Disclaimer & Warning: The information in this blog is only provided for informational purposes. This information is not designed to be used to treat any disease or health problem. Instead, always consult with your physician for proper treatment.

Wednesday, September 18, 2013

Questions to Ask Your Doctor About Cancer Treatment

Before you meet with your doctor to ask questions about your cancer treatment, you should do your homework and be prepared before the appointment.

Tips to Help You Get Your Questions Answered
Your doctor should make time to explain the treatment options and answer your questions. Here are some tips to help you communicate better with your doctor and other members of your health care team:
  • Consider writing your questions down before your appointment, which can lower your stress level and help you make the most of your visit. You may want to print this list, starting with the questions below, and bring it to your next appointment. .
  • Bring a notebook or a tape recorder to the appointment. During the appointment, write down your doctor's answers, ask a family member or friend to write them down for you, or make an audio recording. That will allow you to read or listen to the information later, taking the time you need to process it.
  • Tell your doctor if you are having trouble understanding an explanation or unfamiliar medical words. Sometimes, the doctor may be able to draw a picture or give an example that would help you understand.
  • Let your doctor know if you are interested in seeking a second opinion. Most doctors understand the value of a second opinion, and your current doctor may even be able to recommend another doctor.
  • Ask your doctor or nurse where you can find additional information or printed materials about your condition. Many offices have this information readily available.
  • Talk with your health care team about information you have found on the Internet or in books or magazines. Not all information is accurate and reliable.
Potential Questions to Ask the Doctor
Asking your doctor questions is an important part of managing your care. You will choose to ask specific questions based on your unique needs and interests, and those questions may change over time.

Consider the following questions as you decide what you want to ask your doctor:

General information
  • What type of cancer do I have?
  • Where is it located?
  • What are the risk factors for this disease?
  • Is this type of cancer caused by genetic factors? Are other members of my family at risk?
  • How many people are diagnosed with this type of cancer each year?
  • What lifestyle changes—such as diet, exercise, and rest—do you recommend I make to stay as healthy as possible before, during, and after treatment?
  • Where can I find more information about my type of cancer?
  • What are some common symptoms of this type of cancer?
  • How can I prevent or manage them?
  • What are the treatment options for my symptoms?
  • Will certain activities make my symptoms worse?
  • What should I do if new symptoms arise or existing ones worsen?
  • What diagnostic tests or procedures will I need? How often?
  • Where will I go to have the tests or procedures?
  • How can I prepare myself for them?
  • What will we learn from the tests or procedures?
  • When will I get the results, and how will I receive them? For example, will I receive them over the phone or at my next appointment?
  • What does my pathology report (laboratory test results) tell us about my cancer?
  • Will I need to repeat any tests or procedures if I seek a second opinion?
  • How and when would you recommend I communicate with loved ones about my diagnosis?
  • What is the stage of my cancer? What does this mean?
  • Has cancer spread to my lymph nodes or any other parts of my body?
  • How is staging used to help decide the best type of cancer treatment?
  • What is my prognosis, also called chance of recovery?
Questions about Finding a Specialist and Getting a Second Opinion
    Will I need a specialist(s) for my cancer treatment?
    Will you help me find a doctor to give me another opinion on the best treatment plan for me?

  • What are my treatment options?
  • Which treatments, or combination of treatments, do you recommend? Why?
  • What is the goal of the treatment you are recommending? Is it to eliminate the cancer, help me feel better, or both?
  • What clinical trials (research studies involving volunteers) are open to me? Where are they located, and how do I find out more about them?
  • Who will be part of my cancer care team, and what does each member do?
  • How much experience do you—or other members of the cancer care team—have treating this type of cancer?
  • Will I need to be hospitalized for treatment, or will this treatment happen in an outpatient clinic?
  • What is the expected timeline for my treatment? Do I need treatment immediately?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • What are the short- and long-term side effects of this treatment?
  • Will this treatment affect my fertility (ability to become pregnant or father children)?
  • How will you treat side effects that I experience during treatment?
  • How can I keep myself as healthy as possible during treatment?
Questions about Surgery
    Is surgery an option for me?  If so, what kind of surgery do you suggest?
    How long will I stay in the hospital?
    If I have pain, how will it be controlled?

