It is critically important for you to clearly understand your cancer diagnosis and proposed treatment plan. An important part of managing your care is knowing what questions to ask your doctor. Here are some examples of the types of questions you will want to ask your doctor:
- Precisely what type of cancer do I have?
- Where exactly is it located?
- What are my risks if I do not treat this disease?
- Is this type of cancer caused by genetic factors? Are other members of my family at risk?
- What are the most common symptoms of this type of cancer?
- Is there anything that can be done to make my symptoms or side effects better?
- Are there activities that may make them worse?
- If new symptoms or side effects arise or existing ones worsen, what should I do?
- What diagnostic tests have you performed? What further tests are necessary?
- What information will these tests tell us?
- How can I prepare myself for each test or procedure?
- Where do I need to go to have these tests?
- When will I get the results? How will the results be communicated to me?
- Will you explain, in patient-friendly language, the pathology report to me?
- Is there any indication a second pathology report is necessary?
- If I seek a second opinion, will I have to repeat any tests or procedures?
- What is the stage of my cancer? In patient-friendly language, what does this mean?
- Has cancer spread to my lymph nodes or anywhere else?
- How is staging used to determine my cancer treatment?
- What are my treatment options?
- Which treatments, or combination of treatments, do you recommend? Why?
- What is the goal of the treatment plan you are recommending?
- Who will be part of my treatment team? What does each member do?
- How much experience do you and the treatment team have treating this type of cancer?
- Will I need to be hospitalized for treatment or is this treatment done in an outpatient setting?
- What is the expected timeline for my treatment plan?
- How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
- What are the short-term side effects of this cancer treatment?
- What long-term side effects may be associated with this cancer treatment?
- What support services are available to me? And to my family?
- Whom should I call with questions or concerns during nonbusiness hours?
- May I contact you or the nurse to talk about additional information I find?
- Who handles health insurance concerns in your office?
- What follow-up tests will I need? How often will I need them?
Comments on Conventional Medical Treatment Options
In addition to the information you generate from your own research and the questions you ask your healthcare team, know that treatment options will typically fall into one or a combination of primary treatment modalities:
- Surgery: removal of the tumor
- Radiation: exposure to x-rays or radium
- Chemotherapy: the use of cytotoxic chemicals
- Immunotherapy: enhancing the body’s own immune function
Surgery is the most frequently employed cancer treatment. It is most effective on solid tumors especially when the cancer is small and has not moved to other parts of the body. Radiation therapy is employed in approximately one-half of all cancer cases. It is often used in combination with other treatment options, for example either before or after surgery. Chemotherapy is most often used when the cancer has spread or when the diagnosis is a systemic-type cancer. It is increasingly common to observe chemotherapy being used to shrink solid tumors prior to surgery. It is often used in combination with radiation therapy and surgery to control tumor growth.
Other types of conventional medical treatment modalities include:
- Hormonal: employs or manipulates bodily hormones
- Investigative: experimental programs
Hormonal treatment is used in cancers that depend on hormones for their growth. Hormones are either removed, added, or their production is blocked through drugs or surgery that removes the hormone-producing gland. Investigative protocols are experimental. They are typically the last choice.
As you evaluate your conventional treatment options, please carefully consider the following insights based on 35 years of helping patients get well and stay well:
- While surgery is the most common form of conventional treatment, dozens of types of cancer diagnosis do not indicate surgery. Many patients panic when they are told their cancer is “inoperable.” If you have been told that your cancer in inoperable, do not despair. Recognize that inoperable does not equate with incurable!
- If your oncologist suggests surgery, and you concur, the decision as to who actually performs the procedure is yours. Your choice of surgeons is important. You’re more likely to get a well-qualified surgeon if you choose one who is a fellow of the American College of Surgeons and who is also board-certified in his or her field. Only about half of practicing surgeons are board-certified, so be sure to ask.
Special note to premenopausal breast cancer patients:You typically have some flexibility on the timing of your surgery. Scientific evidence is mounting that fewer breast cancer recurrences are reported among women who choose to have their surgery during the luteal phase of the menstrual cycle, i.e., 14-30 days following the onset of menstruation. Except for one Canadian study which suggested Day 8 to be the optimal time, research shows surgery performed in the latter half of the menstrual cycle results in the fewest recurrences. Ask your surgeon for the most up-to-date research information prior to scheduling. You may have to assert yourself here; most surgeries are scheduled at the convenience of the surgeon and/or the hospital.
- Thoroughly understand chemotherapy. Before you say yes to chemotherapy, seek proof, such as scientific papers and reports, on the effectiveness of the treatment being offered. The American Society of Clinical Oncology https://www.asco.org/ is an excellent resource. Examine the hard evidence that the suggested chemotherapy protocol actually cures, extends life, or improves quality of life. Those are the three “outcomes” against which you must measure all treatments—conventional, experimental, complementary, and alternative.If your clinician uses the terms “response” or “tumor response” or “reduce the tumor burden” or “achieve a remission,” these represent different standards. These terms mean shrinkage or stopping the progression of the cancer. None of these terms are synonymous with “cure.” A cure actually requires that your body fight the cancer on a cellular level and that your immune system maintain a disease-free state. To maximize your opportunity for such a response, I encourage you to follow as many of the health-enhancing, life-enriching principles on this website as possible.
- The administration of chemotherapy is not an exact science. Ask your oncologist about chemotherapy sensitivity (in vitro) testing. Here, samples of your tissue are chemically analyzed in laboratory tests to determine interaction with different agents. In about a week, your oncologist will receive a report establishing which drugs are not likely to work as well as the most active agents. The net effect is a personalized treatment program optimized before you begin.
- Chemotherapy may be in pill form, and be taken by mouth, or it may be in liquid form and injected into a muscle or, most commonly, given through a vein. The drugs may be administered in a daily, weekly, or monthly program for periods ranging from a few months to a lifetime. Side effects, once the fear of all patients, are now being more effectively controlled.
- Radiation therapy is most often administered by means of an external beam machine. Proton beam radiation is the most exact type of radiation and is preferred. Internal radiation is becoming more widely accepted where radioactive material is surgically implanted into or on the area to be treated. This procedure requires precision. You will maximize your opportunity for receiving excellent care if you choose a physician who is certified by the American Board of Radiology.
All cancers are treatable. Even in cases where the cancer is advanced, experimental investigative programs are available. If your cancer is not responding to conventional treatment, ask about hormonal treatment and clinical trials. Note the resources at https://www.clinicaltrials.gov/ Click on “Search for Clinical Trials” and then enter your diagnosis.
Once again, conventional treatment has a central place in the cancer journey. In interviews with thousands of cancer survivors, Cancer Recovery found over 96 percent of survivors initiated and completed a course of conventional therapy. It is a myth that cancer survivors turn exclusively to alternative, non-traditional cancer treatments in large numbers. In the late 1980’s, a Food and Drug Administration study estimated that 40 percent of cancer patients use unconventional treatments. That may be true; in fact, I believe the number may now be much higher, perhaps 60 percent. But survivors do not give up the traditional treatments. They integrate complementary whole-person practices into a comprehensive recovery program. Given our current levels of understanding, this integration represents your very best opportunity for surviving cancer.