alt.support.cancer -
Frequently Asked Questions
Part 1
Table of
Contents
What are the risk factors
associated with cancer?
How are the various 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?
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 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?
What does cancer stage and
grade mean?
Is stage and grade the same
thing?
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 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?
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?
Where can I find information
about doctors and hospitals in my state?
How can I get a second
opinion?
Where can I get an outside
consultation?
How can I get travel
assistance for treatment?
What about reduced airfares
for cancer patient treatment?
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?
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?
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?
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?
What is the doctors role in
delivering bad news?
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 combination
chemotherapy?
Are there cancer drugs other
than chemo?
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?
|
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?
|
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?
|
· 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?
|
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?
|
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
|
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
|
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
|
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
|
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
|
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?
|
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?
|
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?
|
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?
|
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?
|
http://www.principalhealthnews.com/topic/cancerguide/ Cools Tools, By Deepi Brar Consumer Health
Interactive
Where can I find cancer
statistics?
|
Look
in the recommended links section of the FAQ for links to some statistics.
What are the chances of
developing cancer?
|
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?
|
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?
|
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?
|
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
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
"Do
your homework, find an oncologist you trust, and follow their advice." -
Steph
Should I wait until I feel
pain before seeing a doctor?
|
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
|
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?
|
Schedule
screening exams based on your risk factors, and then get the exam.
What is involved in
screening and testing for cancer?
|
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?
|
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?
|
· 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
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
Learn
about these treatment-related topics:
· Infections in Individuals with Cancer
· Informed Consent
Are there any tools to
help me with the treatment decision?
|
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?
|
· 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?
|
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?
|
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?
|
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?
|
· 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?
|
· 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?
|
· 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?
|
· 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?
|
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?
|
· 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?
|
· 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?
|
· 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?
|
· 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?
|
· 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?
|
· 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?
|
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?
|
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?
|
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?
|
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?
|
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
|
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?
|
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?
|
Locate
the board that certifies that cancer specialty and request a list of
recommended surgeons.
Where can I find cancer
centers listed by state?
|
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?
|
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?
|
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?
|
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?
|
Surgery
volume information about individual hospitals and doctors http://www.healthcarechoices.org/surgvol.htm
How can I locate a
colorectal surgeon?
|
Locate
a colorectal surgeon at http://www.fascrs.org/
How can I find a breast
cancer specialist?
|
How
to find a breast specialist http://www.nabco.org/index.php/index.php/177
How can I find an
oncologist?
|
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?
|
ASCO
Cancer Centers and Cooperative Groups http://www.asco.org/ac/1,1003,_12-002414,00.asp
How can I get a referral?
|
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?
|
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?
|
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?
|
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?
|
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?
|
The
National Patient Travel Helpline http://www.patienttravel.org/
What about reduced
airfares for cancer patient treatment?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
· 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?
|
· 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?
|
http://www.mickaela.org/ provides assistance for uninsured breast
cancer patients.
What about people without
medical coverage that have other cancers?
|
Check
the links section for your cancer type for a foundation
Where can I get financial
assistance for cancer care?
|
http://www.thecancer.info/financial_aid.htm Financial Assistance for Cancer Care
Who can help with
questions about family or medical leave?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
ASCO,
Patient Support Organizations at http://www.asco.org/ac/1,1003,_12-002412,00.asp
How do I deal with fear?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
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
|
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?
|
· 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?
|
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?
|
"Unlikely"
- Steph
What should I do if my
cancer is incurable?
|
"I
suggest to anyone who has an incurable illness - get on with life for as long
as you can." - Steph
Will chemotherapy extend
survival?
|
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".