Step 1: Understand That No Single Treatment Fits All Cancers

Before comparing treatments, it’s essential to understand that cancer is not one disease — it’s
over 100 different diseases. The ‘best’ treatment depends on:
● Type of cancer (lung, breast, blood, colon, brain, etc.)
● Stage of cancer (early Stage I–II vs advanced Stage III–IV)
● Your genetic mutations (EGFR, HER2, PD-L1 expression, BRCA, etc.)
● Your age, overall health, and other existing medical conditions
● Previous treatments you’ve already received
● Your personal goals — cure vs. quality of life vs. life extension

Option A: Surgery — Remove the Cancer at Its Source

Surgery remains the most direct way to treat solid tumours. The goal is to physically remove
the cancerous tissue — either the tumour alone, the tumour plus a margin of healthy tissue, or
the entire affected organ. Modern cancer surgery in India includes:
● Robotic Surgery (da Vinci, Versius): Minimally invasive, highly precise — available at Apollo,
Fortis, Manipal
● Laparoscopic Surgery: Keyhole surgery for colon, liver, stomach cancers
● Open Surgery: Still the standard for large or complex tumours
● Cytoreductive Surgery + HIPEC: For abdominal/peritoneal cancers

When is Surgery the Best Choice?

Option B: Chemotherapy — The Traditional Backbone

Chemotherapy uses powerful drugs to kill fast-dividing cells — including cancer cells. While it’s
one of the oldest cancer treatments, it remains critically important in many cancer types and is
often combined with surgery or radiation. Chemotherapy can be given intravenously (IV drip)
or orally (tablets). In India, chemotherapy is widely available across all major cities and even
district hospitals under government schemes.

Pros of Chemotherapy:

● Works throughout the body — ideal for blood cancers and widespread disease
● Very affordable in India — from Rs. 10,000 per cycle for generics
● Well-studied with decades of data on effectiveness
● Can be used before surgery (neoadjuvant) to shrink tumours

Cons of Chemotherapy:

● Attacks healthy cells too — causes hair loss, nausea, fatigue, low immunity
● Not all cancers respond well to chemo
● Can cause long-term organ damage (kidneys, heart, nerves)

Option C: Immunotherapy — Harnessing the Power of Your Immune
System

Immunotherapy is arguably the biggest revolution in cancer treatment in the last decade. It
doesn’t directly kill cancer — instead, it removes the ‘brakes’ that cancer puts on your immune
system, allowing your body’s own T-cells to recognise and destroy the tumour. The main types
available in India include:

• Checkpoint Inhibitors:
  Pembrolizumab, Nivolumab, Atezolizumab — block PD-1/PD-L1/CTLA-4 pathways. Used in
  lung, melanoma, bladder, kidney, head & neck cancers.
• CAR-T Cell Therapy:
  Patient’s T-cells are genetically modified to attack cancer. Approved for blood cancers.
  NexCAR19 made in India — much more affordable.
• Cancer Vaccines:
  Therapeutic vaccines to stimulate immune response against specific cancer antigens. Still
  mostly in trials in India.
• Monoclonal Antibodies:
  Trastuzumab (Herceptin) for HER2+ breast cancer, Bevacizumab for colorectal/lung — widely
  available in India.

Option D: Targeted Therapy — Precision Treatment for Specific
Mutations

Targeted therapy is arguably the most personalised form of cancer treatment. After genomic
testing identifies specific mutations in your cancer, your oncologist prescribes drugs designed
to block exactly those mutations. It’s like giving a cancer cell a ‘laser-guided missile’ instead of
a bomb. Some examples of targeted therapies available in India:

Option E: Proton Therapy — When Precision Radiation Matters Most

Conventional radiation therapy uses X-rays that enter the body and deliver radiation both
before and after reaching the tumour. Proton therapy is far more precise — protons stop
almost exactly at the tumour (the ‘Bragg Peak’), delivering minimal radiation to surrounding
tissue. This is especially critical when the tumour is near vital structures like the brain, spinal
cord, eyes, or heart.

Proton Therapy is especially recommended for:
● Paediatric (childhood) cancers — reduces risk of growth problems and secondary cancers
● Brain tumours, skull-base tumours, meningioma
● Head and neck cancers near eyes, optic nerves, salivary glands
● Prostate cancer with low rectal dose desired
● Lung and liver tumours requiring high-dose re-irradiation

Your 5-Step Decision Guide: How to Choose the Right Treatment

Step 1: Get a Proper Diagnosis
Ensure you have a confirmed cancer diagnosis with pathology report, staging scans (PET-CT,
MRI), and ideally an NGS/molecular test of your tumour tissue. You cannot make an informed
decision without knowing your cancer’s molecular profile.

Step 2: Get a Second Opinion
Cancer treatment decisions are complex and sometimes irreversible. Always seek a second
opinion from a senior oncologist at a tertiary cancer centre like Tata Memorial, AIIMS, Apollo
Cancer Institute, or Rajiv Gandhi Cancer Institute.

Step 3: Discuss Goals of Treatment
Be honest with your oncologist about what matters most to you — Is it cure? Extending life?
Maintaining quality of life? Minimising side effects? This shapes which treatment combination
is recommended

.
Step 4: Ask About Clinical Trials
India has hundreds of active clinical trials for cancer. Trials often give you access to the latest
therapies — sometimes free of cost. Ask your oncologist or check the CTRI (Clinical Trials
Registry India) website.

Step 5: Consider a Multidisciplinary Team (MDT) Approach
The best cancer centres use a tumour board — a team of surgeons, medical oncologists,
radiation oncologists, pathologists, and radiologists — who collectively review your case and
recommend the best treatment plan.

Questions to Ask Your Oncologist Before Starting Treatment

● What is the goal of this treatment — cure, control, or palliative care?
● What are the response rates for this treatment in my specific cancer type and stage?
● What side effects should I expect, and how will they be managed?
● Are there any clinical trials I am eligible for?
● Is genomic testing available for my tumour to guide treatment?
● Will I need surgery + chemo + radiation, or can one treatment suffice?
● What is the estimated total cost, and is any government scheme applicable (Ayushman
Bharat, CGHS, etc.)?
● How long will the treatment take, and will I be able to work during it?

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