Chart — Oncology

Cancer Treatment Modalities

All six major cancer treatment modalities compared — purpose, examples, advantages, limitations, and nursing considerations. Most patients receive multiple modalities in combination or sequence.

Educational use only. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

Modality	Purpose	Advantages	Limitations	Nursing Considerations
⚕Surgery Mastectomy, colectomy, nephrectomy, SLNB, Whipple procedure, oophorectomy	Curative removal of localized tumor; staging; debulking; palliative symptom relief	+Fastest removal of visible tumor burden +Provides definitive histological staging +Potentially curative for localized disease +No systemic toxicity	−Cannot treat microscopic or systemic disease −Risk of surgical complications, anesthesia −Not possible for all tumor locations −Lymphedema risk if lymph nodes removed	✦Pre-op: teaching, bowel prep, consent verification ✦Post-op: standard surgical nursing — airway, circulation, wound, pain, DVT prevention ✦Lymphedema education if lymph nodes dissected ✦Body image support (ostomy, mastectomy, amputation)
💊Chemotherapy Doxorubicin, cisplatin, cyclophosphamide, vincristine, 5-FU, paclitaxel, methotrexate	Cytotoxic — kills rapidly dividing cancer cells; curative, neoadjuvant, adjuvant, or palliative intent	+Systemic — treats metastatic disease +Can achieve cure in some hematologic malignancies +Multiple administration routes (IV, oral, intrathecal) +Can be combined for synergistic effect	−Non-selective — also damages normal fast-dividing cells −Bone marrow suppression (neutropenia, anemia, thrombocytopenia) −GI toxicity, alopecia, mucositis, neuropathy −Drug-specific organ toxicities (cardio, nephro, neuro) −Drug resistance can develop	✦Monitor blood counts — nadir timing 7–14 days ✦Hazardous drug safe handling — PPE required ✦Antiemetic premedication, mucositis care ✦Febrile neutropenia protocol readiness ✦Extravasation prevention and management
☢Radiation Therapy External beam (EBRT, IMRT, SBRT), brachytherapy (seed implants, tandem and ovoids), I-131	Uses ionizing radiation to damage cancer cell DNA and prevent replication; curative, adjuvant, or palliative	+Non-invasive (external beam) — no surgery required +Can treat tumors inaccessible by surgery +Excellent local control rates +Palliates bone pain, brain mets, SCC, SVCS	−Local treatment — does not treat systemic disease −Site-specific side effects: mucositis, dermatitis, esophagitis, cystitis, diarrhea −Delayed effects: fibrosis, secondary malignancy (rare) −Cumulative dose limits to organs at risk (OAR)	✦External beam: no radiation precautions needed ✦Brachytherapy: time/distance/shielding; dosimeter use ✦Skin care: gentle washing, avoid heat/cold/sun ✦Do NOT remove radiation field skin markings ✦Fatigue management — most universal side effect
🛡Immunotherapy Checkpoint inhibitors (pembrolizumab, nivolumab, ipilimumab), CAR-T, rituximab, trastuzumab (mAbs), IL-2, sipuleucel-T	Harnesses the patient's immune system to recognize and destroy cancer cells	+Durable long-term responses (checkpoint inhibitors) +Potential for cure in some metastatic cancers (melanoma, lung) +CAR-T: high response rates in refractory hematologic malignancies +Monoclonal antibodies: highly targeted, low off-target toxicity	−Immune-related adverse events (irAEs) — autoimmune inflammation in any organ −Not all patients respond — biomarker testing required (PD-L1, MSI) −CAR-T: cytokine release syndrome (CRS), neurotoxicity (ICANS) −High cost; access barriers −irAEs can occur months after last dose	✦Monitor for irAEs: colitis, pneumonitis, hepatitis, endocrinopathies, dermatitis ✦Teach patient to report ANY new symptom — irAEs can occur any time ✦CAR-T: ICU-level monitoring for CRS (fever, hypotension, tachycardia) ✦Steroid management for irAEs — hold immunotherapy ✦Assess thyroid function, LFTs, pulmonary function regularly
🎯Targeted Therapy Imatinib (BCR-ABL), trastuzumab (HER2), erlotinib (EGFR), vemurafenib (BRAF), palbociclib (CDK4/6), olaparib (PARP)	Targets specific molecular pathways, proteins, or gene mutations driving cancer growth	+High selectivity — attacks specific cancer driver mutation +Often more tolerable than traditional chemotherapy +Oral formulations available (many TKIs) — convenience +Can be effective when chemotherapy has failed	−Only works if tumor has the specific target — requires biomarker testing −Resistance frequently develops over time −Drug interactions common (oral agents + P450 metabolism) −Cardiotoxicity (trastuzumab, anti-VEGF), hepatotoxicity, skin rash (EGFR-TKIs)	✦Confirm biomarker/mutation test result before administration ✦Medication adherence education — oral agents require consistent daily dosing ✦Trastuzumab: baseline ECHO, monitor LVEF each cycle ✦EGFR inhibitor rash: moisturize, avoid sun, avoid standard acne treatments ✦Drug-drug interaction screening — many oral TKIs have significant interactions
⚡Hormonal Therapy Tamoxifen, anastrozole/letrozole/exemestane (AIs), leuprolide (LHRH agonist), bicalutamide/enzalutamide, fulvestrant	Blocks or reduces hormones that drive hormone-sensitive cancer growth (estrogen, testosterone)	+Highly effective for hormone receptor-positive tumors +Oral administration — convenient +Long-term use proven to reduce recurrence rates +Can be used for years post-surgery as maintenance	−Only effective for hormone receptor-positive tumors (ER+, PR+, AR+) −Tamoxifen: increased endometrial cancer risk + DVT/PE risk −Aromatase inhibitors: arthralgias, osteoporosis, fracture risk −ADT (prostate): metabolic syndrome, osteoporosis, sexual dysfunction, depression −Resistance develops — alternative hormonal agents used sequentially	✦Tamoxifen: report vaginal bleeding, leg pain, dyspnea (DVT/PE, endometrial cancer) ✦Aromatase inhibitors: DEXA scan baseline, calcium/vitamin D supplementation ✦ADT: monitor bone density, metabolic labs, cardiovascular risk, mood ✦Adherence education — years of daily therapy required for benefit ✦Psychosocial support: libido, sexual function, body image concerns

