alt.support.cancer - Frequently Asked Questions

Part 1


Table of Contents

What is cancer?

What causes cancer?

What are the risk factors associated with cancer?

How are the various cancers named?

How are breast cancers named?

Cancer terminology: the language of cancer

Classifying cancer by type of tissue

Classifying cancer by type of cell

Classifying by site of the tumor's origin

Naming of benign or malignant tumors

What primary categories are cancers commonly grouped into?

Where can I find more information about cancer?

Where can I find cancer educational information?

What web sites exist to teach children about cancer?

Are there interactive sites that explain cancer?

Where can I find cancer statistics?

What are the chances of developing cancer?

What can I do to reduce the risk of cancer?

Are there any good cancer diet programs online?

Are there guidelines on nutrition and physical activity for cancer prevention?

Recommendations for individual choices

What factors affect risk for the most common cancers?

What other dietary factors affect cancer risk?

Are there any cancer-fighting foods?

Will eating certain foods help reduce my chances of getting cancer?

Why can't I just get the nutrients I need from supplements?

What foods should I avoid?

If I do get cancer, can any foods help treat or cure it?

What can I do to improve my health care?

Should I have periodic health exams?

What screening tests should I have?

What is screening?

What are the screening exams?

What are the symptoms of cancer?

If I have a symptom listed above, does that mean I have cancer?

I have a cancer symptom, what should I do?

Should I wait until I feel pain before seeing a doctor?

What self-exams can I perform to aid in early detection of cancer

What can I do to help in early detection?

What is involved in screening and testing for cancer?

How do I interpret my lab results?

What should be done to prepare for meeting with my doctor?

Clinical staging

What does cancer stage and grade mean?

Is stage and grade the same thing?

What does TNM mean?

What is the Gleason system?

What is the Dukes system?

What is the best treatment for my cancer?

What are my treatment options?

What else is important to know about treatments?

Are there any tools to help me with the treatment decision?

What do I need to know to make an informed treatment decision?

What questions should be asked before deciding on a treatment?

How would you change this to help a patient who has two or more treatments to consider?

What are practice guidelines?

What general questions should you ask your doctor?

What should you ask your medical oncologist about chemotherapy?

What should you ask your doctor about surgery?

What should you ask about a clinical trial?

What questions should be asked of the surgeon?

What questions should be asked by patients with colon and rectal cancer?

What questions should patients with brain cancer ask their physician?

What questions should patients with breast cancer ask their physician?

What questions should patients with common gynecologic cancers ask their physician?

What questions should patients with kidney cancer ask their doctor?

What questions should patients with multiple myeloma ask their physician?

What questions should patients with prostate cancer ask their physician?

What questions should you ask the oncologist?

What is the purpose behind questions to the doctor?

What rights does a patient have?

What are the patients responsibilities?

The Patient's Pledge

How can I choose the right cancer doctor?

Where can I get general help finding a doctor, surgeon, or hospital?

Where can I find cancer centers listed by state?

What professional medical associations will help locating centers or doctors?

Where can I find hospitals or physicians worldwide?

Where can I find research about correlation of high volume colon cancer surgery and patient outcome?

Where can I find information about surgery volume by hospital or doctor?

How can I locate a colorectal surgeon?

How can I find a breast cancer specialist?

How can I find an oncologist?

Where can I find information about doctors and hospitals in my state?

How can I get a referral?

Can I refer myself?

How can I get a second opinion?

What is outside consultation?

Where can I get an outside consultation?

How can I get travel assistance for treatment?

What about reduced airfares for cancer patient treatment?

What about free air travel?

Do corporations help cancer patients travel free for treatment?

What can I do if I do not qualify to travel free?

Where can I find local transportation from the airport to the treatment center?

Where can I find lodging near the treatment center for my family?

Will a nonprofit organization help if I can't afford lodging?

Who can help me find free or low cost travel and lodging for care?

Where can lymphoma patients get financial assistance?

How do people without medical coverage get treatment for breast cancer?

What about people without medical coverage that have other cancers?

Where can I get financial assistance for cancer care?

Who can help with questions about family or medical leave?

I am a U.S. citizen with financial and employment concerns due to cancer. What legal rights do I have?

How can I cut costs for nonprescription items?

What is the impact of having cancer?

How should we deal with the stigma of cancer?

What are the ranges of emotion that normally accompany a diagnosis of cancer?

What is denial?

How to deal with denial?

How to deal with the anger?

Is depression a problem for cancer patients?

I am a caregiver for a cancer patient, what should I know to be most effective?

Where can I find other cancer patient support organizations?

How do I deal with fear?

I am worried that there will be a relapse, what should I do?

I feel alone with no one to talk to, what should I do?

I am suffering with a lot of pain, what should I do?

Is it possible to have cancer and a healthy sex life?

I have some breathing difficulty, how can I improve my sleep?

What can I do to get a good night's sleep?

I tried the sleep suggestions, no help, what is the problem?

How to deal with children's nightmares?

When can I consider myself cured?

What is the prognosis for my cancer?

What is the prognosis for colorectal cancer?

Dealing with bad news

What is the doctors role in delivering bad news?

What does inoperable mean?

Could chemo shrink enough of the tumor, so it becomes operable?

What should I do if my cancer is incurable?

Will chemotherapy extend survival?

What is chemotherapy?

How does chemotherapy work?

What is combination chemotherapy?

Are there cancer drugs other than chemo?

Is chemo 100% safe?

Should I start chemotherapy?


Disclaimer: this FAQ is provided for educational purposes only. It cannot be used for diagnosing or treating a disease. If you have or suspect you may have cancer, you should consult your doctor. The external links in this FAQ are provided for the convenience of alt.support.cancer newsgroup visitors. The alt.support.cancer newsgroup has no interest in, responsibility for, or control over the linked sites and no responsibility is accepted for information on any linked page, please read the linked provider's own disclaimer where appropriate. The alt.support.cancer newsgroup makes no promises or warranties of any kind, express or implied, including those of merchantability or fitness for a particular purpose, as to the content of any linked site. In no event shall the alt.support.cancer newsgroup be liable for any damages resulting from use of these links.

What is cancer?

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Cancer is a collection of more than 200 diseases, all of which share one common trait: the uncontrolled growth and spread of abnormal cells. There are several kinds of cancer, including:

·        Carcinomas form in cells that cover the skin or line the mouth, throat, lungs and organs

·        Sarcomas are found in the bones, muscles, fibrous tissues and some organs

·        Leukemias arise from white blood cells in the blood or bone marrow

·        Lymphomas originate in the lymphocyte cells (white blood cells that help fight infection) found in the blood, spleen and lymph nodes

What causes cancer?

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The more we can learn about what causes cancer, the more likely we are to find ways to prevent it. In the laboratory, scientists explore possible causes of cancer and try to determine exactly what happens in cells when they become cancerous. Researchers also study patterns of cancer in the population to look for risk factors, conditions that increase the chance that cancer might occur. They also look for protective factors, things that decrease the risk.

Even though doctors can seldom explain why one person gets cancer and another does not, it is clear that cancer is not caused by an injury, such as a bump or bruise. In addition, although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious; no one can "catch" cancer from another person.

Cancer develops over time. It is a result of a complex mix of factors related to lifestyle, heredity, and environment. A number of factors that increase a person's chance of developing cancer have been identified. Many types of cancer are related to the use of tobacco, what people eat and drink, exposure to ultraviolet (UV) radiation from the sun, and, to a lesser extent, exposure to cancer-causing agents (carcinogens) in the environment and the workplace. Some people are more sensitive than others are to factors that can cause cancer.

Still, most people who get cancer have none of the known risk factors. In addition, most people who do have risk factors do not get the disease.

Some cancer risk factors can be avoided. Others, such as inherited factors, are unavoidable, but it may be helpful to be aware of them. People can help protect themselves by avoiding known risk factors whenever possible.

What are the risk factors associated with cancer?

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·        Tobacco

·        Diet

·        Ultraviolet radiation

·        Alcohol

·        Ionizing radiation

·        Chemicals and other substances

·        Hormone replacement therapy (HRT)

·        Diethylstilbestrol (DES)

·        Close relatives with certain types of cancer

How are the various cancers named?

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Medical professionals frequently refer to cancers based on their histological type. However, the public is more familiar with cancer names based on their primary sites. The most common sites in which cancer develops include the skin, lungs, female breasts, prostate, colon and rectum, cervix and uterus.

Compared with those based on histological type, cancers named after the primary site may not be as accurate. Take lung cancer for example; the name does not specify the type of tissue involved. It simply indicates where the cancer is located. In fact, depending on how the cells look under a microscope, there are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer can be further divided into various types named for the type of cells in which the cancer develops, typically: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

However, it's important to know that cancer can be classified by either the cell type or its primary site. Saying that a woman has uterine carcinoma or uterine cancer is the same thing as saying that she has cancer (or carcinoma) of the uterus.

How are breast cancers named?

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The first determination for naming is whether the breast cancer is "in situ" or "invasive". In situ cancers remain within the boundaries of the kind of cells that formed them. In situ means in place staying where it belongs and not spreading. For this reason in situ cancers are sometimes called precancerous, meaning they may develop into invasive cancers later. About 20-40% of in situ cancers will do this if not removed. Currently, about 12% of detected breast cancers are in situ. This percentage is increasing because breast cancers found on mammograms are often in situ. The other breast cancers are all invasive cancers. Invasive cancers have broken out of the boundaries of the group of cells they came from and are invading or growing into the nearby breast tissue.

The second part of the name tells something about that particular kind of cancer. Some breast cancers get their names from the cells of the breast that turned into cancer. If the cancer arises from the cells of the tubes or ducts that normally carry milk to the nipple, it is called "ductal" or from the ducts. Eighty percent of breast cancers are ductal. If a cancer arises from the part of the breast that produces milk, it is called a lobular cancer. "Lobular" refers to lobes, or the milk producing structures. Ten percent of breast cancers are lobular. Another cancer type is inflammatory breast cancer (3%), which causes the breast to look like it has an infection. The names of other uncommon forms describe what the pathologist sees when s/he looks at the cancer under the microscope. For example, tubular breast cancer forms tube-like structures, medullary breast cancer has the color of the part of the brain called the medulla, mucinous cancers contain mucus-like material, and papillary cancer has finger-like projections.

Cancer terminology: the language of cancer

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The ways in which cancers are named can convey a good deal of information about them. However, their designations often have to be "decoded." As is generally the case with medical terms, the "language" of cancer is made up of compound words that contain a root, a prefix, and a suffix; the common ones can be found here.

Specific cancers may be named in multiple ways. One of the ways is to describe the tissue type involved, cell type involved, or site of origin. Cancers are also classified as to whether they are benign or malignant and by their clinical stage.

Classifying cancer by type of tissue

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Carcinoma

A neoplasm (literally "new growth"-that is, a cancer or tumor) occurring in the epithelial cells that line organs and cover the surface of the body (~ 90% of all cancers fit into this category)

Sarcoma

A solid tumor occurring in connective tissue, muscle, and bone (~ 2% of all cancers)

Leukemia or lymphoma

A neoplasm occurring in the circulatory (leukemia) or lymphatic (lymphoma) systems (~ 8% of all cancers)

The embryonic origin of these tissues led to these categories:

·        ectoderm (outer layer of cells), from which the skin and nervous system are derived, is the usual source of a carcinoma

·        mesoderm (middle layer of cells), from which bone, muscle, and blood are derived, is the usual source of a sarcoma, leukemia, or lymphoma

·        endoderm (inner layer of cells), from which the lining of internal organs is derived, may also be the source of a carcinoma

Connection to the embryonic nature of some tumors has led to two cancer-related terms:

Blastoma ("immature tumor")

A neoplasm that resembles embryonic tissue

Teratoma

A neoplasm that arose in tissues derived from all three embryonic germ layers (ectoderm, mesoderm, and endoderm)

Classifying cancer by type of cell

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Tumors may be identified by the type of cell within a tissue or organ that has transformed into a cancer:

·        Adenomatous cells-ductal or glandular cells

·        Squamous cells-flat cells

·        Myeloid-blood cell

·        Lymphoid-lymphocytes or macrophages

Classifying by site of the tumor's origin

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The name of a cancer may first designate the site in the body where the neoplasm originated and then indicate the type of tissue in which it has occurred, the cell type, and/or the founder's name, or some combination of these terms. The following are some examples:

·        Breast-breast carcinoma of ductal, medullary, papillary, etc, cells

·        Bone-osteosarcoma, Ewing's sarcoma

·        Eye-retinoblastoma

·        Lip, tongue, mouth, nasal cavity-squamous cell carcinoma

·        Lymphocytes-acute lymphocytic leukemia, chronic lymphocytic leukemia, Hodgkin's lymphoma

·        Prostate-adenocarcinoma

·        Ovary-adenocarcinoma, choriocarcinoma, teratoma, Brenner tumor

Naming of benign or malignant tumors

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Benign tumors are not cancer. They can often be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.

