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How Is Cancer Treated?

The four major types of treatment for cancer are surgery, radiation, chemotherapy, and biologic therapies. You might also have heard about hormone therapies such as tamoxifen and transplant options such as those done with bone marrow. The number of treatment choices you have will depend on the type of cancer, the stage of the cancer, and other individual factors such as your age, health status, and personal preferences. You are a vital part of your cancer care team - you should discuss with them which treatment choices are best for you. Don't be afraid to ask as many questions as you have. Make sure you understand your options. A cancer diagnosis usually gives people a sense of urgency in making choices about treatment and services. However, take the time to consider all the options available to you so you will be as well informed as possible.

What Treatment Will Be Best for Me?

Your cancer treatment will be entirely based on your unique situation. Certain types of cancer respond very differently to different types of treatment, so determining the type of cancer is a vital step toward knowing which treatments will be most effective. The cancer's stage (how widespread it is) will also determine the best course of treatment, since early-stage cancers respond to different therapies than later-stage ones. Your overall health, your lifestyle, and your personal preferences will also play a part in deciding which treatment options will be best for you. Not all types of treatment will be effective in your situation, so be sure that you understand your options. Don't be afraid to ask questions; it is your right to know what treatments are most likely to help you and what their side effects may be. Palliative versus Curative Goals: Before starting treatment, ask about the goal of treatment. Is the purpose of the treatment to cure the cancer, control it, or treat symptoms? Sometimes the goal of treatment can change.

What Is Staging?

Staging is the process of finding out how far the cancer has spread. Staging the cancer is a vital step in determining your treatment choices, and it will also give your health care team a clearer idea of the outlook for recovery.

Staging can take time, and people are usually anxious to begin treatment soon. Do not worry that the staging process is taking up treatment time. Keep in mind that by staging the cancer, you and your health care team will know which treatments are likely to be the most effective before beginning the treatment. For additional information, please see Staging.

There is more than one system for staging. The TNM system is the one used most often. It gives three key pieces of information:

•    T describes the size of the tumor, and whether the cancer has spread to nearby tissues and organs.
•    N describes how far the cancer has spread to nearby lymph nodes.
•    M shows whether the cancer has spread (metastasized) to other organs of the body.

Letters or numbers after the T, N, and M give more details about each of these factors. For example, a tumor classified as T1, N0, M0 is a tumor that is very small, has not spread to the lymph nodes, and has not spread to distant organs of the body. Once the TNM descriptions have been established, they can be grouped together into a simpler set of stages, stages 0 through stage IV (0-4).

In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious, widespread cancer.

After looking at your test results, your doctor will tell you the stage of your cancer. Be sure to ask your doctor any questions you might have about what the stage of your cancer means and how it will impact your treatment options.

What Should I Ask My Doctor About Cancer?

Your relationship with your doctor is a critical part of your care. Ideally, you will have one doctor who coordinates all of your care. This doctor should be someone with whom you feel comfortable, someone you feel listens to your concerns and answers all of your questions thoughtfully and thoroughly. Your doctor will explain your diagnosis, health status, treatment options, and progress throughout treatment. There will also be nurses working with your doctor who have specialized knowledge and skills. These nurses are there to assist you with your treatment or any side effects you may have. In many cases, the nurse can answer your questions directly. Nurses can also help you get the answers you need from other members of your health care team.

Like all successful relationships, your relationship with your doctor is a two-way street. It is your responsibility to ask questions and become educated about your treatment and health - to become an active part of your cancer care team. Doctors differ in how much information they give to people with cancer and their families. Likewise, people who are newly diagnosed also differ in the amount of information they need or want. If your doctor is giving you too much or too little information, let them know. Ask them whatever questions you have, and keep them informed of your needs. As in any relationship, clear and honest communication is the key to success. Your doctor will discuss your treatment plan with you. The following are examples of questions to ask during the discussion:

•    What type of cancer do I have? What is the stage or extent of my cancer?
•    What is my prognosis, as you view it?
•    What treatment do you recommend and why?
•    What is the goal of treatment; cure or control of my symptoms?
•    What are the possible risks or side effects of treatment?
•    What are the pros and cons of my treatment?
•    Are there other treatments for me to consider?
•    How often will I need to come in for treatment or tests?
•    How long will my treatments last?
•    What if I miss a treatment?
•    Will my life change? Will I need to make changes in my work, family life, and leisure time?
•    What are the names of the drugs I will take? What are they for?
•    What other drugs or treatments may I have to take?
•    How will you know that my treatment is working?
•    Why do I need a blood test and how often?
•    If other specialists take part in my care, who will coordinate my entire treatment program?
•    What symptoms or problems should I report right away?
•    If I do not feel sick, does that mean the treatment is not working?
•    What are the chances that my cancer may recur (come back), with the treatment programs we have discussed?
•    What can I do to be ready for treatment?
•    Will I still be able to have children after treatment?
•    Are there any special foods I should or should not eat?
•    Can I drink alcoholic beverages?
•    What costs will I have?
•    What is the best time to call you if I have a question?

Make sure that all your concerns and questions, no matter how small, have been answered. It may take more than one visit to discuss all of your concerns, as new questions may come to mind. It may be hard to remember all your doctor says to you. Some people find it helpful to take notes, bring a family member or friend, tape record the conversations, and/or bring a prepared list of questions and write down the doctor's answers.

Remember that you have the right to a second opinion about your diagnosis and the recommended treatment. Asking for a second opinion does not mean that you don't like or trust your doctor. Doctors understand you need to feel that every possibility for the best treatment is being explored. You can also ask your doctor if they have consulted with other specialists at their treatment center.

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