Questions about Other Types of Treatment
    Where will I go for treatment?
    How is the treatment given?
    How long will each treatment session take?
    How many treatment sessions will I have?
    Should a family member or friend come with me to my treatment sessions?

Questions about Side Effects
    What are the possible side effects of the treatment?
    What side effects may happen during or between my treatment sessions?
    Are there any side effects that I should call you about right away?
    Are there any lasting effects of the treatment?
    Will this treatment affect my ability to have children?
    How can I prevent or treat side effects?

Questions about Medicines and Other Products You Might Be Taking
    Do I need to tell you about the medicines I am taking now?
    Should I tell you about dietary supplements (such as vitamins, minerals, herbs, or fish oil) that I am taking?
    Could any drugs or supplements change the way that cancer treatment works?

Clinical trials
  • What are clinical trials?
  • How do clinical trials help people with cancer?
  • Are any clinical trials treatment options for me?
  • What happens during a clinical trial?
  • What are the benefits and risks of participating in a clinical trial?
  • How will I be monitored while participating in a clinical trial?
  • What are my responsibilities during the clinical trial?
  • Are there any costs associated with my participation in a clinical trial?
  • Where can I learn more about clinical trials?
  • What support services are available to me? To my family?
  • May I contact you or the nurse if I have additional questions?
  • Whom should I call with questions or concerns during non-business hours?
  • Can you recommend a social worker to help locate support services?
  • Where can I find resources for children? For older adults?
  • If I'm worried about managing the costs related to my cancer care, who can help me with these concerns?
  • Who handles health insurance concerns in your office?
Follow-up care
  • What follow-up tests will I need, and how often will I need them?
  • Is there anything else I should be asking?
KEY POINT! If you do your homework and research before your doctor's appointment, you should find answers to many of these questions. Then, when you ask the doctor, you'll know two things: (1) What you learned was correct (or wrong); and, (2) What your doctor knows.

Types of Cancer Treatments
There are many types of cancer treatment. The types of treatment that you receive will depend on the type of cancer you have and how advanced it is.

The main types of cancer treatment include:
Chemotherapy: Uses drugs to kill cancer cells.

Hormone Therapy: Slows or stops the growth of cancer that uses hormones to grow.

Immunotherapy: Helps your immune system fight cancer.

Radiation Therapy: Uses high doses of radiation to kill cancer cells and shrink tumors.

Targeted Therapy: Targets the changes in cancer cells that help them grow, divide, and spread.

Stem Cell Transplant: Procedures that restore blood-forming stem cells in people who have had theirs destroyed by high doses of cancer treatments, such as chemotherapy and radiation therapy.

Surgery: A procedure in which a doctor with special training, called a surgeon, removes cancer from your body.

Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. When you need treatment for cancer, you have a lot to learn and think about. It is normal to feel overwhelmed and confused. But, talking with your doctor and learning about the types of treatment you may have can help you feel more in control.

Blood Tests
Samples collected for cancer blood tests are analyzed in a lab for signs of cancer. The samples may show cancer cells, proteins or other substances made by the cancer. Blood tests can also give your doctor an idea of how well your organs are functioning and if they've been affected by cancer.

Examples of blood tests used to diagnose cancer include:

Complete blood count (CBC). This common blood test measures the amount of various types of blood cells in a sample of your blood. Blood cancers may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found. A bone marrow biopsy may help confirm a diagnosis of a blood cancer.

A CBC measures the amount of three types of cells in your blood:
  • White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells.
  • White blood cell differential. A white blood cell differential is a test that measures the number of each type of white blood cell. There are five major types of white blood cells, and each type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells.
    • Neutrophils
    • Lymphocytes
    • Monocytes
    • Eosinophils
    • Basophils
  • Red blood cell count. Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood. There are several ways to measure red blood cells. Two of the most common are:Platelet count. A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.
    • Hematocrit (Hct), the percentage of your blood that is made up of red blood cells
    • Hemoglobin (Hgb), the amount of the protein in red blood cells that carries oxygen
The amounts of each of these types of cells have a normal range. Your health care team will note this range on your CBC lab results. A range is used instead of a specific number because a normal amount is different for each person.

