Why not all cancers need aggressive treatment anymore

For decades, cancer treatment has followed a familiar, frightening script. After diagnosis, a blanket aggressive treatment followed: surgery, chemotherapy, and radiation, all of which often began with the idea that faster and harder action saves lives. Today, that thinking is quietly changing. Medical science now shows that not all cancers behave the same way, and not all of them need the most intense forms of treatment.

Cancer as a ‘family’

Cancer is no longer seen as a single disease. It is understood as a broad family of conditions, each with its own personality. Some cancers grow fast and spread early. Others move slowly, sometimes so slowly that they never cause harm during a person’s lifetime. When treatment considers all cancers as equally dangerous, it can sometimes cause more damage than good.

Many cancers are now detected earlier than ever before. Screening tests and imaging tools pick up very small tumours that might not have been found in the past. Early detection can indeed be life-saving in numerous instances, yet it also has the potential to uncover cancers that might otherwise have remained dormant for longer periods.

Active surveillance

The idea of active surveillance takes root in cases where physicians can carefully observe the cancer, instead of prescribing aggressive treatments. Regular scans, blood tests, and check-ups are used to monitor any changes in the disease. If the cancer remains stable, treatment is deferred. If it begins to grow or cause problems, treatment then begins.

While there is no data for the number of such cases in India yet, studies point to active surveillance being increasingly considered for low grade, localised prostate cancers, some chronic blood cancers such as CLL (Chronic Lymphocytic Leukemia ), low grade neuroendocrine treatment (NET) and low grade Non Hodgkins lymphoma (B cell NHL).

Treatment advances

Advances in biology play a major role in this shift. Scientists now understand more about how cancer cells behave at the genetic level. Tests, such as next generation sequencing, can identify these different tumour subtypes amongst the same organ . This information also helps doctors avoid overtreating their patients and aggressively focus on more precise care.

The accuracy of treatments has also undergone considerable enhancements. In the past, therapies often impacted healthy cells alongside cancerous ones. Recent advancements in precision oncology, however, target particular pathways or markers within cancer cells. This precision allows certain cancers to respond favourably to less aggressive treatments, or to medications that manage the disease rather than eradicating it entirely.

Prioritising quality of life

Quality of life now carries more weight in treatment decisions. Aggressive cancer therapy can leave lasting effects. Patients may experience long-term effects such as fatigue, neuropathy, cardiovascular complications, fertility challenges, and cognitive impairments, even after cancer remission. When a cancer poses little immediate threat, exposing a patient to these risks may not be warranted. The goal shifts from just survival to living well.

Age and overall health also matter more than before. Sometimes, older people with slow-growing cancers might not even have many symptoms. In such cases, strong treatments can actually lead to making them less independent or can even worsen other health problems they already have. Often, a more laidback approach allows them to keep up their daily routines and feel good for longer.

People’s perception of cancer is evolving too. The word ‘cancer’ once automatically signalled a life-threatening crisis. Now, some cancers are better understood as low risk conditions that need careful watching rather than immediate action. This does not mean the disease is ignored. It means care is tailored, measured, and responsive.

This change does not suggest that aggressive treatment becomes unnecessary. Many cancers still require urgent and intensive care. Fast-growing tumours, advanced disease, and cancers that spread early continue to demand strong treatment strategies. The change now, is in being able to recognise which cancers fall into which category and treating them through tailor-made, personal regimens.

What the future holds

The future of cancer treatment is progressing towards personalised care. Not every diagnosis calls for a full-scale attack. Sometimes, the smartest approach involves patience, close attention, and restraint.

Treatment decisions are increasingly being based on the specific biology of the tumour, the overall health of the patient, and their individual needs and priorities. This method aims to minimise adverse effects, optimise the use of medical resources and most importantly, ensure a good quality of life for patients. This shift represents progress, not hesitation, and it marks a more thoughtful era in cancer medicine.

(Dr. Randeep Singh is director and senior consultant, oncology Services, medical oncology, haemato-oncology & BMT, Narayana Hospital, Gurugram. randeep.singh.dr@narayanahealth.org)

Published – February 10, 2026 10:25 am IST