Benign tumors:

·        are generally slow growing and enclosed in a fibrous capsule

·        are generally considered innocuous, although their location can make them serious, such as a tumor located in the brain, where removal by surgery poses serious risks

·        are not considered cancerous (that is, they are not malignant)

·        are given names that usually end in "oma" (Latin origin, indicates a swelling)(although a melanoma is a malignant skin cancer)

Malignant tumors are cancer. Cells in these tumors are abnormal and divide without control or order. They can invade and damage nearby tissues and organs.

Malignant tumors:

·        proliferate rapidly, invading neighboring tissues

·        can metastasize, or spread, to other sites of the body

·        are named using the conventions of tissue, cell type, and origin

A tumor of the bone is an osteoma if benign and an osteosarcoma if malignant; a tumor of nerve cells may be a ganglioneuroma if benign and a neuroblastoma if malignant; a tumor of melanocytes are nevi if benign but a melanoma if malignant.

Finally, some neoplasms are named after the physician who first described them. These designations may not convey as much information as other naming conventions do; for example, Wilm's tumor, Hodgkin's lymphoma, and Kaposi's sarcoma.

What primary categories are cancers commonly grouped into?

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Most Common Cancers:

·        Bladder Cancer

·        Breast Cancer

·        Colon Cancer

·        Endometrial Cancer

·        Head & Neck Cancer

·        Leukemia

·        Lung Cancer

·        Melanoma

·        Non-Hodgkin's Lymphoma

·        Ovarian Cancer

·        Prostate Cancer

·        Rectal Cancer

Childhood Cancers:

·        Brain Stem Glioma

·        Cerebellar Astrocytoma

·        Cerebral Astrocytoma

·        Ependymoma

·        Ewing's Sarcoma/Family of Tumors

·        Germ Cell Tumor, Extracranial

·        Hodgkin\'s Disease

·        Leukemia, Acute Lymphoblastic

·        Leukemia, Acute Myeloid

·        Liver Cancer

·        Medulloblastoma

·        Neuroblastoma

·        Non-Hodgkin's Lymphoma

·        Osteosarcoma/Malignant Fibrous Histiocytoma of Bone

·        Retinoblastoma

·        Rhabdomyosarcoma

·        Soft Tissue Sarcoma

·        Supratentorial Primitive Neuroectodermal and Pineal Tumors

·        Unusual Childhood Cancers

·        Visual Pathway and Hypothalamic Glioma

·        Wilm's Tumor and Other Childhood Kidney Tumors

Less Common Cancers:

·        Acute Lymphocytic Leukemia

·        Adult Acute Myeloid Leukemia

·        Adult non-Hodgkin's lymphoma

·        Brain Tumor

·        Cervical Cancer

·        Childhood Cancers

·        Childhood Sarcoma

·        Chronic Lymphocytic Leukemia

·        Chronic Myeloid Leukemia

·        Esophageal Cancer

·        Hairy Cell Leukemia

·        Kidney Cancer

·        Liver Cancer

·        Multiple Myeloma

·        Neuroblastoma

·        Oral Cancer

·        Pancreatic Cancer

·        Primary central nervous system lymphoma

·        Skin Cancer

·        Small-Cell Lung Cancer

Body Location/System:

·        AIDS-Related

·        Bone

·        Brain

·        Breast

·        Digestive/Gastrointestinal

·        Endocrine

·        Eye

·        Genitourinary

·        Germ Cell

·        Gynecologic

·        Head and Neck

·        Hematologic/Blood

·        Leukemia

·        Lung

·        Lymphoma

·        Musculoskeletal

·        Neurologic

·        Pregnancy and Cancer

·        Respiratory/Thoracic

·        Skin

·        Unknown Primary

Where can I find more information about cancer?

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Look in the Links section of the FAQ. It contains many references listed in categories that make it easy to find what you are looking for.

The ACS site is a good place to start: http://www.cancer.org/docroot/home/index.asp?level=0

Where can I find cancer educational information?

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http://www.nhsdirect.nhs.uk/subjectindex.asp?N1=5&N2=19 This is an excellent site for cancer education.

What web sites exist to teach children about cancer?

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The Adventures of Captain Chemo at http://www.royalmarsden.org/captchemo/index.asp were created by Ben de Garis who died in July 1999, aged 18, having had treatment at The Royal Marsden Hospital since he was 13. Captain Chemo is based at the Royal Marsden web site and is primarily geared towards helping children and families/friends understand childhood cancer.

Are there interactive sites that explain cancer?

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http://www.principalhealthnews.com/topic/cancerguide/ Cools Tools, By Deepi Brar Consumer Health Interactive

Where can I find cancer statistics?

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Look in the recommended links section of the FAQ for links to some statistics.

What are the chances of developing cancer?

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Your Cancer Risk at http://www.yourcancerrisk.harvard.edu/ estimates your risk of cancer and provides personalized tips for prevention. It doesn't tell you if you'll get cancer or not. Anyone can use Your Cancer Risk, but it's most accurate for people age 40 and over who have never had any type of cancer. It includes the most common types of cancer.

Guidelines for Detection, Prevention, and Risk of Cancer can be found at http://www.nccn.org/physician_gls/f_guidelines.html for the following cancers:

·        Breast Cancer Risk Reduction

·        Breast Cancer Screening and Diagnosis

·        Cervical Cancer Screening

·        Colorectal Cancer Screening

·        Genetic/Familial High Risk Screening

·        Prostate Cancer Early Detection

Skin cancer http://www.skincancer.org/prevention/index.php and http://www.cancer.umn.edu/page/clinical/skin3.html

http://www.cancer.umn.edu/page/patients/riskred6.html Cancer Risk Reduction, Smoking and Cancer

http://www.cancer.umn.edu/page/research/prevent4.html Carcinogenesis and Chemoprevention Research Program

http://www.cancer.umn.edu/page/research/prevent.html Cancer Prevention and Etiology

Cancer Prevention and early detection http://www.cancer.org/docroot/PED/ped_1.asp

Smoking cessation http://www.cancer.umn.edu/page/risk/quitsmok.html Quitting Smoking

What can I do to reduce the risk of cancer?

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The American Cancer Society's seven dietary guidelines for reducing the risk of cancer are:

1.       Cut down on total fat.

2.       Cut down on salt-cured, smoked and nitrate-cured foods.

3.       Eat more high-fiber food.

4.       Include foods rich in vitamins A and C in your daily diet.

5.       Include cabbage-family vegetables in your diet.

6.       If you do drink, keep alcohol consumption moderate.

7.       Avoid obesity

Are there any good cancer diet programs online?

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The Win against Cancer program developed by the University of Minnesota is a good one. They have developed a "WIN at Home" page for Internet users. Here are some key points of the program from their site:

The site is located at http://www.cancer.umn.edu/page/winathome/index.html

"You control one of the most powerful weapons known to prevent cancer: your food choices. You decide what you eat and you can decide to make changes in those choices. This website contains information on lowering cancer risk through diet.

This information is from a successful health education campaign developed by the University of Minnesota. Residents of Willmar, Minnesota, were the first to participate. Participants received one pamphlet weekly."

"If you would like to experience the Win against Cancer program as a six-week course, begin with the starting questionnaire. Then read the six sections of this web site (the top six buttons on the left), one per week. At the end of the six weeks, fill out the ending questionnaire and compare the results!"

"This information is also on the colorful 8 Ways to WIN Poster. To print the poster, click on the "8 Ways to WIN Poster" link and then use your browser's "print" command. The poster is large, so you may need to adjust your print settings."

Are there guidelines on nutrition and physical activity for cancer prevention?

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The American Cancer Society (ACS) has issued its 2002 update on guidelines for reducing the risk of cancer with healthy food choices and physical activity. The full report appears in CA: A Cancer Journal for Clinicians, March/April 2002.

These guidelines are developed and published every five years by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy. Recognizing that the ability to make healthy choices is often affected by factors within the environment in which people live, work, and play, the panel tried to identify key social and structural factors that influence access to resources for an active lifestyle. This year, the committee adds a recommendation for community action to accompany the four recommendations for individual choices for nutrition and physical activity.

In the United States, evidence suggests that one third of the more than 500,000 cancer deaths that occur each year can be attributed to diet and physical activity habits.

Recommendations for individual choices

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In the United States, about 35 percent of cancer deaths may be avoidable through dietary modification. Epidemiologic studies have shown that populations with diets high in fruits and vegetables and low in animal fat, meat, or calories have a reduced risk of some of the most common types of cancer. The panel focuses on the following recommendations:

Eat a variety of healthy foods, with an emphasis on plant sources. Eat five or more servings of a variety of vegetables and fruits every day in various forms (fresh, frozen, canned, dried, and juiced); limit French-fries, snack chips, and other fried vegetable products; choose 100 percent juice if you drink fruit or vegetable juices. Greater consumption of fruits and vegetables has been associated with a lower risk of lung, oral, esophageal, stomach, and colon cancer.

Choose whole grain rice, bread, pasta, and cereals; limit consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks, and sugars. Whole grains are an important source of vitamins and minerals associated with lower risk of colon cancer, such as folate, vitamin E, and selenium. They are higher in fiber and other nutrients than refined flour products. Beans are particularly rich in nutrients that may protect against cancer, and are a low-fat, high-protein alternative to meat.

Limit consumption of red and processed meats, especially those high in fat. Choose fish, poultry, or beans as an alternative to beef, pork, and lamb; when eating meat, select lean cuts and have smaller portions, using meat as a side dish; prepare meat by baking, broiling, or poaching, rather than frying or charbroiling, to reduce the overall fat content. High-fat diets have been associated with an increase in risk for cancer of the colon, rectum, prostate, and endometrium. Choose lean meats and lower-fat dairy products, and substitute vegetable oils for butter or lard.

Adopt a physically active lifestyle. Adults should engage in at least moderate activity for 30 minutes or more on five or more days a week. Forty-five minutes or more of moderate-to-vigorous activity a week may further enhance reductions in the risk of breast and colon cancer.

Children and adolescents should have at least 60 minutes a day of moderate-to-vigorous physical activity for at least five days a week. This should be encouraged because one of the best predictors of adult activity is activity level during childhood and adolescence, and because of the critical role, activity plays in maintaining a healthy weight.

Regular activity helps maintain a healthy body weight by balancing caloric intake with energy expenditure. Moderate-to-vigorous activity is needed to metabolize stored body fat and to modify physiologic functions that affect insulin, estrogen, androgen, prostaglandins, and immune function. Physical activity accelerates the movement of food through the intestine, reducing the length of time that the bowel lining is exposed to mutagens, may decrease the exposure of breast tissue to circulating estrogen, and improves energy metabolism and reduces circulating concentrations of insulin and related growth factors.

Moderate activities require effort equivalent to a brisk walk. Vigorous activities engage large muscle groups and cause an increase in heart rate, breathing depth and frequency, and sweating. Men older than 40 years, women older than 50 years, and people with chronic illnesses should consult their physicians before starting a vigorous exercise program. To reduce risk of musculoskeletal injuries, stretching and warm-up periods should be part of each program.

Maintain a healthy weight throughout life. Current trends indicate that the largest percentage of calories in the American diet come from foods high in fat, sugar, and refined carbohydrates. Limiting portion sizes, especially of these types of foods, is another important strategy to reduce total caloric intake. Meals in restaurants typically exceed the portion sizes needed to meet recommended daily caloric intake. Balance caloric intake with physical activity and lose weight if currently overweight or obese. Obesity is a major risk factor for cancer, diabetes, stroke, and coronary heart disease.

If you drink alcoholic beverages, limit consumption. Men should limit themselves to two drinks per day and women to one drink per day. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof distilled spirits. Alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. The risk increases substantially with intake of more than two drinks per day.

What factors affect risk for the most common cancers?

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Currently, the best advice is to consume antioxidants through food sources rather than supplements.

Bladder cancer

The major risk factors for bladder cancer are smoking and exposure to certain industrial chemicals. Limited evidence suggests that drinking more fluids and eating more vegetables may lower the risk of bladder cancer.

