer is old age.[148] Although it is possible for cancer to strike at any age, most people who are diagnosed with invasive cancer are over the age of 65.[148] According to cancer researcher Robert A. Weinberg, "If we lived long enough, sooner or later we all would get cancer."[149] Some of the association between aging and cancer is attributed to immunosenescence,[150] errors accumulated in DNA over a lifetime,[151] and age-related changes in the endocrine system.[152]
Some slow-growing cancers are particularly common. Autopsy studies in Europe and Asia have shown that up to 36% of people have undiagnosed and apparently harmless thyroid cancer at the time of their deaths, and that 80% of men develop prostate cancer by age 80.[153][154] As these cancers did not cause the person's death, identifying them would have represented overdiagnosis rather than useful medical care.
The three most common childhood cancers are leukemia (34%), brain tumors (23%), and lymphomas (12%).[155] Rates of childhood cancer have increased by 0.6% per year between 1975 to 2002 in the United States[156] and by 1.1% per year between 1978 and 1997 in Europe
Palliative care
Palliative care refers to treatment which attempts to make the patient feel better and may or may not be combined with an attempt to attack the cancer. Palliative care includes action to reduce the physical, emotional, spiritual, and psycho-social distress experienced by people with cancer. Unlike treatment that is aimed at directly killing cancer cells, the primary goal of palliative care is to improve the patient's quality of life.Patients at all stages of cancer treatment need some kind of palliative care to comfort them. In some cases, medical specialty professional organizations recommend that patients and physicians respond to cancer only with palliative care and not with cancer-directed therapy.[133] Those cases have the following characteristics:[134]
- patient has low performance status, corresponding with limited ability to care for oneself[133]
- patient received no benefit from prior evidence-based treatments[133]
- patient is ineligible to participate in any appropriate clinical trial[133]
- the physician sees no strong evidence that treatment would be effective[133]
Multiple national medical guidelines recommend early palliative care for people whose cancer has produced distressing symptoms (pain, shortness of breath, fatigue, nausea) or who need help coping with their illness. In people who have metastatic disease when first diagnosed, oncologists should consider a palliative care consult immediately. Additionally, an oncologist should consider a palliative care consult in any patient they feel has a prognosis of less than 12 months even if continuing aggressive treatment.[135][136][137]
Surgery
Surgery is the primary method of treatment of most isolated solid cancers and may play a role in palliation and prolongation of survival. It is typically an important part of making the definitive diagnosis and staging the tumor as biopsies are usually required. In localized cancer surgery typically attempts to remove the entire mass along with, in certain cases, the lymph nodes in the area. For some types of cancer this is all that is needed to eliminate the cancer.[138]Chemotherapy
Chemotherapy in addition to surgery has proven useful in a number of different cancer types including: breast cancer, colorectal cancer, pancreatic cancer, osteogenic sarcoma, testicular cancer, ovarian cancer, and certain lung cancers.[138] The effectiveness of chemotherapy is often limited by toxicity to other tissues in the body.Radiation
Radiation therapy involves the use of ionizing radiation in an attempt to either cure or improve the symptoms of cancer. It is used in about half of all cases and the radiation can be from either internal sources in the form of brachytherapy or external sources. Radiation is typically used in addition to surgery and or chemotherapy but for certain types of cancer such as early head and neck cancer may be used alone. For painful bone metastasis it has been found to be effective in about 70% of people.[139]Alternative treatments
Complementary and alternative cancer treatments are a diverse group of health care systems, practices, and products that are not part of conventional medicine.[140] "Complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine.[141] Most complementary and alternative medicines for cancer have not been rigorously studied or tested. Some alternative treatments have been investigated and shown to be ineffective but still continue to be marketed and promoted.[142]Prognosis
See also: List of cancer mortality rates and Cancer survivor
Cancer has a reputation as a deadly disease. Taken as a whole, about
half of people receiving treatment for invasive cancer (excluding carcinoma in situ and non-melanoma skin cancers) die from cancer or its treatment.[6] Survival is worse in the developing world.[6]
However, the survival rates vary dramatically by type of cancer, with
the range running from basically all people surviving to almost no one
surviving.Those who survive cancer are at increased risk of developing a second primary cancer at about twice the rate of those never diagnosed with cancer.[143] The increased risk is believed to be primarily due to the same risk factors that produced the first cancer, partly due to the treatment for the first cancer, and potentially related to better compliance with screening.[143]
Predicting either short-term or long-term survival is difficult and depends on many factors. The most important factors are the particular kind of cancer and the patient's age and overall health. People who are frail with many other health problems have lower survival rates than otherwise healthy people. A centenarian is unlikely to survive for five years even if the treatment is successful. People who report a higher quality of life tend to survive longer.[144] People with lower quality of life may be affected by major depressive disorder and other complications from cancer treatment and/or disease progression that both impairs their quality of life and reduces their quantity of life. Additionally, patients with worse prognoses may be depressed or report a lower quality of life directly because they correctly perceive that their condition is likely to be fatal.
Epidemiology
|
no data
≤ 55
55–80
80–105
105–130
130–155
155–180
|
180–205
205–230
230–255
255–280
280–305
≥ 305
|
Deaths from cancer were 5.8 million in 1990[146] and rates have been increasing primarily due to an aging population and lifestyle changes in the developing world.[6] The most significant risk factor for developing cancer is old age.[148] Although it is possible for cancer to strike at any age, most people who are diagnosed with invasive cancer are over the age of 65.[148] According to cancer researcher Robert A. Weinberg, "If we lived long enough, sooner or later we all would get cancer."[149] Some of the association between aging and cancer is attributed to immunosenescence,[150] errors accumulated in DNA over a lifetime,[151] and age-related changes in the endocrine system.[152]
Some slow-growing cancers are particularly common. Autopsy studies in Europe and Asia have shown that up to 36% of people have undiagnosed and apparently harmless thyroid cancer at the time of their deaths, and that 80% of men develop prostate cancer by age 80.[153][154] As these cancers did not cause the person's death, identifying them would have represented overdiagnosis rather than useful medical care.
The three most common childhood cancers are leukemia (34%), brain tumors (23%), and lymphomas (12%).[155] Rates of childhood cancer have increased by 0.6% per year between 1975 to 2002 in the United States[156] and by 1.1% per year between 1978 and 1997 in Europe
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