In our final section on Cancer, we will address Part (4) Treatment and Part (5) Outcomes.
4. Cancer Treatment
There are multiple different types of doctor specialists involved in cancer treatment. Sometimes one specialists directs all the care. Sometimes multiple specialists treat the same type of cancer, so which specialist is used depends on access, availability and patient preference. Other times, various treatments are orchestrated by various specialists on the same patient. It depends on the (1) type of cancer and (2) the stage of the cancer.
First, regarding the type of cancer, let’s go back to the list of cancers from the first blog post and then list the corresponding treating specialist or specialist (the ‘type’ of treatment will be listed in parenthesis—Cancer treatment may require Chemotherapy, Surgery and/or Radiation Therapy):
Skin Cancer—Dermatologist (removal) and occasionally Mohs Surgeon (removal) or Surgical Oncologist (removal).
Lung Cancer—Medical Oncologist (chemo), Cardiothoracic Surgeon (surgery), Radiation Oncologist (radiation therapy)
Breast Cancer—Medical Oncologist (chemo), General Surgeon or Surgical Oncologist (surgery), Radiation Oncologist (radiation therapy)
Prostate Cancer—Urologist (surgery), Radiation Oncologist (radiation therapy)
Colon Cancer—Medical Oncologist (chemo), General Surgeon, Surgical Oncologist or Colorectal Surgeon (surgery), Radiation Oncologist (radiation therapy)
Leukemia—Medical Oncologist (chemo)
Lymphoma—Medical Oncologist (chemo)
Throat Cancer—ENT (surgery), Radiation Oncologist (radiation therapy)
Esophageal Cancer—Medical Oncologist (chemo), General Surgeon, Surgical Oncologist or Cardiothoracic Surgeon (surgery)
Uterine Cancer—Gynecologic Oncologist or Surgical Oncologist (surgery and chemo—or possibly Medical Oncologist for chemo)
Ovarian Cancer—Gynecologic Oncologist or Surgical Oncologist (surgery and chemo—or possibly Medical Oncologist for chemo)
Cervical Cancer—Gynecologic Oncologist or Surgical Oncologist (surgery and chemo—or possibly Medical Oncologist for chemo)
Pancreatic Cancer—Medical Oncologist (chemo), General Surgeon or Surgical Oncologist (surgery), Radiation Oncologist (radiation therapy)
Liver Cancer—Medical Oncologist (chemo), General Surgeon, Surgical Oncologist, Hepatobiliary Surgeon (surgery), Transplant Surgeon (transplant, yes you can sometimes treat liver cancer with a liver transplant)
Stomach Cancer—Medical Oncologist (chemo), General Surgeon or Surgical Oncologist (surgery)
Brain Cancer—Medical Oncologist (chemo), Neurosurgeon (surgery), Radiation Oncologist (radiation therapy)
Bone Cancer—Medical Oncologist (chemo), Orthopedic Surgeon (surgery)
‘Soft Tissue’ Cancer/Sarcoma–Medical Oncologist (chemo), Surgical Oncologist (surgery)
Kidney Cancer—Medical Oncologist (chemo), Urologist (surgery)
Bladder Cancer—Medical Oncologist (chemo), Urologist (surgery)
Confused? Navigating cancer care can be very complicated, which is why coordinating treatment, side-effects of the treatment and complications of the cancer is suboptimal—sometimes it’s just downright bad. One solution to this coordination problem is to have cancer care at a Comprehensive Cancer Center. At these centers, not only is there more multidisciplinary coordination of care, but there is also potentially readier access to clinical trials and experimental treatments for very complex cancer cases.
The National Cancer Institute has designated 68 medical centers in 35 states as Comprehensive Cancer Centers. Click HERE for a link to the Office of Cancer Centers page for a detailed listing. Per the National Cancer Institute’s Website:
“The NCI-Designated Cancer Centers are recognized for their scientific leadership, resources, and the depth and breadth of their research in basic, clinical, and/or population science. Comprehensive Cancer Centers demonstrate an added depth and breadth of research, as well as substantial transdisciplinary research that bridges these scientific areas. Basic Laboratory Cancer Centers conduct only laboratory research and do not provide patient treatment. There are 20 Cancer Centers, 41 Comprehensive Cancer Centers, and 7 Basic Laboratory Cancer Centers.
The final medical point on treatment is that the goal is to ‘kill’ or remove the cancerous cells. Chemotherapy and Radiation Therapy kill cancer cells and Surgery removes cancer cells.
The major side effect of Chemotherapy is that in addition to killing the cancer cells, it also often kills good cells too—cells that typically reproduce within the body: cells related to hair growth and the digestive system tend to be the most affected. This is why some people will lose their hair during chemo and often have nausea, vomiting, diarrhea and weight loss.
Radiation Therapy also kills cells that are next to the cancer cells that are being ‘zapped’ by the radiation. People can then experience side effects from losing those healthy cells—for example radiation therapy for prostate cancer can result in incontinence and impotence.
Surgery can have a whole host of side effects related to the risk of the procedure (e.g. post-operative infection, bleeding, etc) or related to the removal of the tumor and surrounding tissue (e.g. the need for possible breast reconstructive surgery or chronic diarrhea from removal of a segment of the colon in colon cancer).
There are some cancers that are much more ‘treatable’ than others. Breast Cancer is often highly treatable. Certain types of Leukemia and Lymphoma are often highly treatable. Other cancer are very difficult to treat. Pancreatic cancer has historically been very hard to treat. Certain brain cancers have historically been very hard to treat.
The Stage at which the cancer is identified also impacts how ‘treatable’ it is. Stage 1 cancer is usually much more treatable than Stage 4 cancer (with varying degrees for Stage 2 and 3 in between)
The ‘Performance Status’ of the patient affects how well they will be able to handle the chemo, surgery and radiation. An otherwise healthy person has the best functional status and will likely have a better outcome than someone who is unable to walk or care for themselves—either because of the cancer or because of other underlying medical conditions (e.g. diabetes, cardiovascular disease, etc.). There is an actual numerical scale: 0 = Asymptomatic and Fully Active; 4 = Bedbound and Completely Disabled with 1, 2 and 3 in between.
Once the cancer is initially no longer detectable, it is said to be in Remission. That does not mean that all the cancer is ‘gone’ necessarily. There could still be microscopic amounts of cancer left that are just undetectable, which is why ongoing surveillance and scanning may be necessary to determine if there is Recurrence. Depending on the cancer, after a certain amount of time in Remission, the cancer is then said to be ‘Cured.’ That distinction is based on recurrences in other patients in the past. In some cancers, recurrence could happen after 5, 10 even 15 years of remission. In other cancers, Hodgkin’s Lymphoma for example, after some people have been treated and are in remission, then the cancer has Never Returned for the rest of their lives.
This is certainly not all there is to be said about cancer, but I hope this Mini Med School section has been helpful for you. Cancer is a very scary and emotional experience for all those involved and I hope these last 3 blog posts have given you more context.
Often confusion itself can take its toll, so I wanted to alleviate at least a little confusion if possible.
To learn how Compass helps 2,000+ employer clients and their employees sort through the administrative, insurance confusion and billing confusion of cancer care, visit compassphs.com