Brain cancer

There are no known nutritional risk factors for brain cancer.

Breast cancer

Risk is increased by several factors that cannot be easily modified: menarche before 12 years of age, nulliparity (a female that has not borne offspring) or first birth at 30 years or older, late age at menopause, and a family history of breast cancer. Risk can be reduced by limiting the use of hormone replacement therapy, avoiding obesity, staying physically active, and breastfeeding. The best nutritional advice is to engage in vigorous activity at least four hours a week, avoid or limit alcoholic beverages to no more than one a day, and minimize lifetime weight gain.

Colorectal cancer

Risk of colorectal cancer is increased in those with a family history, with the use of tobacco, and possibly with excessive alcohol consumption. Obesity and diets high in red meat have also been associated with increased risk of colon cancer. Risk may be decreased by using aspirin or other nonsteroidal anti-inflammatory drugs and possibly, hormone replacement therapy. Diets high in vegetables and fruits have been associated with decreased risk. Increasing evidence suggests that vigorous activity may have an even greater benefit in reducing risk than regular moderate exercise.

Endometrial cancer

To reduce the risk of endometrial cancer, maintain a healthy weight through diet and regular exercise, and eat at least five servings of fruits and vegetables a day.

Kidney cancer

The best way to reduce the chances of kidney cancer is to avoid becoming overweight.

Leukemias and lymphomas

There are no known nutritional factors for decreasing the risk for leukemias or lymphomas.

Lung cancer

Currently, the best advice to reduce risk of lung cancer is to avoid exposure to tobacco and to eat at least five servings of fruits and vegetables a day.

Oral and esophageal cancers

Avoid all forms of tobacco, restrict alcohol consumption, avoid obesity, and eat at least five servings of vegetables and fruits a day.

Ovarian cancer

There are no firmly established nutritional risk factors for ovarian cancer, but vegetable and fruit consumption may lower risk.

Pancreatic cancer

Avoid tobacco use, maintain a healthy weight, remain physically active, and eat five or more servings of fruits and vegetables a day.

Prostate cancer

To reduce risk, limit intake of animal-based products, especially red meats and high-fat dairy products, and eat five or more servings of fruits and vegetables a day.

Stomach cancer

To reduce risk, eat at least five servings of fruits and vegetables a day.

What other dietary factors affect cancer risk?

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The following address concerns about diet and physical activity in relation to cancer:

1.       There is currently no evidence that the substances found in bioengineered foods now on the market are harmful or that they would increase or decrease cancer risk because of the added genes.

2.       Men and women should try to get recommended levels of calcium primarily through food sources.

3.       There is no evidence that lowering blood cholesterol levels has an effect on cancer risk.

4.       There is no evidence that caffeine use increases the risk of cancer.

5.       Fluorides do not increase cancer risk.

6.       Folic acid deficiency may increase the risk of colorectal and breast cancer. To reduce this risk, folic acid is best obtained through eating vegetables, fruits, and enriched grain products.

7.       Additives are usually present in very small quantities in food, and no convincing evidence exists that any additive consumed at these levels causes human cancers.

8.       Insufficient evidence exists to support a specific role for garlic in cancer prevention.

9.       Radiation does not remain in the foods after treatment, and there is no evidence that eating irradiated foods increases cancer risk.

10.   Even if lycopene in foods is associated with lower risk for cancer, it does not follow those high doses taken, as supplements would be more effective or safe.

11.   Consumption of meats preserved by methods using smoke or salt—increases exposure to potentially carcinogenic chemicals—should be minimized. Braising, steaming, poaching, stewing, and microwaving meats minimize the production of these chemicals. Microwaving and steaming may be the best ways to preserve the nutritional content in vegetables.

12.   Consumption of olive oil is not associated with any increased risk of cancer.

13.   At present, no research exists to demonstrate whether organic foods are more effective in reducing cancer risk than are similar foods produced by other farming methods.

14.   There is no evidence that residues of pesticides and herbicides at the low doses found in foods increase the risk of cancer.

15.   There is no evidence that phytochemicals taken, as supplements are as beneficial as the vegetables, fruits, beans, and grains from which they are extracted.

16.   No evidence suggests that salt used in cooking or in flavoring foods affects cancer risk.

17.   There is a narrow margin between safe and toxic doses of selenium. The maximum dose in a supplement should not exceed 200 mcg per day. Seafood, meats, and grain products are good sources of selenium.

18.   There is no convincing data that soy supplements are beneficial in reducing cancer risk.

19.   Food is the best source of vitamins and minerals, not supplements. If a supplement is taken, the best choice is a balanced multivitamin/mineral supplement containing no more than 100 percent of the daily value of most nutrients, because high doses of some nutrients can have adverse effects.

20.   Tea has not been proven to reduce cancer risk in humans.

21.   The few studies in which vitamin C has been given as a supplement have not shown a reduced risk of cancer.

22.   Recent evidence demonstrates that trans-fats have adverse cardiovascular effects, such as raising blood cholesterol levels, but their relationship to cancer risk has not been determined.

23.   Drinking at least eight cups of liquid a day is usually recommended, and some studies indicate that even more may be beneficial.

Are there any cancer-fighting foods?

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While there is no proof that these foods do what is claimed here, they can help in achieving a well-rounded diet. Good nutrition and diet are important to a cancer patient.

·        Tomatoes - These tasty spheres are bursting with the powerful antioxidant vitamin C and lycopene. Vitamin C bolsters the immune system and fends off cancer-causing free radicals, and lycopene is instrumental in cutting the risk of stomach, mouth, bladder, cervical, colon and prostate cancer.

·        Cruciferous Vegetables - Broccoli, red cabbage, cauliflower, kale, red beets and brussels sprouts all belong to this veggie family. All are amply fortified with cancer-fighting phytochemicals, including sulforaphane, beta-carotene and indolcarbinol.

·        Spinach - Popeye knew his nutrition. This dark, leafy vegetable is chock-full of antioxidants such as glutathione, vitamin C, beta-carotene, folic acid and carotenoids. Bright orange carrots are also an excellent source of beta-carotene and carotenoids -- chemicals known to curb various cancers.

·        Beans - Beans, beans, they're good for ... beating digestive and breast cancer! Soybeans are stocked with protease inhibitors that don't let cancer cells invade the body, and also contain isoflavones instrumental in protecting against breast cancer. Fava beans fight carcinogens, reducing the risk of cancer in the digestive tract.

·        Hot red peppers - Biting into these zesty peppers may set off a fire in your mouth, but the capsaicin inside snuffs out harmful carcinogens emitted by cigarettes and some foods. These hot chilies rate number one in protecting against lung cancer. Caution: Capsaicin, is believed to have blood-thinning properties (natural blood thinner), a minor nuisance for some of us, but for some who have blood problems or already on blood thinners for other reasons, may need to check with their doctors before consuming capsaicin.

·        Garlic - This member of the onion family isn't only powerful in flavor and scent. Garlic effectively thwarts carcinogens with organosulfides and allicinthus, helping to protect the body from breast cancer.

·        Oranges - Jam-packed with cancer-fighting bioflavonoids and immune system-boosting vitamin C, oranges also contain 170 photochemicals, including carotenoids. In addition, limonoids found in oranges and other citrus fruit fuel the immune system to fight cancer.

·        Berries - Strawberries, blueberries, cranberries, raspberries, blackberries and red and purple grapes boast more than a sweet taste. These bite-sized fruits get their dark hue from anthocyanins that can neutralize carcinogens. Plus, berries are bursting with flavonoids, a powerful group of cancer-fighting antioxidants.

·        Fiber-Rich Foods - Foods full of fiber, such as whole wheat, grains, fortified cereals and apples, protect the body from pancreatic and stomach cancer while also helping to flush toxins from the body. And apples provide an additional cancer kicker with their ample supply of ellagic acid. Ellagic acid inhibits cancer cell division, thus thwarting the growth process of breast, pancreatic, esophageal, skin, colon and prostate cancer -- confirming that apples truly do keep the doctor away.

·        Green and Black Tea - Long heralded for their health benefits, black and green tea are teeming with antioxidants known as polyphenols, the most potent called catechin. Whether you drink them cold or hot, green and black tea can help you fight cancer.

Shoot for five to nine servings of fruits and vegetables and six to eleven servings of beans and grains on a daily basis. Don't be intimidated by the numbers. Servings are small and can be satisfied with one piece of fruit, a half a cup of fruit or vegetables, or one slice of bread.

Will eating certain foods help reduce my chances of getting cancer?

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Yes. In addition, since fully one-third of cancer deaths each year are attributed to a poor diet, eating right is one of the most important things you can do to protect yourself. Start by loading up on fruits and vegetables. Studies show that people who eat the most produce run just half the cancer risk faced by people who eat the least. Many foods from the garden contain nutrients such as vitamin C, vitamin E, and selenium, which act as antioxidants; they trap and absorb free radicals, unstable oxygen molecules that form when cells burn off energy during normal metabolism. Left unchecked, free radicals can damage cells and lead to cancer. Other substances, called phytochemicals, may work by preventing carcinogens from forming in the body.

Why can't I just get the nutrients I need from supplements?

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The verdict is still out on supplements' cancer-fighting potential. On the promising side, one study of selenium supplements suggested that they might cut the risk of lung, colorectal, and prostate cancer, while vitamin E has lowered prostate cancer and death among smokers. However, other studies aren't so encouraging. Scientists in the United States and Europe were alarmed to find that giving beta-carotene supplements to smokers actually increased their chances of getting lung cancer.

The problem is that although researchers have started to identify various compounds in food that can disarm cancer cells in the lab, they still don't know how these substances act inside the body. So far, no single food or chemical has been proved to work on its own. Until more is known about supplements, it's probably smarter to get cancer-fighting protection from a variety of fruits, vegetables, and grains, which will deliver a range of nutrients and keep you from taking in large and possibly harmful amounts of any one substance. The same goes for fiber supplements. The health benefits may come from a combination of elements rather than the fiber alone, so it's better to get your fiber from the real thing.

What foods should I avoid?

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Cut back on fat. A high-fat diet has been linked to an increased risk of breast, colon, and prostate cancer. You should get less than 30 percent of your daily calories from fat. (In the average American diet, 37 percent of calories come from fat). Cut down most of all on saturated fat—the kind that hardens at room temperature—found in animal products like meat and butter.

Drink alcohol in moderation, if at all. Drinking raises your risk of cancer of the mouth, larynx, pharynx, esophagus, lungs, liver, and colon. If you're a man, hold the line at two drinks a day. If you're a woman, your body metabolizes alcohol differently, so you need to limit yourself to no more than one can of beer, one glass of wine, or one hard drink a day.

Eat processed meats sparingly; such items as hot dogs and lunchmeats contain nitrates and nitrites. These preservatives have been linked to cancer of the esophagus and stomach in countries like Iceland, China, and Japan, where people eat large amounts of smoked, salted, or cured meat.

Don't overdo the barbecued meats. The longer you leave your meat on the barbeque, the more carcinogens form in it. To reduce cooking time on the grill, first thaw meat or partly cook it in the microwave.

If I do get cancer, can any foods help treat or cure it?

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There are tantalizing hints that diet can play a role in cancer treatment. A small Japanese study published in 1998, for instance, found that breast cancer was about half as likely to recur or metastasize in women who drank four or more cups of green tea a day. Nevertheless, there's no solid evidence yet that any particular food or diet can cure cancer. Until there is, one of the best ways to boost your immune system is to make sure that you're getting plenty of nutrients by eating a wide variety of fruits, vegetables, grains, and legumes. Consider working with a registered dietitian to devise a meal plan that's right for you.

What can I do to improve my health care?

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Develop a basic health competency

To get the best medical care available today, consumers need to develop a basic health competency-and that includes overseeing your preventive care. Understanding which tests may be appropriate for you at the current time and how often you should be tested is a competency that helps you secure the best care available to you. Even more important than knowing which tests to take when, however, is the knowledge of what your major risks are and how you can prevent the diseases you are at risk of developing. You should:

·        Know your family health history

·        Know what immunizations you've had

·        Know what health problems you are at risk for

·        Increase your awareness of medical tests that are of value to you

·        Talk to and work with your health care provider to maintain your health (identify lifestyle changes you can make that will most improve your health and encourage your health care provider to discuss screening tests with you)

·        Review your health insurance plan and talk to your insurance provider (know what your health care plan does and does not cover and understand the processes for getting referrals and reimbursements)

You can still rely on your doctor to tell you what tests are most worthwhile for you, but do so from a base of knowledge about yourself and your health.

Should I have periodic health exams?

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The days of the generic annual physical are over. Today, preventive services are customized, taking into account your health status, risk factors, and personal and family health history. This more individualized approach is often built around a periodic health exam. Although you may still be seeing your health care provider for a checkup, you won't necessarily receive the same tests as everyone else, or even the same tests you had last year.

During a routine health exam, in addition to the screening discussed earlier, the following items are checked:

·        Blood pressure

·        Height and weight

·        Immunization status (The Centers for Disease Control and Prevention recommend immunizations based on age, occupation, health status, and other factors.)

·        Health of the oral cavity

·        Vision and hearing (as appropriate for your age)

What screening tests should I have?

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The table below summarizes the tests recommended for men and women in different age groups. Those that are recommended as routine tests are identified; those that are administered when risk factors warrant are identified under "Other tests." Please keep in mind that for many of these tests, no national consensus exists, so it is best to consult with your doctor to determine what tests are right for you. In addition, recommendations for newborn screening vary by state (or country).

Screening Tests for Newborns & Infants

·        Metabolic defects

·        Other tests that may be recommended based on known risk factors:

·        Iron deficiency

·        Lead poisoning

·        HIV

Screening Tests for Children (2-12)

·        Cholesterol

·        Lead poisoning

·        Tuberculosis

Screening Tests for Adolescents (13-19)

·        Breast cancer

·        Cervical cancer

·        Chlamydia

·        Cholesterol

·        Skin cancer

·        Other tests that may be recommended based on known risk factors:

·        Tuberculosis

Screening Tests for Young Adults (20-29)

·        Breast cancer

·        Cervical cancer

·        Chlamydia

·        Cholesterol

·        Skin cancer

·        Other tests that may be recommended based on known risk factors:

·        Iron overload

·        Tuberculosis

Screening Tests for Adults (30-49)

·        Breast cancer

·        Cervical cancer

·        Cholesterol

·        Skin cancer

·        Thyroid dysfunction

·        Other tests that may be recommended based on known risk factors:

·        Chlamydia

·        Colorectal cancer

·        Diabetes

·        Iron overload

·        Prostate cancer

·        Tuberculosis

Screening Tests for Adults (50 and Up)

·        Breast cancer

·        Cervical cancer

·        Cholesterol

·        Colorectal cancer

·        Skin cancer

·        Thyroid dysfunction

·        Other tests that may be recommended based on known risk factors:

·        Chlamydia

·        Diabetes

·        Iron overload

·        Osteoporosis

·        Prostate cancer

·        Tuberculosis

What is screening?

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Sometimes, cancer can be found before the disease causes symptoms. Checking for cancer (or for conditions that may lead to cancer) in a person who does not have any symptoms of the disease is called screening. In routine physical exams, the doctor looks for anything unusual and feels for any lumps or growths. Specific screening tests, such as lab tests, x-rays, or other procedures, are used routinely for only a few types of cancer.

What are the screening exams?

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Breast. A screening mammogram is the best tool available to find breast cancer before symptoms appear. A mammogram is a special kind of x-ray image of the breasts. Breast cancer screening has been shown to reduce the risk of dying from this disease. The National Cancer Institute recommends that women in their forties and older have mammograms on a regular basis, every 1 to 2 years.

Cervix. Doctors use the Pap test, or Pap smear, to screen for cancer of the cervix. For this test, cells are collected from the cervix. The cells are examined under a microscope to detect cancer or changes that may lead to cancer.

Colon and rectum. A number of screening tests are used to find colon and rectal (colorectal) cancer. If a person is over the age of 50 years, has a family medical history of colorectal cancer, or has any other risk factors for colorectal cancer, a doctor may suggest one or more of these tests:

·        Sometimes tumors in the colon or rectum can bleed. The fecal occult blood test checks for small amounts of blood in the stool.

·        The doctor sometimes uses a thin, lighted tube called a sigmoidoscope to examine the rectum and lower colon. Or, to examine the entire colon and rectum, a lighted instrument called a colonoscope is used. If abnormal areas are seen, tissue can be removed and examined under a microscope.

·        A barium enema is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, which outlines the colon and rectum on the x-rays.

·        A digital rectal exam is an exam in which the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.

Other. Although it is not certain that screening for other cancers actually saves lives, doctors also may suggest screening for cancers of the skin, lung, and oral cavity. And doctors may offer to screen men for prostate or testicular cancer, and women for ovarian cancer.

What are the symptoms of cancer?

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Cancer can cause a variety of symptoms. Some symptoms are:

·        Thickening or lump in the breast or any other part of the body

·        Obvious change in a wart or mole

·        A sore that does not heal

·        Nagging cough or hoarseness

·        Changes in bowel or bladder habits

·        Indigestion or difficulty swallowing

·        Unexplained changes in weight

·        Unusual bleeding or discharge

If I have a symptom listed above, does that mean I have cancer?

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When these or other symptoms occur, they are not always caused by cancer. They may also be caused by infections, benign tumors, or other problems. It is important to see the doctor about any of these symptoms or about other physical changes. Only a doctor can make a diagnosis.

I have a cancer symptom, what should I do?

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"Do your homework, find an oncologist you trust, and follow their advice." - Steph

Should I wait until I feel pain before seeing a doctor?

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No, you should not wait to feel pain. Early cancer usually does not cause pain.

What self-exams can I perform to aid in early detection of cancer

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Based on your gender learn how to conduct the appropriate self-exams and perform them regularly:

http://www.nlm.nih.gov/medlineplus/ency/article/001993.htm Breast lump self-exam

http://www.nospit.com/HomeExam.html Oral Cancer Self-Exam

http://www.nlm.nih.gov/medlineplus/ency/article/003909.htm Testicular self-examination

http://www.ivf.com/vse.html Your Guide to The Benefits of Vulvar Self-Examination

http://www.skincancer.org/self_exam/spot_skin_cancer.php Skin cancer self-exam

What can I do to help in early detection?

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Schedule screening exams based on your risk factors, and then get the exam.

What is involved in screening and testing for cancer?

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The NCI has specific information on screening and testing for various cancers at http://www.cancer.gov/cancer_information/testing/. Screening or testing information is available for the following types of cancer:

·        Bladder Cancer

·        Breast Cancer

·        Cervical Cancer

·        Colon and Rectal Cancer

·        Endometrial Cancer

·        Esophageal Cancer

·        Gastric Cancer

·        Hepatocellular Cancer

·        Lung Cancer

·        Neuroblastoma

·        Oral Cancer

·        Ovarian Cancer

·        Prostate Cancer

·        Skin Cancer

·        Testicular Cancer

How do I interpret my lab results?

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Understanding Blood Tests, A Guide for Patients with Cancer at http://www.vh.org/adult/patient/cancercenter/bloodtests/index.html is a good site to learn how to interpret blood tests. Another good site is Interpretation of Lab Results at http://www.globalrph.com/labinter.htm.

What should be done to prepare for meeting with my doctor?

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·        Do research into the problem before meeting with the doctor. This will prepare you so that you ask the right questions.

·        Make a list of questions. Check them off as they are answered.

·        Take a tape recorder, ask if it is OK to tape the meeting.

·        Take another person to help with the question and answer session.

·        Download the "Questions to ask about cancer" PDF file from ACS at http://www.cancer.org/docroot/ETO/content/ETO_1_9x_General_Cancer_Questions_to_Ask.pdf.asp?sitearea=ETO

Clinical staging

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The terminology of clinical staging is intended to describe the severity of the neoplasm (a new growth of tissue serving no physiological function) and the extent to which the disease has progressed.

What does cancer stage and grade mean?

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Classification of cancer determines appropriate treatment and helps determine the prognosis. Cancer develops progressively from an alteration in a cell's genetic structure due to mutations, to cells with uncontrolled growth patterns. Classification is made according to the site of origin, histology (or cell analysis; called grading), and the extent of the disease (called staging).

Cancers are often "staged" or rated on how extensive they are before treatment. By determining the correct stage, a physician can plan the best therapy and evaluate the results. Many systems are used to stage or grade tumors. The earlier the stage when diagnosed, the greater the opportunity for cure or improvement.

Typically, the stages are:

·        Stage I, the simplest form, indicates that the tumor is small and confined to the organ or tissue where it began. The best chance for cure is when the tumor is still in Stage I.

·        Stage II means the tumor has spread to surrounding tissues.

·        Stage III means the tumor has spread into surrounding tissues and lymph nodes.

·        Stage IV signifies more extensive spread, often to many organs or parts of the body

The grade and stage of a cancer are determined to offer a prognosis and to determine treatment. Both grade and stage are usually represented by Roman numerals, the best situation by I, the worst by III, IV, or V depending on the tumor type and determined by rules.

Is stage and grade the same thing?

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No! Do not confuse grade and stage!

Tumor grade is assigned by the pathologist to reflect the cancer's degree of differentiation.

·        Grade I: Well-differentiated, cells look like normal organ (benign = Grade 0)

·        Grade II: Not so well-differentiated

·        Grade III: Worse than that

·        Grade IV: Even worse

·        Grade V: Worst of all (most tumor types are graded I-III or I-IV)

Tumor stage is assigned by the clinician based on all available information on the extent of tumor spread.

·        Stage I might mean the tumor is smaller than 1 cm diameter, without metastases

·        Stage II might mean the tumor is larger than 1 cm and/or is symptomatic and/or there are metastases to the regional lymph nodes

·        Stage III might mean the tumor has infiltrated a non-resectable structure and/or there are distant metastases

Rules for assigning stage are quite elaborate and different for each type of tumor.

Tumors of high grade generally present at high stage while tumors of low grade present at low stage.

What does TNM mean?

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TNM is a standardized grading system that identifies tumor, node, and metastases. The TNM (tumor, node, metastasis) staging system is used to construct stages that range from 0 (zero) to IV (four). There are three variables involved in the TNM system:

"T" for tumor:

·        TX unable to assess size

·        T1 might mean primary tumor is smaller than 1 cm in diameter

·        T2 might mean primary tumor is larger than 1 cm in diameter

·        T3 might mean primary tumor is invading something non-resectable

"N" for regional lymph nodes:

·        NX nodal status unknown

·        N0 would mean no tumor in regional lymph nodes

·        N1 might mean tumor in a few nearby lymph nodes

·        N2 might mean many nodes, or some nodes farther downstream, are involved

"M" for metastases:

·        MX unknown if distant metastases

·        M0 would mean no distant metastases

·        M1 would imply distant metastases, etc.

For example, the TNM stage for a lung cancer that is invading or encasing the superior vena cava but has metastases only in two nearby lymph nodes might be T3 N1 M0.

Clinical stages of cancer combine the TMN classification system with a numerical value to provide a profile of the disease for treatment and prognosis recommendations.

What is the Gleason system?

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The Gleason System is used in grading prostate cancer. If your diagnostic tests and other examinations reveal a malignant tumor, your physician may use the Gleason grading system to help describe the appearance of the cancerous prostate tissue.

In order to do this, a pathologist will look at the biopsied prostate tissue under a microscope. He or she will examine the way that the cancerous cells look compared to normal prostate cells.

If the cancerous cells appear to resemble the normal prostate tissue very closely, they are said to be very well differentiated and are considered to be Gleason grade 1. This means that the tumor is not expected to be fast growing.

On the other hand, if the cells in question look irregular and very different from the normal prostate cells, then they are very poorly differentiated and are assigned a Gleason grade 5.

Grades 2-4 are used for tumors that fall between grades 1 and 5, with higher numbers corresponding to a faster growing tumor. Because prostate cancer tissue is often made up of areas that have different grades, the pathologist will closely examine the areas that make up the largest portion of the tissue. Gleason grades are then given to the two most commonly occurring patterns of cells.

Once the two grades have been assigned, a Gleason score can be determined. This is done by adding together the two Gleason grades. The Gleason score that results will be a number from 2 to 10.

Because Gleason scores on their own can be confusing, you will most likely want to discuss your results with your physician. Your doctor can explain what your Gleason score, along with your other test reports, mean for you as an individual.

Although scores on the higher end of the Gleason scale (7 through 10) usually indicate a more serious prognosis, your age, emotional wellbeing, family support system, and physical health status are all individual factors that can influence the outcome of your disease. In addition, the treatment options that you and your physician choose will be important determinants to the outcome of your disease.

What is the Dukes system?

