Treatment options include surgery for removal of the tumor, radiation therapy, chemotherapy, hormone therapy, a combination of therapy including genetic and pharmacological interventions, or adjuvant therapies. Other therapies, such as chemo- and radiation-injected hormone therapy, are in development. Most effective chemotherapy regimens are based on the combination of two or more cancer-suppressing agents in combination with specific DNA sequence or chromosomal rearrangements for each agent, or specific targets of interest, such as nucleic acid sequence deletions in tumor-initiating cells or in the cytoskeleton of tumor cells. For some cancers, chemo- or radiotherapy-based therapy may be the only option. The choice is usually made by a multidisciplinary committee, comprised of doctors, physicians-in-training, and radiation oncologists. In some rare cases, alternative, noninterventional treatment options may be available, such as surgery, but only in specialized locations such as lung or kidney cancer.
Genetic therapy for metastatic melanoma, for which more recent information is available, is the use of genetic and biochemical technologies to direct and/or re-program the course of tumor cells in ways that are not detectable by the patient (for example in vitro). This technology will be used to modify the genetic code of the patient's cancer cells to make it less likely that they will grow into new metastases and to create "clumping" in the tumor tissue that prevents it from spreading. If genetic therapy is recommended, it will be by the use of either direct genetic modification (in which the patient's own DNA is copied) or in vitro genetic modification. Direct genetic modification involves the construction of genetically modified cells that have been removed from the person and implanted by means of biopsies. These cells are genetically altered to respond differently to the disease. In some cases, the cells are inserted in a specific location where the disease is more likely to manifest. In other cases, they are inserted in the brain, which may result in the patient perceiving a benefit without actually experiencing a benefit. Direct genetic manipulation is also commonly known as gene therapy, recombinant protein therapy, or synthetic mutation therapy.
Chemo- and radiation-induced treatment may be used in limited situations. Radiation therapy is most effective in treating high-grade disease in a large proportion of the patient population; therefore, radiation therapy is often the only treatment that patients receive in their lifetime. Chemotherapy, in general, is usually only used in patients who are advanced or at serious risk for complications. In fact, radiation therapy accounts for 20% to 30% of all radiation treatments in the United States and for nearly all other health care providers in many other countries.
In many cases, genetic genetic counseling is often recommended in the beginning of treatment and will continue to be recommended over the course of treatment in many populations (for example, in combination with an examination of the patient's genealogy).