Systemic Treatment: The Whole Body

The goal of systemic therapy is to get rid of any cancer cells that may have spread to another part of the body. It's an "insurance policy" that may be used even if there is no direct proof that cancer has spread. If the cancer HAS spread and formed tumors elsewhere, systemic treatment can help shrink the cancer and, it is hoped, lead to remission.

Systemic treatment decisions are made based on "personality features" of the cancer. The "meaner" the cancer's personality, the higher the risk of cancer spread, and the greater the need for systemic treatment. The milder the personality, the lower the risk of spread, and the smaller the need for systemic management.

There are four main types of systemic therapy:

1. Hormonal (anti-estrogen) therapies are medicines usually given by pill or, less commonly, by injection under the skin. These medications either 1) reduce the amount of estrogen in your body, or 2) block estrogen's effects, in order to inhibit cancer cell growth throughout your body.
   
   
2. Chemotherapies are medicines given by pill or directly into the bloodstream (through a needle or port) that destroy cancer cells. Chemotherapy works by interfering with the cancer cells' ability to reproduce and function from day to day.
   
   
3. Immune therapy is a very new area of medicine that attempts to use or imitate the body's own system for fighting disease, to defeat the cancer. The name immune therapy comes from the immune system. The goal may be "active immunity"—to stimulate or trick the body's defenses into blocking or counteracting cancer cell activity. Vaccines fall into this category. Or the goal may be "passive immunity," which involves giving the body a fighting protein or "antibody" it lacks, so that the immune system can do its job against the cancer. The name "passive" is used because the body isn't required to do the fighting work.
   
   Currently, only one immune therapy, Herceptin, is widely available. It is given directly into the bloodstream (through a needle or port). Herceptin is only appropriate for women with advanced breast cancer who have a particular cancer gene, called HER2/neu, that is overactive or is being "overexpressed." Herceptin is an example of a "passive immunity" therapy. Special immune proteins (antibodies) in the medication find and stop the bad-acting proteins made by the HER2/neu cancer genes. Halting this protein action brings cancer cell growth under better control.
   
   With more research, vaccines that work with the immune system in different ways—for a wider range of women and cancer types—will become available.
   
   
4. Anti-angiogenesis therapies halt the growth of new blood vessels that bring nutrients to the cancer cells—in other words, you "starve" the tumor of things it needs to grow and survive. Currently, these treatments are available only in clinical trials, on a very limited basis.