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Colorectal cancer is often staged according to the Dukes' system. You may hear your specialist talking about your colorectal cancer as a Dukes' A, B, C or D. This is what the classification means:

·        "Dukes' A" is a cancer that is only affecting the innermost lining of the colon or rectum

·        "Dukes' B" means the cancer has grown into the muscle layer of the colon or rectum

·        "Dukes' C" means the cancer has spread to at least one lymph node in the area

·        "Dukes' D" means the cancer has spread to somewhere else in the body such as the liver or lung

What is the best treatment for my cancer?

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This question is best asked of your cancer team. If you do not have a cancer team, then ask the physician that is treating you for cancer. Get good medical advice from a second source if necessary.

What are my treatment options?

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Learn about the most common forms of treatment and how they're used to fight cancer:

·        Surgery

·        Radiation Therapy

·        Chemotherapy

·        Immunotherapy

·        Antiangiogenesis Therapy

·        Blood Product Donation and Transfusion

·        Bone Marrow & Peripheral Blood Stem Cell Transplantation

·        Cord Blood Transplantation

·        Gene Therapy

·        Photodynamic Therapy

What else is important to know about treatments?

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Learn about these treatment-related topics:

·        Infections in Individuals with Cancer

·        Informed Consent

Are there any tools to help me with the treatment decision?

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Yes. The ACS has a Treatment Decision Tools page at http://www.cancer.org/docroot/ETO/eto_1_1a.asp?sitearea=ETO. You must register and sign in to use the tools. There is no cost. Treatment Decision Tools, like these Cancer Profilers, can help you make an informed decision about your treatment. Using these tools, you can access the detailed analysis of your specific condition, uncover a statistical breakdown of treatment types, and pinpoint the exact topics you should discuss with your doctor.

What do I need to know to make an informed treatment decision?

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·        Types of Treatment - Get detailed information about surgery, radiation, immunotherapy, and complementary therapies.

·        Cancer Drugs - Learn about chemotherapy, and pain control drugs.

·        Clinical Trials - Learn about clinical trials, why they're important, and what they involve.

·        How to Choose Treatment Facilities - Search for hospitals, health care facilities, and physician profiles to find a treatment center.

·        How to Choose Health Professionals - Search for physician profiles and recommendations.

·        Treatment Decision Tools - Get a detailed profile of a specific type of cancer to make informed choices about treatment.

·        Cancer Treatment Guidelines - Learn what professionals the leading cancer centers in the country recommend.

What questions should be asked before deciding on a treatment?

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Patients with cancer have to make very significant decisions about which, if any, treatment to take. The aims of treatment are often rather "woolly", and "success" is measured in things like reduced tumour markers or decreased size of abnormalities on CT scans. These things MAY be associated with improved outcome, but not necessarily so. The fact is that although technically treatments are complex and require skilled supervision, the decision to embark on a treatment should be, if not simple, at least amenable to being assessed logically and objectively.

This is the way I get my patients to look at the cost-benefit analysis when deciding on a course of treatment I have suggested would be right for them. The "algorithm" isn't specific to cancer, or even orthodox medicine, but most patients find it useful, and I hope some people on this NG may, too.

Question 1

Does the cancer I have pose a threat to my life or health?

If the answer to this is "No", then you probably shouldn't be taking treatment.

If yes, consider treatment by going to the next question.

Question 2

Does the suggested treatment have any realistic chance of curing me, and if so, are the side-effects and risks acceptable to me?

If the answer to either part of this is "No", then you probably shouldn't be taking treatment.

Otherwise go to the next question.

Question 3

Although the treatment stands no real chance of curing me, does it stand a realistic chance of extending my survival by some worthwhile amount, and are the side-effects/risks acceptable?

If the answer to either part of this is "No", then you probably shouldn't be taking treatment.

Otherwise go to the next question.

Question 4

Although the treatment stands no real chance of curing me, or of extending my survival, does it stand a realistic chance of improving my quality of life, after I have taken into account the side-effect/risks?

If "Yes", go for it.

If the answer is "No", then you probably shouldn't take the treatment.

A patient's quality of life is not measured by PSA levels, but by how they feel and how well they are able to carry on with their life. Improvement in a patient's quality of life is not measured by whether the oesophageal cancer looks smaller on the CT scan, but whether the patient can swallow better. A patient with bone pain is not better because the bone scan is better, but because the pain is better.

Think about it. - Steph

How would you change this to help a patient who has two or more treatments to consider?

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I think it would be the same .... Ask yourself whether treatment is necessary at all, then ask the questions for each individual treatment, I guess. - Steph

What are practice guidelines?

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Practice guidelines are the standard accepted practices a physician uses to treat cancer patients. As a patient, you can view NCCN Physician Guidelines Treatment of Cancer by Site at http://www.nccn.org/physician_gls/f_guidelines.html.

What general questions should you ask your doctor?

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·        What kind of cancer do I have?

·        How far along is my cancer? (What stage is it?)

·        Should I get a second opinion?

·        What are all my treatment options?

·        What treatments are best for me?

·        How long will my treatments last?

·        Will I have to stay in the hospital to get my treatment? For how long?

·        Will my treatment keep me from doing certain things I enjoy?

·        How often will I need to be checked after my treatment?

·        Can I go back to my normal daily activities after treatment?

·        Are there any clinical trials that I might want to join?

·        What has been your experience with lung cancer patients like me?

·        Can you recommend any patient support groups in my area?

·        Is there anything I should read about my cancer?

What should you ask your medical oncologist about chemotherapy?

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·        How has chemotherapy changed for the better in recent years?

·        How can chemotherapy ease the symptoms of my cancer?

·        What drugs can I take to help me handle the side effects?

·        Should I consider taking chemotherapy as a preventative treatment?

·        How long will my chemotherapy treatments last?

·        Will I be able to return to my normal activities after chemotherapy?

·        What experiences have other patients had with chemotherapy?

What should you ask your doctor about surgery?

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·        Am I a good candidate for surgery?

·        Will I be able to return to my normal life after surgery?

·        What are the chances that surgery will remove all of my cancer?

·        Should I consider taking chemotherapy or radiation after surgery to make sure all the cancer is destroyed?

·        What exercises can I do after surgery to get stronger?

·        How have your other surgery patients felt about the procedure?

What should you ask about a clinical trial?

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·        What are the possible risks and benefits?

·        What are possible side effects of the treatment?

·        How long will the trial last?

·        Will I have to travel to another hospital, city or state?

·        Will my insurance cover the costs of this treatment?

·        Can I have family members with me when I receive treatment?

·        Will I have to change doctors during the trial?

You should talk with your doctor about any clinical trials you might want to join. It is important to remember that while clinical trials have been helpful for many patients, there is no guarantee that a new treatment will work for you.

What questions should be asked of the surgeon?

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The American College Of Surgeons suggests a list of questions for you to ask when your doctor recommends surgery:

·        What indications have led your doctor to suggest an operation?

·        What, if any, alternative treatments are available?

·        What will be the result if you do not have surgery?

·        What are the basic procedures?

·        What are the risks?

·        How can the operation improve your health or quality of life?

·        How long will you be in the hospital?

·        What can you expect for your recovery period?

·        When can you resume normal activities?

·        What effects will there be from the operation?

What questions should be asked by patients with colon and rectal cancer?

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·        Am I in a high-risk group for colon or rectal cancer?

·        If so, are my children or other relatives also at risk?

·        How often should family members or I be screened?

·        What is the most accurate test?

·        Are these procedures painful?

·        If polyps are found during a screening test, what is done?

·        Are screening tests covered by insurance?

·        If a screening test is positive, what tests are used to diagnose colon or rectal cancer?

·        How quickly will I learn the results?

·        Who will get the results and interpret them for me?

·        If I am diagnosed with colon or rectal cancer, what is the next step?

·        Should I get another opinion? If so, from whom?

·        What is the extent of my cancer? Has it spread?

·        What treatment or treatments would you recommend for me?

·        How successful has this treatment been for others in similar situations?

·        What type of specialist should I see first? A surgeon, a medical or radiation oncologist?

·        If I need major surgery, will I have to have a colostomy? If so, for how long?

·        What will happen if I don't follow your suggested treatment plan?

·        Will my treatment require hospitalization? For how long?

·        What should I expect from the treatment? Will it make me sick?

·        What are my chances for a full recovery based on others with similar cancers?

·        After treatment, how often should I get checked to see if the cancer has returned?

What questions should patients with brain cancer ask their physician?

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·        How many brain tumors do you treat each year?

·        Does your practice include multidisciplinary care?

·        Do you discuss complicated brain tumor cases at a tumor board type of meeting, and what kind of specialists attend such meetings?

·        Was my pathology slides reviewed by an experienced neuropathologist?

·        Do you favor second opinions?

·        Are there brain tumor centers of excellence that you recommend?

·        Do you work with a social worker who assists brain tumor patients?

·        Do you have or know of a local support group for brain tumor patients?

·        Do you have reading material that would help me understand my disease?

·        Are you willing to follow my case if I have my treatments provided in another center?

·        What protocols do you have that would be appropriate for my type of tumor?

What questions should patients with breast cancer ask their physician?

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·        Do I have noninvasive or invasive cancer?

·        How much staging and further testing do I need?

·        How will my lymph nodes be evaluated; that is, what type of biopsy will be done?

·        Has my cancer been tested for estrogen and progesterone receptors and other needed studies? If not, when will that be done?

·        Can I have breast conservation therapy done? If not, why not? If I take chemotherapy first and the cancer shrinks, can this treatment be done then?

·        Will I need radiotherapy? Why? What will it accomplish?

·        Will I be offered tamoxifen if estrogen or progesterone receptors were positive?

·        Am I eligible or suitable for a clinical trial?

·        What is my chance of remaining well in the next 5-to-10 years? If I take chemotherapy, how much will that improve my chance of survival?

·        What side effects should I expect?

What questions should patients with common gynecologic cancers ask their physician?

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·        Are you board certified in Obstetrics and Gynecology and do you have a Certificate of Special Competence in Gynecologic Oncology or are you board certified in Medical Oncology?

·        Are you involved in clinical trials in ovarian, cervical and endometrial cancers through a national cooperative group such as the Gynecologic Oncology Group, Southwest Oncology Group or Eastern Cooperative Oncology Group?

·        Who is available for questions or emergencies at night and on weekends and how do I reach them?

·        Is your practice restricted to patients with gynecologic cancers?

·        Following surgery for endometrial cancer, what will determine whether I will require further treatment with radiation therapy?

·        Will I be able to work or care for my family during treatment for my cancer? What is the recovery period following surgery, chemotherapy or radiation therapy?

·        Do all patients with ovarian cancer require chemotherapy?

·        How long will I need to receive chemotherapy following surgery for ovarian cancer? Will I have surgery again after completion of chemotherapy?

·        How will the treatment of my cancer affect my ability to have children? Will treatment of my cancer cause me to go through the menopause?

·        Can I take estrogen replacement therapy following surgery for endometrial or ovarian cancer? What are the potential risks and benefits of estrogen therapy?

·        If I am treated for cervical cancer with radiation therapy, will I also require chemotherapy with the radiation therapy? How, when, and where will the chemotherapy be administered?

·        How will the treatment of my cancer affect sexual function? If I have problems with sexual function during or after treatment, with whom can I discuss this problem?

·        How often will I be seen following completion of treatment? What can I expect at these office visits? Will I have routine tests performed to determine whether my cancer is in remission?

What questions should patients with kidney cancer ask their doctor?

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·        Do you obtain a detailed medical history on your patients?

·        Do you educate your patients on the causes of kidney cancer, the options of treatment, the risks and what would happen if nothing were done?

·        Do you normally take care of patients with kidney cancer? How many?

·        What type of staging x-rays do you obtain on your patients with kidney cancer?

·        Do you do kidney surgery? How many per year?

·        What are your indications for either a radical nephrectomy or partial nephrectomy?

·        What complications can I expect from either type of surgery?

·        What is the chance of the kidney cancer coming back after surgery? And where?

·        What type of follow-up do you do on kidney cancer patients?

·        Do you treat metastatic disease? If not, do you refer to an oncologist who does?

·        What type of immunotherapies do you work with?

·        Do you perform clinical trials in kidney cancer?

What questions should patients with multiple myeloma ask their physician?

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·        What criteria do you use to make the diagnosis of multiple myeloma?

·        Do I have MGUS, smoldering myeloma or solitary plasmacytoma as an explanation for my elevated level of monoclonal protein?

