Cancer is a Word, Not a Sentence. Miriam Stoppard

line up the treatment options in your mind, and discuss them with your medical team.

       The risk benefit analysis—a quick checklist

      The whole approach to treatment of any cancer is balancing the potential benefits of a treatment approach against the potential risks—both the consequences and/or the side effects of the treatment, and the risks associated with not receiving that treatment.

      To make it easier to conceptualise this balancing process, we can use the following checklist of important questions, the ones at the centre of the whole approach to the treatment of your particular cancer.

      Those questions are:

      First, what is this particular cancer likely to do in the future in my case? In many respects, this is the most important question of all in trying to get a grip on your particular situation and what treatment options are appropriate.

      What you really want to do is get an idea of what your cancer is like in respect to the following three aspects:

      1 Might the cancer recur? Is the chance of it coming back high, or low, or intermediate?

      2 Might it spread? Might the cancer metastasise to other parts of the body (for example, the bones or the lungs). And if that is a possibility, is the chance of it happening high, or low, or intermediate?

      3 Might it pose a risk to my health or my life? If it does, is the size of that threat big, or small, or intermediate? And in what time frame might it do damage: short-term, long-term, or intermediate?

      Second, what are the treatment options, and which ones may make the future better for me? The aim here is to get a handle on the different treatment options, answering the question, ‘What could we do?’ before the question, ‘What will we do?’ The seven-category system, which follows shortly, will help you with this. And in Part Two we will discuss the various types of treatment in greater detail.

      Third, what are the risks, the consequences, and/or the side effects of those treatment options? The aim here is to find out how the proposed treatment option is likely to affect the quality of your life, then for how long.

      As you get the basic facts from your medical team, and more information from the pharmacy, and the out-patient treatment unit staff, among others, keep in mind these things:

      Some treatment side effects vary. Some side effects are definite and universal: if you have a chemo drug called Adriamycin, for example, you will definitely lose your hair, and it will definitely grow back. But with many treatments—radiotherapy is a good example—you may have a lot of skin reaction or you may have none at all. You can predict the amount of skin reaction to a certain extent by how easily you burn when you sit in the sun. But even so the effect may vary.

      Which means that you have to ask yourself this question: How much would a particular side effect alter my quality of life?

      This is a very personal matter. You have to think about what you do in your daily life and what you enjoy. Then you have to assess the way it would affect you, and how much that would matter to you. The best way to do this is to think about the worst-case scenario: if you got the side effect, what’s the worst it could do to your quality of life? Then think of that continuing over the estimated length of time (which is of course just that, an estimate). That will give you some idea of the worst risk from the treatment. And that will make it a bit easier to balance the side effect against the potential benefit.

      Let’s keep all that in mind as we look at the objectives—the planned benefits—of the treatment plan.

       The seven main types of treatment plans

      In this section, I’m going to put it all together, to help you build up an assessment of the risks and benefits in your case. To do that, you must first understand the objective of the whole exercise, and ask some important questions. (I know, sometimes it seems the questions will never end. In a way that’s true. But each question, and every answer, gets you further along the path of knowledge and control.)

       What is the main objective of the treatment?

       Is cure a realistic objective?

       Is the idea to try to reduce the chance of the cancer recurring or spreading?

       Is the objective to try to control the disease itself?

       Is the objective to reduce symptoms caused by the disease?

      To help you make sense of this, we are going to divide up the main objectives of treatment into seven broad categories, and I’ll give one or two examples of cancer situations in which that treatment approach would be used.

      The details of the treatment plan are often so complicated that it is easy to lose sight of the overall goal. So a reminder of the main game-plan is helpful.

      In practical terms, then, you can think of the major objective of the treatment plan as being in one of these seven categories:

      1. THE BIOPSY OR INITIAL SURGERY IS ALL YOU NEED.

      There are a few cancers in which, if the cancer is limited to a small area, the biopsy or the initial surgery is all that is necessary at present. In these situations, the area of cancer is very small and is completely contained inside the tissue that was removed at surgery, and in the case of certain cancers at this particular stage, the chance of its spreading is zero. In other words, the entire risk has been removed. This is not a common situation, but it does happen.

      Most people are relieved and delighted to hear that they do not need any further treatment. But a few might worry that they are getting substandard treatment, or even that they are being ‘brushed off’ and not getting what they need. So it is worth knowing that this is the correct and standard form of treatment in a few well-defined situations. Here are some examples:

      Pre-invasive cancer of the cervix (when the cone biopsy has removed all the malignant cells);

      Early stage colon or rectal cancer (when the cancer has not penetrated through the dividing layer of the bowel wall, called the muscularis mucosa);