Today there are many forms of treatment available to the physician who is planning a medical regimen for the patient with cancer. However, in spite of the many advances in treatment, e.g., chemotherapy, hormone therapy, which can be used to slow down the disease, the only known methods of curing cancer are surgery and radiation.

Surgery

Surgery for cancer must be more extensive than surgery performed for other reasons. The surgeon must insure the removal of the entire cancerous area, and must also provide for the inclusion of a margin of disease-free tissues along with the growth which is removed. Very often there are lymph nodes to which the disease has spread, and these, too, must be removed. Extreme caution must be observed to avoid cutting into diseased tissue and causing spread of the cancer.

The actual extent of any operation for cancer is dependent upon the growth potential of the cancer involved, its size at the time of operation, and how it tends to metastasize throughout the body. The extent of surgery can vary from a simple excision of a skin cancer to complete removal of a diseased organ together with adjacent structures. A pelvic exenteration (see glossary) is an example of the latter. Unless the surgery is adequate the patient's disease will spread and the treatment will seldom result in a cure.

Radiation

The use of radiation to treat cancer has been well known for many years. Radium and X-ray, the forms which are used most often with intent to cure the patient, have been available since the turn of the century. In recent years supervoltage apparatus and the advent of cobalt and similar radioisotopes for use in teletherapy units have added to the armamentarium. Certain tumors respond well to treatment with X-ray; others do not. Some tumors may be treated by either surgery or radiation. The decision as to which method of therapy should be utilized for a particular patient is one which can be made only by the physician who knows all of the circumstances surrounding the patient's illness.

The problem in radiation therapy is to deliver a lethal dose to the tumor and to minimize the damage to the surrounding tissue. This takes a great deal of skill and scientific knowledge. Radiation therapy is a planned course of treatment which entails preparation just as important and complete as that required for a surgical procedure.

The treatment schedule is guided by many factors-the age and condition of the patient; the size, location, depth, and extent of the tumor; the type, quantity, and quality of radiation; the rate at which it is administered; and the response of the tumor. It can therefore be anticipated that treatment schedules will vary. Therapy is sometimes interrupted depending upon the overall response of the patient as evaluated by the radiologist.