·        What stage of multiple myeloma do I have?

·        What are my therapeutic options and how did you arrive at your current treatment recommendation?

·        What are the side effects of treatment and is there anything I can do to reduce the severity of side effects? What directions will you and your staff provide me if side effects do occur?

·        Am I a candidate for high dose chemotherapy with stem cell rescue or allogeneic bone marrow transplant?

·        Am I a candidate for supportive care treatments including bisphosphonates or erythropoietin?

·        What diagnostic tests will you perform to monitor the status of my disease and at what frequency will these be performed?

·        Will you or your office staff direct me to a support group for patients and their families?

·        What is your opinion of research trials and am I a candidate for any clinical trials designed to improve the treatment of myeloma?

·        Do you work with clinical investigators who might have access to new treatments for myeloma?

What questions should patients with prostate cancer ask their physician?

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Diagnosis

·        Has my cancer spread (metastasized) to other parts of my body?

·        What stage is my cancer?

·        Can you tell if this is a fast-growing type of prostate cancer, or a slow-growing type? What is the Gleason sum and are there other prognostic factors that we should investigate?

Tests

·        What tests will I have done?

·        When should I expect the results from these tests?

·        What will these tests tell me about my cancer?

·        If I need to get copies of my records, scans, X-rays, whom can I contact?

Treatment

·        What is the standard treatment for my type of prostate cancer?

·        What is the prognosis (outlook) for my type of prostate cancer with such standard treatment?

·        Are there any other treatments that might be appropriate for my type of prostate cancer?

·        What treatment do you recommend? Based on what?

·        What are the comparative risks or benefits of the treatment you are recommending?

·        Are there any other treatments that might be appropriate for this type of prostate cancer?

·        Will there be tests during my treatment to determine if it is working?

·        Where will I receive my treatment?

·        How will I receive my treatment? Is it a pill? Is it an injection?

·        What will it feel like to be treated?

·        Can I drive to and from my appointments?

·        Can I stay alone after my treatments, or do I need to have someone stay with me?

·        Will I have to be in the hospital to get my treatments?

·        Who will administer my treatments?

·        How often, during treatment, will I see a physician? The nurse?

Clinical Trials

·        Are there any clinical research studies or research being done on my type of prostate cancer?

·        Are you involved in clinical trials?

·        Would I be a candidate for clinical research if it were a treatment option for me?

·        Where can I find out more about research on prostate cancer?

·        Is there anyone else in the area involved in research that I might contact to discuss my prostate cancer?

Economics

·        How do I find out what portion of the treatment my insurance company will cover?

·        Is there someone in your office (or facility) who assists patients with questions about insurance? Who would that be?

·        If my insurance does not pay for a particular treatment or medication that might be beneficial to me, will you choose an alternate treatment? Could it be less effective?

·        Do you have access to pharmaceutical patient assistance programs that I could use if I cannot afford a particular medication or my insurance will not pay it?

·        To whom can I talk about getting treatment if I do not have insurance?

·        Side Effects

·        What are the possible side effects of this treatment?

·        When might these side effects occur?

·        Could these side effects be life threatening?

·        How long will the side effects last?

·        What can/will be done to prevent these side effects or reduce their possibility?

What questions should you ask the oncologist?

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Why do you recommend radiation treatment?

·        What Stage is my cancer?

·        What is the significance of cancer found in the lymph nodes?

·        Why is radiation recommended for me?

·        Why is it necessary to radiate the lymph nodes?

·        What is a port?

·        Can you show me where these lymph nodes are and what part of my body would be radiated?

·        Do I have any other choice of treatment? (Surveillance? Chemo?)

·        If surveillance is an option (If you are Stage 1, it is an option), can I see a medical oncologist before making a decision about the radiation treatments?

·        What are the benefits of having radiation?

·        What are the risks and side-effects of the treatments?

·        What do I have to gain or lose by not having the radiation now?

·        Will I be cured?

·        If I choose surveillance and the cancer comes back, will I be treated by radiation or by chemotherapy?

·        What type of costs am I looking at?

·        Have you treated someone for this stage and type of cancer before? If so, how many?

·        What percentage of patients usually responds to this treatment?

·        How quickly must I decide about my treatment?

·        Will a reduction or delay in treatment reduce my chances of being cured?

Radiation Treatment

·        How soon should radiotherapy be started?

·        In what form and how often will the treatment be given?

·        What kind of radiation are you going to use?

·        How does the doctor work out the radiotherapy dose?

·        How long will each treatment take?

·        How long will the entire course of therapy last?

·        Where will I have to go for treatment?

·        Who will administer my treatments?

·        How often, during treatment, will I see a physician? a nurse?

·        Can I drive to and from my appointments?

·        Will I need someone to accompany me to the treatments?

·        Can I stay alone after my treatments, or do I need to have someone stay with me?

·        Can I continue to work, exercise, etc. during these treatments? Are there special precautions I should take while on radiotherapy or afterwards?

·        What will it feel like to get treated?

·        What type of results should I expect to see with the treatment?

·        Will there be tests during my treatment to determine if it is working?

·        Are there any medications I should not take while I'm going through treatment?

·        What are the precautions or restrictions during treatment? After treatment? (For example, skin creams, lotion, underarm shaving, etc.)

·        Are there any activities I should or should not do while I'm going through treatment?

After The Radiation Treatments

·        What happens when the treatment finishes?

·        What does it take to say we're done? What are the criteria to stop treatment and go to the monitor phase?

·        How can I tell if the treatment is working?

·        How long will it be before I feel better and can get back to my normal routine?

·        How often is checkups and tests required after treatment is completed and which specialist will manage my care?

·        Would you be willing to consult with an expert if a problem arises?

Radiation Related Side Effects

·        What are the side effects of this treatment?

·        Nausea?

·        Vomiting?

·        Hair loss (will my hair grow back in the radiation port?)

·        Low blood cell counts? (anemia: low red-blood-cell count, neutropenia: low count of one type of white-blood cell, low platelets, etc.)

·        Diarrhea/constipation?

·        Skin changes?

·        Incontinence?

·        Infertility?

·        Pain?

·        Sores along the digestive tract?

·        Ulcers?

·        Fatigue?

·        When might these side effects occur?

·        How long will the side effects last?

·        What can I do to reduce the side effects?

·        Will side effects get better/worse/same over the course of treatment?

·        What kind of "schedule" can I expect during the radiation treatments (when will I begin having nausea, when will I stop having nausea.)?

·        How can I get practical advice in dealing with side effects?

·        Could these side effects be life threatening?

·        Which side effects should I report to the health care provider immediately?

·        Will my treatment affect driving?

·        Will the treatment affect my work/education?

·        Will I still be able to look after my family, or will I need help?

·        Does radiotherapy make you radioactive?

·        Will radiotherapy make my hair fall out?

·        How will it affect my sex life?

·        If I can have sex during or after my treatment, will my partner be at risk in any way?

·        What type of precautions do I need to take?

·        Will radiotherapy make me infertile?

·        Will I be able to father children after the treatment?

·        How can I find out more about the sperm banking service?

·        What are the long-term side effects of radiotherapy?

·        Will I be able to live a normal life when I get older?

Radiation Support

·        Whom can I talk to about problems with sex and fertility?

·        Where can we go to get emotional/mental/marital/medical support during treatment? Does the hospital/clinic offer such services?

·        I'm worried about what my friends will say. How can I handle that?

Radiation Miscellaneous

·        Can changing what I eat help me recover from my cancer and/or the radiotherapy?

·        Is there anything I should avoid?

·        Whom can I talk to about what I should be eating?

·        What are the telephone numbers I should have in order to reach you? The nurse? The hospital?

·        When do I next see you?

What is the purpose behind questions to the doctor?

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You should ask these questions to assure yourself that the doctor takes a meticulous, thorough approach to diagnosis and treatment, and that he or she is accessible and flexible.

What rights does a patient have?

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The Patient's Bill of Rights was first adopted by the American Hospital Association in 1973 and revised in October 1992. Patient rights were developed with the expectation that hospitals and health care institutions would support these rights in the interest of delivering effective patient care. The American Hospital Association encourages institutions to translate and/or simplify the bill of rights to meet the needs of their specific patient populations and to make patient rights and responsibilities understandable to patients and their families. According to the American Hospital Association, a patient's rights can be exercised on his or her behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.

The Patient's Bill Of Rights

·        The patient has the right to considerate and respectful care.

·        The patient has the right and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information about his or her diagnosis, treatment, and prognosis.

·        Except in emergencies when the patient lacks the ability to make decisions and the need for treatment is urgent, the patient is entitled to a chance to discuss and request information related to the specific procedures and/or treatments available, the risks involved, the possible length of recovery, and the medically reasonable alternatives to existing treatments along with their accompanying risks and benefits.

·        The patient has the right to know the identity of physicians, nurses, and others involved in his or her care, as well as when those involved are students, residents, or other trainees. The patient also has the right to know the immediate and long-term financial significance of treatment choices insofar as they are known.

·        The patient has the right to make decisions about the plan of care before and during the course of treatment and to refuse a recommended treatment or plan of care if it is permitted by law and hospital policy. The patient also has the right to be informed of the medical consequences of this action. In case of such refusal, the patient is still entitled to appropriate care and services that the hospital provides or to be transferred to another hospital. The hospital should notify patients of any policy at the other hospital that might affect patient choice.

·        The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision-maker and to expect that the hospital will honor that directive as permitted by law and hospital policy.

·        Health care institutions must advise the patient of his or her rights under state law and hospital policy to make informed medical choices, must ask if the patient has an advance directive, and must include that information in patient records. The patient has the right to know about any hospital policy that may keep it from carrying out a legally valid advance directive.

·        The patient has the right to privacy. Case discussion, consultation, examination, and treatment should be conducted to protect each patient's privacy.

·        The patient has the right to expect that all communications and records pertaining to his/her care will be treated confidentially by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize confidentiality of this information when it releases it to any other parties entitled to review information in these records.

·        The patient has the right to review his or her medical records and to have the information explained or interpreted as necessary, except when restricted by law.

·        The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient also must have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.

·        The patient has the right to ask and be told of the existence of any business relationship among the hospital, educational institutions, other health care providers, and/or payers that may influence the patient's treatment and care.

·        The patient has the right to consent to or decline to participate in proposed research studies or human experimentation or to have those studies fully explained before they consent. A patient who declines to participate in research or experimentation is still entitled to the most effective care that the hospital can otherwise provide.

·        The patient has the right to expect reasonable continuity of care and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.

·        The patient has the right to be informed of hospital policies and practices that relate to patient care treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital's charges for services and available payment methods.

What are the patients responsibilities?

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The collaborative nature of health care requires that patient and/or their families and surrogates participate in their care. The effectiveness of care and patient satisfaction with the course of treatment depends, in part, on the patient's fulfilling certain responsibilities:

·        Patients are responsible for providing information about past illnesses, hospitalizations, medications, and other health-related matters. .

·        Patients must take responsibility for requesting additional information or clarification about their health status or treatment when they do not fully understand the current information or instructions.

·        Patients are responsible for making sure that the health care institution has a copy of their written advance directive if they have one.

·        Patients are responsible for informing their physicians and other caregivers if they anticipate problems in following prescribed treatment.

·        Patients also should be aware that the hospital has to be reasonably efficient and equitable in providing care to other patients and the community. The hospital's rules and regulations are designed to help the hospital meet this obligation.

·        Patients and their families are responsible for being considerate of and making reasonable accommodations to the needs of the hospital, other patients, medical staff, and hospital employees.

·        Patients are responsible for providing necessary information for insurance claims and for working with the hospital as needed to make payment arrangements.

·        A patient's health depends on much more than health care services. Patients are responsible for recognizing the impact of their lifestyles on their personal health.

The above information is from the following web site http://www.cancer.org/docroot/MIT/content/MIT_3_2_Patients_Bill_Of_Rights.asp and is ©Copyright 2003 American Cancer Society, Inc.

The Patient's Pledge

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The Patient's Pledge

I will be heard.

I will not be intimidated.

I will listen to my body, my symptoms matter.

I will be fully informed and be included in the final decision.

I will have the best care.

I am entitled to hope.

I am entitled to compassion and to be treated with dignity.

I will stand up for my own best interests.

I will praise good care and report bad care.

I will be safe.

(anonymous) From http://www.ibcsupport.org/new.html

How can I choose the right cancer doctor?

