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 often better fight it. So if you are comfortable doing so, 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 cancer, and whether it has spread.
- The diagnosis of cancer is devastating and can seem 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. It has simply been too small to detect. 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, surgery for removal of the breast can be a major procedure with an impact upon your sense of your body image. Take your time to ask about and understand your options.
- 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.
Understand your treatment options.
- In general, you may be offered 1 of 4 strategies or combinations: surgery, radiation therapy, biologic therapy, or chemotherapy. Be sure you understand whether or not the cancer is potentially curable. Understand the difference between being well enough for surgery versus whether or not the cancer appears to be resectable. The former 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 either does not appear to be resectable before surgery, or at surgery cannot be removed in its entirety, the surgery may not ultimately provide much benefit.
- 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. 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 types of chemotherapy if they are reccommended and you choose to take it. 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 benefit am I being offered by chemotherapy? What does this mean? What will it cost me both in terms of side effects and dollars?
- 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 possibly "buying" from chemotherapy. Not every patient gets the benefit from chemotherapy, but all may get side effects. The offer of a doubling of your expected survival may only occur if you get benefit from the treatment. Ask what the likelihood is of benefit and what that benefit may include. Will your pain get better, or will it just be that a lump of cancer will shrink for a while?
- 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 a sensible option to consider.
Knowledge is powerful medicine.
- 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. Be careful with message boards. People with the same type of cancer that you have, at the same stage, and at your same age may still have very different responses to treatment. trust your doctors, an remember that each person is different.
Medically Reviewed by a Doctor on 6/3/2016
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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