especially for support groups and palliative care
www.cancereurope.com: The European School of Oncology site, with good links to other cancer sites in the EU.
Look in Chapter 4 for more cancer-treatment information, and in Part 2 of this Directory for useful websites and contact details of those offering helpful cancer information.
If you would like to speak to a doctor in more detail about your cancer, you may be able to get help from the pathology department of the hospital that diagnosed your tissue samples. Pathology departments have doctors called ‘pathologists’, whose job it is to understand the course that specific diseases tend to follow. Because pathologists do not see many patients, they usually have quite a lot of patience. You may find that one of these doctors is willing to come to the phone, if you ring the pathology department, and tell you in detail about the nature of your tumour and its likely behaviour in the future. Of course, it is possible that all this information will simply raise more questions than it answers, so it is perfectly appropriate that, having gathered your information, you go back to your consultant and/or GP to ask your next round of questions.
If you would like a broader integrated medicine perspective, this may also be the time to seek the advice and help of an integrated medicine doctor (see the Resources Directory).
Knowing when to stop
It is important to know when to stop with this process of seeking information about your cancer so that you do not become overly preoccupied with reading more and more about your condition. As soon as you feel satisfied that you have a reasonable grasp of the situation, it is time to move on to making your treatment decisions.
Understanding the medical approach to cancer
Once you know about your cancer and have assessed your situation and the level of risk, you can consider the treatment options.
Generally speaking, the aim of cancer doctors is to attempt to remove the primary tumour before it has spread, then to destroy any stray cells around the site of the primary with radiotherapy, or more distantly spread cells with chemotherapy. With blood cancers, attempts are made to destroy the cancer cells in the blood with chemotherapy and then to remove the abnormal parent cancer cells from the bone marrow, replacing them with healthy cells. This involves bone marrow grafts, which use healthy new marrow from a donor after the patient’s unhealthy bone marrow is destroyed.
Nowadays, cancer treatments tend to be more aggressive, offering the whole gamut of surgery, radiotherapy and chemotherapy right from the start of the treatment process. In the 1970s and 1980s, it was more usual to treat the primary tumour only, saving radio-and chemotherapy for recurrences. However, the thinking these days is that it is better to go for complete eradication or cure from the outset rather than allowing the cancer to become established in the body.
Because doctors want to ‘nip cancer in the bud’ as soon as it has been diagnosed, there is often an enormous sense of rush and panic at the time of diagnosis. And being on the receiving end of this can be traumatic. While you are still reeling from the news and going through an emotional reaction, those around you are busy trying to get on with starting your treatment. So again, it should be stressed how important it is that you slow them down until you have made the right choice for you and are ready to undergo your well-considered treatment.
On occasions, you may be advised to have chemotherapy first to shrink and contain the primary tumour before attempting to remove it surgically. Sometimes, the primary or secondary tumours may be deemed inoperable – in which case, the treatment offered is usually chemotherapy. If the tumour is widespread throughout the body, the treatment given may be palliative – intended to deal with the symptoms rather than cure the disease. This usually amounts to shrinking the tumour with radio-or chemotherapy to buy vital time for you to get your own integrated health creation programme together.
When thinking about treatment, the following are the questions you need to ask:
• What treatments are suggested for my cancer and why?
• What are the chances of the tumour being cured?
• What are the side-effects of treatment in the short and long term?
• What are the risks of treatment?
• Do I trust my cancer consultant or do I need to seek a second opinion?
• Is my hospital able to give me access to the most up-to-date treatment for my type of cancer, or should I be looking further afield?
• Which are the centres of excellence for my particular kind of cancer nationally and internationally?
• Are there treatment research trials going on for my kind of cancer and, if so, would I like to be entered into one of those trials?
• Do I want to go straight into medical treatment of my cancer or do I need time to prepare myself mentally, physically and practically first?
• If the results with conventional medical treatment are not likely to be good, do I want to keep medical treatment on hold as an option while I work entirely on improving my health with alternative cancer treatments and holistic health promotion?
• If I wish to defer treatment while trying to work with natural methods, am I sure that I am not putting myself at undue risk in doing so?
• You may also wish to ask: If the tumour cannot be cured, what is the likely progression of the disease and my life expectancy?
Specialists who look after people with cancer
There are four different types of specialists who look after people with cancer:
• surgeons, who are usually the first to be consulted if there are primary or secondary tumours that are removable (but who are not necessarily cancer specialists)
• medical oncologists, who specialize in the treatment of cancer with chemotherapy and/or radiotherapy
• palliative care physicians, whose role is to help manage your symptoms, and arrange for your support and care
• anaesthetists, who can offer specialist help if there is a problem with severe, ongoing pain.
It varies from place to place whether you see an oncologist or surgeon first, but it is wise to make sure you do see an oncologist at some point because they are specialists in cancer and its treatment. Ask your GP whether there are any other relevant specialists who may be able to help you.
Getting more details
When your specialists tell you about your treatment options, it is important to establish the details of the proposed treatment so that you can make an informed decision.
As you focus on a particular treatment as the most likely one for you, make sure to ask the following questions:
• What will the treatment involve?
• When and where will it take place?
• Who will be responsible for my treatment?
• How long will it continue for?
• How will it make me feel?
• How long should I take off work for treatment and convalescence afterwards?
• What side-effects can it cause?
• How long will it take me to get over these side-effects?
• Will these side-effects be permanent or temporary?
• What are the benefits of the treatment in terms of prolonged survival, symptom improvement or disease-free interval (the time you can expect to enjoy with no problems from the cancer)?
•