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Here are some tips for picking the right doctor:

Check volume. High volume surgeons tend to have better results. If you need surgery, look for a high volume surgeon whose specialty is in the type and stage of your cancer. For example, if you have stage III breast cancer then you want a surgeon who does many stage III breast cancer surgeries. Surgeons who do a lot of the type of surgery you need is likely to have the experience you're looking for and be more up-to-date on the latest surgical techniques specific to that type of surgery. Contact the hospital where the doctor practices and ask about his/her surgery volume for your type and stage of cancer.

Check reports. Call your state board of quality assurance and ask for any information (e.g., malpractice cases, quality of care complaints) they have on file about the doctor. This information may not be published but should be available. Keep in mind that doctors who treat a large number of cancer cases each year may have more information on file than a doctor who treats fewer cases, so take into account the doctor's treatment volume when you're checking out the numbers and consider percentages rather than actual numbers.

Check credentials. Check the credentials of any doctors involved in your treatment, including your surgical oncologist, medical oncologist, radiation oncologist, and radiologist. Look at this example for picking a highly qualified surgical oncologist. Just because a doctor is listed as a specialist in an area doesn't mean he/she is board-certified in that area. Choose specialists who are board-certified for their specialty; ideally they might even have a sub-specialty in your particular cancer as well. In addition to the professional organization that certifies healthcare professionals in specific areas, reputable resources for locating and finding information about a healthcare professional include:

·        National Cancer Institute's (NCI) Cancer Information Service at 1-800-4CANCER

·        Physician.com at 1-888-YOUR-DOC

·        American Society of Clinical Oncology (ASCO)

·        American Medical Association (AMA)

·        1-800-776-CERT.

Choose honesty over sensitivity. Pick a doctor who's going to be upfront and honest with you, not one who has a hard time delivering bad news or isn't willing to discuss the inevitable uncertainties around treatment outcomes. You need to be told the truth regardless of how difficult it is to bear and may appreciate this in the end.

Choose an educator over a decision-maker. Choose a doctor who educates you about your disease and treatment options and guides you in understanding these options. You must be able to fully utilize your doctor as an information source but remain autonomous and an active participant in your care and the ultimate decision-maker. You want your doctor to give you opinions, information, and data but you don't want him/her to make all the decisions for you.

Go with who feels right. Pick a doctor you trust and with whom you are comfortable. Don't be afraid to choose a different doctor if you don't feel comfortable, even if you've already started treatment. When you have cancer, your relationship with your doctor is one of the most important relationships in your life. Remember, you're putting your life in their hands.

Look for teamwork. Look for a treatment center that encourages their health care professionals to work as a team in determining treatment for each patient's unique situation. In these multidisciplinary environments, health care professionals often meet regularly to discuss a patient's status and test results and coordinate recommendations for the patient's optimal treatment.

Where can I get general help finding a doctor, surgeon, or hospital?

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Locate the board that certifies that cancer specialty and request a list of recommended surgeons.

Where can I find cancer centers listed by state?

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There is a link to "NCI-designated Cancer Centers (P30), Cancer Centers Listed by State" in the links section of this FAQ.

What professional medical associations will help locating centers or doctors?

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http://www.ama-assn.org/aps/amahg.html AMA Physician Select provides basic professional information on virtually every licensed physician in the United States and its possessions, including more than 690,000 doctors of medicine (MD) and doctors of osteopathy or osteopathic medicine (DO).

http://www.cancer.gov/clinicaltrials/finding/NCI-cancer-centers/map/ NCI Cancer Centers

Where can I find hospitals or physicians worldwide?

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http://directory.google.com/Top/Health/Medicine/Hospitals/ Search for a hospital using Google Directory

Use the Worldwide Directory of Oncologists / Hematologists at http://www.worldoncology.net/Patient_Resources.htm to find a hospital or physician worldwide.

Where can I find research about correlation of high volume colon cancer surgery and patient outcome?

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Research showing a correlation between higher volume of colon cancer surgery and better patient outcomes can be found at http://www.healthcarechoices.org/coloncansurgery.htm#colonres

Where can I find information about surgery volume by hospital or doctor?

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Surgery volume information about individual hospitals and doctors http://www.healthcarechoices.org/surgvol.htm

How can I locate a colorectal surgeon?

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Locate a colorectal surgeon at http://www.fascrs.org/

How can I find a breast cancer specialist?

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How to find a breast specialist http://www.nabco.org/index.php/index.php/177

How can I find an oncologist?

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Find an Oncologist http://www.asco.org/ac/1,1003,_12-002215,00.asp

Where can I find information about doctors and hospitals in my state?

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ASCO Cancer Centers and Cooperative Groups http://www.asco.org/ac/1,1003,_12-002414,00.asp

How can I get a referral?

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Doctor referrals are common. Ask your doctor to give you some recommendations from which you may choose. After discussing about what is best for you, your doctor can arrange for you to get help with a specialist.

Can I refer myself?

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Another option is self-referral, where you contact the cancer center and apply for treatment. Self-referral can be done over the telephone or via websites. MD Anderson is one such cancer center that has a website explaining the procedure https://www2.mdanderson.org/sapp/contact/sreferral.cfm.

How can I get a second opinion?

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Before starting treatment, the patient may want to have a second opinion from another doctor about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it.

There are ways to find a doctor who can give a second opinion:

·        The patient's doctor may be able to suggest specialists to consult.

·        The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer treatment facilities all over the country, including cancer centers and other programs supported by the National Cancer Institute.

·        Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

·        The Official ABMS Directory of Board Certified Medical Specialists lists doctors names along with their specialty and their educational background. This resource, produced by the American Board of Medical Specialties (ABMS), is available in most public libraries. The ABMS also provides an online service to help people locate doctors http://www.certifieddoctor.org/

What is outside consultation?

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Some centers and hospitals are equipped to give a second opinion through a process called outside consultation where you do not have to travel to the distant cancer center or hospital. Your test results, images, and reports are forwarded to the center for evaluation. A team of specialists will review the records and issue a second opinion.

Where can I get an outside consultation?

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Ask your health care provider for assistance. You should contact the cancer center or hospital for further information. Some may have Internet sites that give information or allow you to initiate outside consultation. For example; you can get more information or request an outside consultation at MD Anderson Cancer Center at http://www3.mdanderson.org/depts/pathology/consult.html.

How can I get travel assistance for treatment?

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The National Patient Travel Helpline http://www.patienttravel.org/

What about reduced airfares for cancer patient treatment?

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If you are traveling to a hospital or cancer center in another city, ask if they have a discount arrangement with an airline for the patient and family. For example, M.D. Anderson has a discount program with Continental Airlines that allows reduced fares for patients and family when traveling for cancer treatment.

What about free air travel?

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AirLifeLine http://www.airlifeline.org/a1/servlet/visit/ coordinates free air transportation for people in need.

Do corporations help cancer patients travel free for treatment?

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Yes. Corporate Angel Network http://www.corpangelnetwork.org/ arranges free travel on corporate jets for cancer patients, bone marrow donors and bone marrow recipients, as long as they:

·        Travel to or from an approved cancer treatment center

·        Are able to walk up and down the steps to a private plane without assistance

·        Do not require oxygen, IV or any other form of life support during the flight

What can I do if I do not qualify to travel free?

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Ask if the cancer center/hospital has an arrangement for reduced airfare, local transportation, and lodging. Some have arranged for their patients to get reduced fares with an airline. You may have to have a patient number to get the reduced fare. The cancer center/hospital can provide information on how to get the best fare.

Where can I find local transportation from the airport to the treatment center?

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Some centers/hospitals may have arrangements with taxi/limo companies to provide reduced fares. Check with the center/hospital for details.

Where can I find lodging near the treatment center for my family?

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If you are traveling to a hospital or cancer center in another city, ask if they have a hotel on-site, and use it, if possible. They may be able to check you in at the hotel and take routine blood and urine samples in your room. For example, M.D. Anderson owns the Rotary House International and provides those services. Some centers/hospitals may have similar facilities or arrangements with local hotels. Check with them for details.

Will a nonprofit organization help if I can't afford lodging?

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The National Association of Hospital Hospitality Houses, Inc. http://www.nahhh.org/ is a nonprofit corporation serving facilities that provide lodging and other supportive services to patients and their families when confronted with medical emergencies.

Who can help me find free or low cost travel and lodging for care?

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·        Air Care Alliance helps cancer patients travel to distant health centers for care. You may call ACA at 1-888-662-6794 toll free in the U.S. Direct number 757-318-9145, or visit their web site at http://www.aircareall.org/

·        The American Cancer Society (ACS) sponsors Hope Lodges, which provide free lodging for those who travel to receive cancer care. Check your local phone book, or visit their web site at http://www.cancer.org/frames.html

·        The Candlelighters Childhood Cancer Foundation can help you make travel arrangements. In the U.S., call (301) 657-8401 or 1-800-366-CCCF. In Canada, call 1-800-363-1062. Also on the Web at http://www.candlelighters.org/

·        Corporate Angel Network helps cancer patients travel to distant health centers for care. Call (914) 328-1313, or visit their web site at http://www.corpangelnetwork.org/

·        The Leukemia Society of America will reimburse up to $750 per year in travel expenses. Call 1-800-955-4LSA, or visit their web site at http://www.leukemia.org/hm_lls

·        Mercy Medical Airlift helps cancer patients travel to distant health centers for care. Call 1-800-296-1191, or visit http://www.mercymedical.org/

·        National Association of Hospital Hospitality Houses (NAHHH) can recommend nearby hotels with reduced rates for cancer patients. Call (301) 961-3094, (317) 883-2226, or 1-800-542-9730; or visit http://www.nahhh.org/

·        The National Cancer Institute, Bethesda, Maryland, will, in some cases, help pay for the travel and lodging expenses of those being treated at the NCI. Call 1-800-4-CANCER.

·        Ronald McDonald House Coordinator, c/o McDonalds Corporation, provides free lodging for children who are being treated for cancer. Call (630) 623-7048, or visit http://www.rmhc.org/home/index.html

·        The Shriners' Hospitals provide free treatment for children who need orthopedic or burn remediation. In the United States, call 1-800-237-5055. In Canada, call 1-800-361-7256. On the Web at http://www.shrinershq.org/index.html.

Where can lymphoma patients get financial assistance?

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·        Try this site for some links to financial help http://www.lymphomainfo.net/surviving/financial.html. While this site cannot help those in financial need, there are a number of organizations in the United States and throughout the world to help those who cannot afford all aspects of treatment. Aid is often for specific needs: transportation costs, drug costs, etc. Some aid is directed to specific groups of patients such as children. The site may have chemotherapy drugs listed at reduced or no cost for people with a proven need. This site contains the following Financial Help Links:

·        Drugs

·        Children

·        US Patient Aid

·        US Travel Help

·        US Social Security

·        United Kingdom

How do people without medical coverage get treatment for breast cancer?

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http://www.mickaela.org/ provides assistance for uninsured breast cancer patients.

What about people without medical coverage that have other cancers?

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Check the links section for your cancer type for a foundation

Where can I get financial assistance for cancer care?

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http://www.thecancer.info/financial_aid.htm Financial Assistance for Cancer Care

Who can help with questions about family or medical leave?

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U. S. Office of Personnel Management, Final Regulations on Family and Medical Leave at http://www.opm.gov/oca/fmla/ The Office of Personnel Management (OPM) has issued final regulations implementing Title II of the Family and Medical Leave Act of 1993 (FMLA). OPM's final regulations were published in the Federal Register on December 5, 1996, and were effective on January 6, 1997.

For further information, please contact OPM's Compensation Administration Division on (202) 606-2858 or FAX: (202) 606-0824 or send an e-mail to payleave@opm.gov.

I am a U.S. citizen with financial and employment concerns due to cancer. What legal rights do I have?

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Many patients and families have financial concerns related to the strain of medical expenses, the cost of daily living and the threat of potential loss of employment and/or insurance. It is important for you to know that legally:

1. You cannot be fired

2. Your insurance cannot be terminated

3. You cannot be discriminated against if you do not have health and disability insurance.

Some resources are available for US residents:

4. If you have been refused insurance by health insurance carriers, see if there is a state Comprehensive Insurance Program.

5. Look for information on whether your state has care available for outpatient services; contact the State Department of Health or your county social services department.

6. Medical assistance, known as Medicaid, is available for people in most states who meet certain income guidelines. You can apply for this program through your county Department of Social Services.

7. The Leukemia and Lymphoma Society provides up to $500 a year for outpatient expenses for patients with leukemia, lymphoma, hodgkin's disease or multiple myeloma. For additional information, contact your hospital social worker.

