Cancer: What You Need to Know (cont.)
Four Essential Things You Should Know (and Follow)
Acknowledge the seriousness of your diagnosis.
Take time to take your best shot.
- You need to know your diagnosis. Because if you can see the enemy, and name the enemy, you can fight it. So if you are comfortable, ask to see your x-rays, CT scans, mammograms, bone scans, and MRIs.
- Find out precisely what type of cancer you have, the stage of your tumor, and whether it has spread.
Understand your treatment options.
- The diagnosis of cancer is devastating and paralyzing. The very words "You have cancer" overwhelm our senses of judgment and reasoning. So take time to think about your course of action before you rush to treatment.
- By the time a cancer has been detected on a chest x-ray, it has been present for about 5 years. By the time a mammogram shows a breast cancer, it also has been present for about 5 years. Therefore, there is no urgency to rush into treatment within a day or two of diagnosis. We need to keep in mind that many treatment options cannot be reversed. For example, removal of the breast is a major life-altering event.
- As with most situations in life, the first shot is the best. If the first-string team is not winning, what chance does the second string have? The same holds true with cancer. If the first kind of treatment does not work, the person is usually weaker and sicker, making the success of the second treatment low. Not zero. But low.
Knowledge is powerful medicine.
- In general, you may be offered 1 of 3 strategies or combinations: surgery, radiation therapy, or chemotherapy. Be sure you understand whether or not the cancer is curable. Understand the difference between operable versus resectable. Operable means that you are capable of tolerating the rigors of surgery. Resectable means that the surgeon believes he or she can remove the tumor. If the tumor cannot be fully removed, if disease is left behind, the outlook may be very serious. In a sense, all patients can have an operation, but if the cancer cannot be removed in its entirety, the surgery may not provide great dividends.
- Ask the doctor about the pros and cons of less invasive techniques. For example, a generation ago, women with breast cancer were treated with a radical mastectomy and the entire breast and chest wall muscles were removed. A huge swollen arm was often the result. Today, the removal of a small amount of breast tissue roughly the size of several sugar cubes followed by radiation and chemotherapy provides results equal to or better than more aggressive treatments.
- Know all about chemotherapy. Find out the names of the drugs, their side effects, and how they will be administered, such as orally through pills, by IV, or as pills under the tongue. In general, these can be somewhat toxic drugs with significant side effects. You want to know up front: What am I buying from chemotherapy? What does this mean?
- Doctors may state that survival is increased by 50% by the use of chemotherapy. Now, for the bad news: If survival is increased from 2 months to 4 months and if those remaining 8 weeks are associated with nausea, vomiting, weakness, and fatigue, that may not be a good bargain. Find out exactly what you are "buying" from chemotherapy.
- There is yet another strategy, and that is to do nothing. For some people, this may be the best choice. Sometimes, we can actively and aggressively watch the patient to detect subtle indications that the cancer is worsening. Cancer of the prostate is an example. Some cells may be dormant for many years, and the treatment may be worse than the disease. In some cases, watchful waiting is our watchword.
- Learn the language of cancer. Understand your disease, and you'll be a true partner in your treatment.
- The Internet has provided people access to tens of thousands of Web sites specifically focusing on health issues. The information on the Internet can be your best ally or your worst enemy. As an ally, use the information from trusted medical sources to make yourself the smartest person your doctor has ever treated. Be wary of sites sponsored by companies hoping to sell you a product or medicine. Access Web sites listed in the next section for more information. If you do not know how to use this tool, friends and family can surely help.
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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