Blood protein testing. A test to examine various proteins in your blood (electrophoresis) can aid in detecting certain abnormal immune system proteins (immunoglobulins) that are sometimes elevated in people with multiple myeloma. Other tests, such as a bone marrow biopsy, are used to confirm a suspected diagnosis.

Tumor marker tests. Tumor markers are chemicals made by tumor cells that can be detected in your blood. But tumor markers are also produced by some normal cells in your body, and levels may be significantly elevated in noncancerous conditions. This limits the potential for tumor marker tests to help in diagnosing cancer.

The best way to use tumor markers in diagnosing cancer hasn't been determined. And the use of some tumor marker tests is controversial.

Examples of tumor markers include prostate-specific antigen (PSA) for prostate cancer, cancer antigen 125 (CA 125) for ovarian cancer, calcitonin for medullary thyroid cancer, alpha-fetoprotein (AFP) for liver cancer and human chorionic gonadotropin (HCG) for germ cell tumors, such as testicular cancer and ovarian cancer.

Circulating tumor cell tests. Experimental blood tests are being developed to find cells that have broken away from an original cancer site and are floating in the bloodstream. More research is needed to understand how these tests can help doctors diagnose advanced cancers.

What the results mean
Test results must be interpreted carefully because several factors can influence test outcomes, such as variations in your body or even what you eat. In addition, keep in mind that noncancerous conditions can sometimes cause abnormal test results. And, in other cases, cancer may be present even though the blood test results are normal.

Your doctor reviews your test results to determine whether your levels fall within a normal range. Or your doctor may compare your results with those from past tests.

Your doctor and other members of your health care team must carefully interpret CBC test results. Keep in mind that many factors, including noncancerous conditions, can lead to results that fall out of the normal range. Ask your doctor to help you understand what your results mean.
  • Low white blood cell count. Some cancer treatments, mainly chemotherapy, may cause a decrease in your body's white blood cells. Cancers that affect the blood and bone marrow can also cause a decrease in the count. These types of cancers include leukemia, lymphoma, and multiple myeloma.
  • Amounts of different white blood cells. Higher-than-normal numbers of lymphocytes or monocytes can indicate the possibility of certain types of cancers. Some cancers and their cancer treatments may cause neutropenia. Neutropenia is a decrease in the number of neutrophils, which increases the chances of a bacterial infection. At times, your doctor may lower your chemotherapy dose to reduce your chance of developing a low neutrophil count. Your doctor may also recommend medication, such as white blood cell growth factors, to increase your body's production of neutrophils, especially if you develop a fever.
  • Low red blood cell count. Some cancer treatments, mainly chemotherapy and radiation therapy, may cause a decrease in red blood cells. This condition is known as anemia. Blood loss, either from surgery or specific cancers, and cancers that directly involve the bone marrow can also cause or worsen anemia. People whose red blood cell count falls too low may need a blood transfusion or medication to help increase it.
  • Low platelet count. Some cancer treatments, such as chemotherapy or radiation therapy, may cause a decrease in platelets. Cancers that directly involve the bone marrow can also cause a decrease in platelets. This can result in a condition called thrombocytopenia, which means a person's blood has an unusually low level of platelets. Patients with low platelet levels have a greater risk of serious bleeding or bruising. If your platelet count falls to very low levels, your doctor may recommend platelet transfusions.
What happens next
Though blood and urine tests can help give your doctor clues, other tests are usually necessary to make the diagnosis. For most forms of cancer, a biopsy — a procedure to obtain a sample of suspicious cells for testing — is usually necessary to make a definitive diagnosis.

In some cases, tumor marker levels are monitored over time. Your doctor may schedule follow-up testing in a few months. Tumor markers are most often helpful after your cancer diagnosis. Your doctor may use these tests to determine whether your cancer is responding to treatment or whether your cancer is growing.

Discuss test results with your doctor. Ask your doctor what your results say about your health and what the next steps should be.

Diagnostic Tests and Procedures
When a doctor selects a diagnostic test(s), he/she will consider the person’s age and medical condition, the type of cancer suspected, the severity of the symptoms, and previous test results. Not everyone will need all the available diagnostic tests. The most common diagnostic tests are as follows.

Barium Enema: An enema is a procedure that delivers liquid into the rectum and colon through the anus. Barium, which is a special dye called a contrast medium, is the liquid used in a barium enema. When an x-ray is taken, the barium shows up bright white, clearly outlining the colon and rectum. Abnormalities, such as inflammation, polyps (precancerous growths), and cancer, are then visible.

Biopsy: A biopsy is a medical procedure that, for most types of cancer, is the only way to make a definitive cancer diagnosis, as it provides the most accurate analysis of tissue. Often, doctors will recommend a biopsy after a physical examination or imaging study, such as an x-ray, has identified a possible tumor.

Bone Marrow Aspiration and Biopsy: A bone marrow biopsy and aspiration is a diagnostic examination of the bone marrow that can provide information about the development and function of blood cells.
Bone Scan: A bone scan is a diagnostic imaging test used to determine if your bone is damaged, either from cancer or from some other cause. The scan will detect cancer that has started in your bones, as well as cancer that has metastasized (spread) to the bone from other areas of your body. It can also track how cancer in the bone is responding to treatment.

Breast MRI for the Early Detection of Breast Cancer: Breast magnetic resonance imaging (MRI) is a procedure being studied more frequently for its role in detecting breast cancer. Although the early results of breast MRI studies are encouraging, breast MRI should not be substituted for mammography for women at average risk for breast cancer. However, it may be an additional tool to screen for breast cancer in women at high risk for developing the disease.

Breast MRI: A breast MRI (magnetic resonance imaging) exam is a diagnostic examination that uses magnetic fields to capture multiple images of the breast tissue, which are combined to create detailed, computer-generated pictures of your breasts. A breast MRI sometimes is used to diagnose and evaluate breast tumors. Under some circumstances, this test may better identify a small mass within a woman's breast than a mammogram or ultrasound, particularly for women with very dense (non-fatty) breast tissue.

Colonoscopy: A colonoscopy is a diagnostic examination used to look inside the entire large intestine, which plays an important role in the body’s ability to process waste. The colon makes up the first five to six feet of the large intestine, and the rectum makes up the last six inches, ending at the anus.

Computed Tomography (CT) Scan: A computed tomography (CT) scan, also called a CAT scan, is a diagnostic exam used to detect tumors, determine the stage of the disease and whether cancerous cells have spread, and find out about the effectiveness of cancer treatment.

Digital Rectal Exam (DRE): A digital rectal exam (DRE) is a screening test that allows a doctor to check the prostate gland in men or the lower colon/rectum in men and women for cancer or other abnormalities. In addition, in association with a vaginal examination, a DRE can check for cancer of the uterus and ovaries in women. A DRE can also be used to check the other organs and structures in the pelvis.

Additional Website Resources

A Cancer Diagnosis: What to Do Next?

Cancer diagnosis: 11 tips for coping - Mayo Clinic

The emotional impact of a cancer diagnosis | American Cancer Society

If A Doctor Says You Have Cancer…

So You Have Cancer: 10 Things to Do Now, Even if You're Not Warren Buffett

Cancer Clinic Dealing with Grief of Diagnosis

Coping with a cancer diagnosis

Your Emotions After a Cancer Diagnosis | We Can Help | LIVESTRONG.org

Stages of Cancer Grief

After cancer diagnosis, what comes next? - CNN.com

Coping with a cancer diagnosis - Cancer Council Australia

Related Resources
    National Cancer Institute
    National Institute of Health
    Treatment Research
    Chemotherapy and You: Support for People With Cancer
    Radiation Therapy and You: Support for People With Cancer
    Questions to Ask Doctor (Cancer.Net)

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