8. The American Cancer Society chapter in your state provides information on resources for travel or housekeeping expenses. For more information, contact the chapter in your community or your hospital social worker.

9. If you are unable to pay for treatment, contact a hospital or county social worker.

10. If your illness becomes prolonged, you may be eligible for disability insurance through your place of employment or for Social Security Disability. Contact the local/regional office of the Social Security Administration for further information about Social Security Disability. Social Security Online is located at http://www.ssa.gov/ . Your employer can answer questions about disability insurance through your job.

11. Free treatment resources

The National Cancer Institute

Bethesda, MD

1-800-4-CANCER

The Shrine of North America

Shriner's Hospitals

In the United States, call 1-800-237-5055

In Canada, call 1-800-361-7256

The St. Jude Children's Research Hospital

(901) 495-3300

How can I cut costs for nonprescription items?

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Get nonprescription items i.e. nutritional drinks on prescription from your pharmacist, when you can. That way insurance/Medicaid will pay for them.

What is the impact of having cancer?

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Please refer to The Psychosocial Impact of Cancer on the Individual, Family, and Society, by Linda M. Gorman, RN, MN, CS, OCN(r), CRNH, at http://www.ons.org/images/Library/ons_publications/PDFs/Books/Psychosocial1.pdf

How should we deal with the stigma of cancer?

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Foster an environment that allows patients to be free of blame and stigma for having the disease. In the case of lung cancer, it is unfortunate that the leading cause of death is highly stigmatized due to its association with smoking. Some people with lung cancer think they are not deserving of treatment. They are a lot quieter than people with HIV/AIDS are. They are a lot quieter than women with breast cancer are. This is a deadly silence.

What are the ranges of emotion that normally accompany a diagnosis of cancer?

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The emotions you will experience are denial, anger, depression, bargaining, and acceptance. They occur in that order, so when you have reached acceptance you have completed the cycle.

What is denial?

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Denying that it is really a cancer, and hope, despite all odds, that it will all be made well, or it will be discovered to be a misdiagnosis - this sort of delusion has been observed to last for several years in some patients. Some others just accept "the death sentence" and die. Not all who die have given up. Not every dying person comes to terms with what is happening in a way that is clear to the outside observer. Can we say who is right, and who is wrong?

Denial is the patient's refusal to take on board the bad news. It is a complex concept that has different meanings in different contexts and serves a multitude of functions. When a person finds the challenges too overwhelming, denial may be the coping strategy that "works". Denial, in this situation, provides psychological protection. However, denial of the illness or of its severity for some patients can cause delayed diagnosis or compromised compliance with treatment. Furthermore, denial is used within an interpersonal context. Each person determines what information can be shared with others. Denial is not an all or nothing phenomenon. Most people use denial to one degree or another, denying some aspects of their illness at least some of the time. This denial may fluctuate widely on a day-to-day or even minute-to-minute basis. It is a dynamic process.

How to deal with denial?

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Please refer to Denial in Cancer Patients, by Dr. Shirley H. W. Zhang, and Dr Doris Tse, at http://www.fmshk.com.hk/hkspm/newsletter/200207_07.pdf

How to deal with the anger?

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Anger may be a result of depression or the result of utter frustration. Frustration can be channeled into seeking ways to improve the situation. Better to work towards better palliative care than to curse the absence of a cure.

Is depression a problem for cancer patients?

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Yes, more than in the general population. Depression cannot be cured. However, it can be effectively treated. Please refer to Depression and Cancer, by Chris Woolston at http://www.principalhealthnews.com/topic/depcancer/

I am a caregiver for a cancer patient, what should I know to be most effective?

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Many people are caring for a chronically ill or disabled spouse, parent, or other family member. Caregiving can be a rewarding experience, especially when you know that your care makes a positive difference. However, caregiving can be difficult. There are three secrets to being a good caregiver:

·        Take care of yourself first.

·        Don't help too much.

·        Don't do it alone.

Where can I find other cancer patient support organizations?

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ASCO, Patient Support Organizations at http://www.asco.org/ac/1,1003,_12-002412,00.asp

How do I deal with fear?

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As a cancer patient or family of a cancer patient, it is normal to feel fear. Learn all you can about the illness and the treatments. Don't be afraid to ask hard questions of your doctors. Try to channel that energy into gaining confidence and improving the situation.

I am worried that there will be a relapse, what should I do?

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It is normal to be worried. Try not to be overly concerned if there has been no diagnosis of relapse. Put yourself into a positive state of mind, as it will improve your day-to-day life.

I feel alone with no one to talk to, what should I do?

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Go to news:alt.support.cancer and share those feelings with the group.

I am suffering with a lot of pain, what should I do?

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There is a section on dealing with pain at http://www.cancer-pain.org/. Some general recommendations are:

·        Notify your doctor if pain management is not working

·        You may wish to post on news:alt.support.chronic-pain or news:alt.support.chronic.pain and seek advice.

·        Breakthrough pain can be treated with Actiq, which, is developed specifically to help manage BTCP. See http://www.actiq.com/patients/aboutactiq/default.asp (Commercial site)

Is it possible to have cancer and a healthy sex life?

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For some patients the answer is yes.

Here are some things you can do to get ready for sexual activity:

·        Plan sexual activity for the time of day when you have the most energy and your health problem bothers you the least.

·        Be sure that you are rested and relaxed.

·        Wait at least 2 hours after you eat.

·        If you need pain medicine to feel better, take the medicine 30 minutes before sexual activity.

·        Limit the amount of alcohol you drink, and avoid using tobacco in any form. Alcohol and tobacco can affect sexual function.

Here are some suggestions about what you can do to maintain your sex life:

·        Hold hands, hug, and touch your partner, even when you do not plan to have sex.

·        Use your senses to make sexual activity richer. For example, have satin sheets on the bed, lightly-scented candles, or play music.

·        Tell your partner what you like and do not like, and listen to your partner's likes and dislikes.

·        Try different sexual positions or use pillows for comfort.

·        Try personal lubricants (Astroglide or K-Y Jelly) to help reduce discomfort with sexual intercourse.

Talk to Your Partner

·        Even with the best of intentions and preparation, there may be times during your illness when you decide that you do not want to be sexually active. Talk to your partner about how you feel and why you feel that way. Talk about how you can help your partner deal with his or her feelings and interest in sexual activity.

Talk to Your Doctor

·        Talk to your doctor about any concerns you have about your sex life. Your doctor may have some ideas that can help.

·        Let your doctor know if you are feeling depressed or if you think that you are having side effects from a medicine.

There are self-help books that discuss sex and specific illnesses.

I have some breathing difficulty, how can I improve my sleep?

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Try these suggestions:

·        Elevate the head with pillows, a wedge, an inflatable bed wedge elevator, or remote control mattress elevator

·        Sleep in a reclining chair with the head elevated

·        Sleep on a couch with head elevated with your back against the couch

What can I do to get a good night's sleep?

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Try the following:

·        Consume less or no caffeine.

·        Avoid alcohol.

·        Drink less fluid before going to sleep.

·        Avoid heavy meals close to bedtime.

·        Avoid nicotine.

·        Exercise regularly, but do so in the daytime, preferably afternoon.

·        Try a relaxing routine, like soaking in hot water (a hot tub or bath) before bedtime.

·        Establish a regular bedtime and wake-up time schedule.

·        Keep a sleep diary before and after you start these suggestions.

I tried the sleep suggestions, no help, what is the problem?

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It may be a sleep disorder. Typical sleep patterns can be disrupted by many factors:

·        Stress

·        Family demands

·        An overly busy schedule

·        Hormonal influences and changes in core body temperature

·        Dieting, which, can lower a woman's body temperature

·        Body aches

·        Nausea

·        Leg cramps

·        Heartburn

·        Depression

·        Anxiety

·        Worry

Seek help from your doctor or a qualified sleep center if the suggestions fail to resolve the problem.

How to deal with children's nightmares?

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There are two types of 'nightmares': a nightmare itself, from which a child awakens, distressed and which is often related to worries and anxiety that s/he is experiencing. This stress may be caused by something major or seemingly minor. Helping to resolve the stress will alleviate this type of nightmare.

The second type is known as a 'night terror' and although the child is equally distressed, s/he may seem to remain asleep and unrousable. These terrors are unrelated to stress or anxiety and are described as part of normal development in some children - they will eventually be outgrown and disappear. One suggestion for dealing with this is to awaken the child 15 minutes or so before the time the nightmares usually occur, and to do this for two weeks. This will help to break the pattern and may resolve things.

When can I consider myself cured?

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Cancer patients mark the yearly anniversary of the end of their treatment as other people do birthdays. One year off treatment is cause for relief. Two years is reason for celebration. At the five-year mark, some people dare to use the word "cured."

What is the prognosis for my cancer?

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Prognosis is defined as the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case. Prognosis is based on staging and historical information. It is a statistical view of overall data and cannot predict an individual's survival.

What is the prognosis for colorectal cancer?

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Stage I

T1 N0 M0 or T2 N0 M0

Duke's A

5 year survival >90%

Stage II

T3 N0 M0

Duke's B

5 year survival 70-85%

T4 N0 M0

5 year survival 55-65%

Stage III

any T N1 M0

Duke's C

5 year survival 45-55%

any T N2, N3 M0

5 year survival 20-30%

Stage IV

any T

any N

M1 (distant)

Duke's D

5 year survival < 5%

Dealing with bad news

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Hearing the news that your doctors think that your cancer cannot be cured is always very difficult. You may feel that you want to discuss the options more fully or have a second opinion. Even if your doctors are busy, they will usually find either time to answer all your questions to the best of their ability, at this point, or a few days later when you are better able to talk to them. It is important that you don't feel under pressure from your family or friends to accept or refuse further treatment. The final decision must be your own, even if you discuss the options with your partner or friends.

You might find it hard to believe what you are hearing, or feel that it is like a nightmare and that you will wake up and find it is not true. The initial shock and disbelief may be replaced after a few hours or days by powerful and often overwhelming emotions. These will make it difficult for you to think straight, and you are likely to need some time on your own or with your partner to come to terms with the news.

You may feel very angry - with yourself, perhaps because you feel you should have done more to prevent or fight your cancer, or with the doctors or nurses, for telling you bad news. You may be angry at fate, or your God, feeling that it is very unfair that this should happen to you. You may fear what the future will bring. You may find yourself tearful and depressed, and be unsure how to cope with all the emotions swirling round inside you. Some people are stunned and resentful to see life going on as normal around them when their own world is in such turmoil.

Everyone experiences some or all of these emotions, but as time goes on, most people find that the distress gets less intense. Dying with cancer does not turn you into a different person, with less need for love, companionship, friendship and fun. For many people their partners, family and friends become even more important, a vital source of support and reassurance. However, people who have cancer sometimes feel that a great deal of responsibility rests with them. It may seem as though you are the one who has to be strong; you have to start the difficult conversations and help other people to face your illness, even though it is you who is ill not them.

If you are able to talk openly about everything to those closest to you, they will probably be relieved and able to respond. However, when you are unwell or feeling low it is very difficult to take on this burden. Remember, this is very private information. You should not feel you have to share it with anyone other than your closest family and friends. In addition, you only need to share as much as you want to share - and at a time when you feel ready. You are in control.

Bad news has the potential to shatter hopes and dreams leading to very different lifestyles and futures. Bad news situations can include cancer diagnosis, disease recurrence, spread of disease, or failure of treatment to affect disease progression, the presence of irreversible side effects, or raising the issue of palliative care and resuscitation.

What is the doctors role in delivering bad news?

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·        Deliver the bad news in a compassionate and caring manner.

·        Ensure that you understand the news and the prognosis.

·        Answer all questions.

·        Leave you with a clear plan for the future, with treatment options or management plan discussed.

What does inoperable mean?

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Not treatable by or remediable by or suitable for surgery. Ask your doctor to explain why. Some reasons are extensive tumors or metastases, a tumor formed within a vital organ, or the patient has a precondition that prevents surgery.

Could chemo shrink enough of the tumor, so it becomes operable?

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"Unlikely" - Steph

What should I do if my cancer is incurable?

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"I suggest to anyone who has an incurable illness - get on with life for as long as you can." - Steph

Will chemotherapy extend survival?

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There is no good evidence it has any significant impact on survival. Very selected studies on highly selected groups of patients usually produce "promising" results. Then there's the "50% do better and 50% not".