Quite often, patients come to see me with a strong idea of the treatment they want, perhaps surgery, or immunotherapy, or a particular drug they've read about. Before we can talk about why that might not be the best option for them, we usually need to take a step back and talk about how cancer actually behaves.
I explain it to patients using an analogy that has nothing to do with medicine at all: lawn care.
Imagine a lovely lawn with one weed growing in it. You wouldn't reach for a watering can full of weed killer. You'd just walk over and pull it out by the roots. Now imagine the same lawn, but the weeds are scattered everywhere. Pulling each one out individually would take forever, so instead you treat the whole lawn.
Cancer treatment follows the same logic. If cancer is confined to one part of the body, we can often go in and remove it directly, with surgery or radiotherapy. When I say radiotherapy, I mean all its forms: stereotactic radiotherapy (SABR), proton beam therapy and IMRT. These are precise, targeted treatments for a localised problem.
If cancer has spread to multiple places in the body, a local treatment won't be enough. That's when we need a drug treatment, something that gets into the bloodstream and reaches cancer cells wherever they are.
There's a third scenario too, and it's one I find genuinely exciting. Say someone has been on a systemic drug treatment, the cancer has responded well, and then a little further down the line, one or two new spots appear on a scan while everything else stays quiet. Rather than reaching straight for the next line of chemotherapy, in the right circumstances we can treat those specific areas with stereotactic radiotherapy and keep someone on a treatment that's already working for everything else.
Increasingly, it isn't a case of choosing one of these approaches over another. If we're serious about turning cancers like stage four lung cancer into something people live with long-term rather than die from, it usually takes a combination of drug treatment, radiotherapy and surgery to get there. That's where working as a genuine multidisciplinary team matters: having the right specialists involved together, so each patient gets whichever combination of treatments gives them the best chance of reaching no evidence of disease on their scans.
I made a short video explaining the lawn analogy in a bit more detail, which you can watch here:
My mission
I'm a consultant clinical oncologist on a mission to get as many people with lung cancer as possible to the point of having no evidence of disease on their scans, while still living their life to the full. Understanding why your treatment plan looks the way it does is, I think, a genuinely important part of that.
If this is useful, feel free to forward it to anyone who might be trying to make sense of a diagnosis, their own or a family member's.
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