NCLEX Quick Reference — Treatment Selection Clues

Localized solid tumor, good surgical candidate

→ Surgery (often first-line curative)

Post-surgery — reduce microscopic residual disease

→ Adjuvant chemotherapy or radiation

Tumor too large for resection — shrink first

→ Neoadjuvant chemotherapy (or radiation)

Metastatic hormone receptor-positive breast cancer

→ Hormonal therapy + CDK4/6 inhibitor (targeted)

Patient with new back pain + lymphoma diagnosis

→ Radiation ± chemotherapy (potential SCC — emergency eval)

HER2-positive breast cancer

→ Chemotherapy + trastuzumab (monitor ECHO)

CML with BCR-ABL mutation

→ Targeted therapy (imatinib — TKI)

External beam radiation — precautions needed?

→ No — patient is NOT radioactive

Combined Modality Sequencing

Neoadjuvant

Before surgery — shrink tumor

Adjuvant

After surgery — eradicate residual

Concurrent

Chemo + radiation simultaneously — synergy

Maintenance

Ongoing after remission to delay relapse

Related Resources

Common Cancer Treatments ReferenceDetailed reference for each treatment modality with NCLEX notes

Open →

Chemotherapy Nursing Considerations GuideCell cycle, drug classes, toxicities, safe handling

Open →

Radiation Therapy Nursing Care GuideExternal beam vs brachytherapy, skin care, radiation safety

Open →

Chemotherapy Side Effects ChartFull chemo toxicity reference: cause × monitoring × nursing interventions

Open →

Source: ONS (Oncology Nursing Society) Core Curriculum; NCCN Clinical Practice Guidelines; ACS Cancer Treatment Information.

Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with ONS Core Curriculum; NCCN Clinical Practice Guidelines; ACS Cancer Treatment Information. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →