After Diagnosis: A Guide for Patients and Families

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Making treatment decisions

The number and kinds of treatment choices you have will depend on the type of cancer, the stage of the cancer, and other factors, such as your age, current health status, and personal needs. You are a key part of your cancer care team – you should talk about what treatment choices are best for you. Don’t be afraid to ask as many questions as you like. Make sure you understand your options. A cancer diagnosis almost always makes people feel they must get treatment as soon as possible. But you usually have plenty of time to think through all the options available so you can make the best possible choice.

How is cancer treated?

The 4 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.

What treatment will be best for me?

Your cancer treatment will be based on your situation. Certain types of cancer respond better to certain types of treatment, so knowing the type of cancer you have is an important step toward knowing what treatments will work the best. The cancer’s stage (how widespread it is) will also determine the best course of treatment.

Your health, lifestyle, and personal preferences will also play a part in deciding what treatment will be best for you. Not all types of treatment will work in your situation, so be sure that you understand your options. Don’t be afraid to ask questions. It’s your right to know what treatments are most likely to help you and what their side effects may be.

What is the goal of my treatment?

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 over time.

What is remission?

Some people think that remission means the cancer has been cured, but this is not always the case. Remission is a period of time when the cancer is responding to treatment or is under control. In a complete remission, all the signs and symptoms of the disease go away and cancer cells cannot be found with any of the tests available for that cancer. It’s also possible to have a partial remission. This is when the cancer shrinks but does not completely disappear.

Remissions can last anywhere from many weeks to many years. Complete remissions may go on for years and over time be considered cures. If the cancer returns, more treatment can lead to another remission. A cancer that has recurred (come back) may respond to a different type of treatment, such as a different drug combination or radiation versus surgery.

What is staging?

Staging is the process of finding out how far the cancer has spread. Staging the cancer is a key step in learning your treatment choices. It will also give your health care team a better idea of the outlook for your recovery. But staging can take time, and people are often eager to begin treatment right away. 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 what treatments are likely to be the best before starting the treatment.

There is more than 1 system for staging cancer. The TNM system is the one used most often. It gives 3 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 instance, a tumor staged 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 found, they can be grouped together into a simpler set of stages, stages 0 through stage IV (0-4). As a rule, 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 affects your treatment options.

Surgery

Many people with cancer have surgery. If the cancer appears to be contained in one area (localized), surgery may be used to remove it along with any nearby tissue that might contain cancer cells. Sometimes it’s hard to tell how much surgery will be needed until the surgeon sees the extent of the cancer during the operation. Surgery is most successful when the tumor has not spread to other areas. Today, surgery offers the greatest chance of cure for many types of cancer.

Other treatments, such as radiation therapy and chemotherapy, may be used along with surgery. They may be given before or after the surgery.

Radiation therapy

Like surgery, radiation treatment is used for localized cancers. Radiation destroys or damages cancer cells so they cannot grow. It can be used alone or along with surgery or chemotherapy. More than half of all people with cancer have radiation treatment at some point.

Radiation therapy is given 2 ways: either through external high-energy rays or through implants put in the body near the tumor.

External radiation

Getting external radiation therapy is painless, much like having an x-ray taken. It’s usually done in an outpatient setting, and the treatments take very little time. Treatment is most often given 5 days a week for 5 to 8 weeks, depending on the size, place, and type of cancer being treated.

Radiation seed implants (called brachytherapy)

In some cases, radiation may be given through implants, sometimes called “seeds.” These are small containers of radiation placed in or near the tumor while a person is in a deep sleep (under general anesthesia) or with the area numbed (local anesthesia). They allow a person to get a higher total dose of radiation to a smaller area and in a shorter amount of time than with external radiation. Some implants can be put in place at an outpatient center, while others may require that the person stay in the hospital for a few days. The placement can be permanent or temporary.

Side effects of radiation therapy

Side effects vary from patient to patient and depend on the part of the body being treated and the amount of radiation used. The most common side effects are fatigue (tiredness), skin changes in the area of treatment, and some loss of appetite. Other side effects usually are related to the treatment of specific areas, such as hair loss following radiation treatment to the head. Most side effects go away in time. But be sure to talk to your health care team about any discomfort you are feeling, as there are often ways to help.

Chemotherapy

While surgery and radiation therapy are used to treat localized cancers, chemotherapy (often called just “chemo”) is used to treat cancer cells that have spread to other parts of the body. Depending on the type of cancer and its stage, chemo can be used to cure cancer, to keep the cancer from spreading, to slow the cancer’s growth, to kill cancer cells that may have spread to other parts of the body, or to relieve symptoms caused by cancer.

What is chemo?

Chemo is treatment with strong drugs that are most often given by mouth or by injection. Unlike radiation therapy or surgery, chemo drugs can treat cancers that have spread throughout the body because they travel through the bloodstream. Most often, a combination of chemo drugs is used.

How is chemo given?

Chemo is given in cycles, each followed by a rest period. A cycle may involve one dose followed by several days or weeks without treatment. This gives the normal cells in the body time to recover from the drug’s side effects. Doses may also be given several days in a row, or every other day for several days, followed by a period of rest. Some drugs work best when given non-stop over several days.

Different drugs work best on different schedules. If more than 1 drug is used, the treatment plan will show how often and exactly when each drug should be given. The number of cycles you get may be planned before treatment starts (based on the type and stage of cancer) or may be flexible, in order to see how the treatment affects the cancer and your health.

After a cancer is removed by surgery, chemo can reduce the risk of cancer returning. Chemo can also be given before surgery to shrink a tumor before it is removed.

Side effects of chemo

Side effects of chemo depend on the type of drugs, the amounts taken, and the length of the treatment. The most common side effects are nausea and vomiting, short-term hair loss, increased chance of infections, and fatigue (tiredness). Most side effects can be controlled with medicines, supportive care, or by changing the treatment schedule. If you have side effects, ask your doctor or nurse about ways to help ease or prevent them. Also, some side effects may need to be treated right away.

People getting chemo sometimes become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor. There are ways to reduce the side effects or make them easier to manage. Keep in mind that the expected benefits of the treatment should outweigh any problems you have because of it.

Biologic therapies

The immune system, the body’s natural defense system, plays a major role in the body’s response to cancer. Some forms of cancer occur when the immune system doesn’t destroy cancer cells or prevent their growth. Biologic therapy is a treatment used for certain cancers. It’s sometimes called immunotherapy or biological response modifier therapy. Biologic treatments use the body’s immune system to fight cancer or to lessen the side effects of some cancer treatments.

Biologic therapies can act in several ways. They can stop or slow down cancer cell growth, help healthy immune cells control cancer, and help to repair normal cells damaged by other forms of cancer treatment.

There are several kinds of biologic therapy now in use. More than 1 kind of biologic therapy may be used, or biologic therapy may be combined with chemo or radiation to treat cancer.

Complementary and alternative therapy

When you have cancer, you are likely to hear about ways to treat your cancer or relieve symptoms that are different from mainstream (standard) medical treatment. These methods can include vitamins, herbs, and special diets, or methods such as acupuncture or massage – among many others.

Not everyone uses these terms the same way, so it can be confusing. The American Cancer Society uses the word complementary to refer to medicines or treatments that are used along with your regular medical care. Alternative medicine is a treatment used instead of standard medical treatment.

Complementary methods: Complementary treatment methods most often are used to help you feel better. Some examples are meditation to reduce stress, acupuncture to relieve pain, or peppermint tea to relieve nausea. There are others. Some of these methods are known to help, and others have not been tested. Some have been proven not to be helpful. A few have even been found harmful.

Alternative treatments: Alternative treatments are those that are used instead of standard medical care. These treatments have not been proven safe and effective in clinical trials. Some of these methods may even be harmful. The biggest danger in most cases is that you may lose the chance to benefit from standard treatment.

Sometimes people suggest that their method can cure your cancer without having serious side effects, and it’s normal to want to believe them. But the truth is that most of these treatments have not been tested and have not been proven to be effective for treating cancer.

Talk to your doctor or nurse about any method you are thinking about using. You can also call us at 1-800-227-2345 to learn more about complementary or alternative methods.

Clinical trials

Clinical trials are carefully controlled research studies that are done with patients. These studies test whether a new treatment is safe and how well it works. Clinical trials may also test new ways to find or prevent a disease. These studies have led to many new ways to prevent, diagnose, and treat cancer.

A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits. If that happens, they may go on to become tomorrow’s standard treatment.

Taking part in a clinical trial does not keep you from getting any other medical care you may need. You are free to leave the study at any time, for any reason. To find out more about clinical trials for your type of cancer, talk to your cancer care team. The American Cancer Society also offers a clinical trials matching service, which will help you find a clinical trial that is right for you. You can reach this service at 1-800-303-5691 or through our Web site at www.cancer.org/clinicaltrials.


Last Medical Review: 03/08/2012
Last Revised: 01/25/2013