Determining Treatment

• What are the general strategies for planning my treatment?
• What are the types of treatment used for people in my clinical situation?
• What can I expect when my treatment is completed?
• What can I expect if my treatment is not working?

What are the general strategies for planning my treatment?
The first step is to be certain of the type of cancer that you have. This occurs when your physicians review the pathology, which is usually obtained from a biopsy and/or at the time of surgery. The next step is to determine the extent of your disease. Your physician must assess the primary tumor(s) and the extent to which it may have metastasized, or spread, from the original location.

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What are the types of treatment used for people in my clinical situation?

Surgery
Surgery may be a step to make a diagnosis, to remove the cancer, and/or to relieve symptoms. Prior to surgery your surgeon will review with you the reasoning behind the surgical procedure(s), the expected outcome including potential benefits and risks, and what your experience will be during the postoperative recovery. Surgery may be combined with chemotherapy and/or radiation oncology. The order of these treatments vary from patient to patient.

Radiation Oncology
Radiation oncology may be recommended as primary treatment of the cancer, or used in conjunction with surgery and/or chemotherapy to further reduce the risk of recurrence. Adjuvant radiation may be used to relieve symptoms such as pain in specific parts of the body. Radiation oncology is effective in treating cancer because the cancer cell is more vulnerable to the damaging effects of radiation than normal cells. After consultation, the radiation oncologist will explain the reasoning behind the radiation, including the potential benefits and side effects. The treatment program will be planned through a process known as "simulation."

For more general information about radiation oncology, go to http://cancer.wehealny.org/radonc/

Chemotherapy
Chemotherapy may be recommended as primary treatment for your cancer or used in conjunction with surgery and/or radiation oncology. In general, chemotherapy treats cancer by exploiting the fact that the cancer cell is more susceptible to chemical damage from the chemotherapy drugs than most normal cells. The medical oncologist will explain the reasoning behind the choice of chemotherapy drugs and the potential benefits, risks and side effects of the chemotherapy, as well as explaining alternative approaches. Chemotherapy treatment is usually given intravenously, often through "port," which is a device that is placed under the skin (with local anesthesia) to provide easier access to your veins.

Chemotherapy can also be given orally or by direct injection. Fortunately, we now have anti-nausea medications that almost always eliminate the nausea and vomiting that used to be associated with chemotherapy. The details about the actual treatments, including the frequency and the duration, will be explained by the medical oncologist and tailored to your particular cancer and clinical factors.

Side effects that can be associated with chemotherapy include lowering of the blood counts, fatigue, hair loss, gastrointestinal symptoms, and organ damage. There is a great deal of variability among the chemotherapy programs and among patients. Every effort is made to predict what the experience will be like for you, while at the same time making you aware of the rare but possible side effects or risks of chemotherapy treatment. You will be monitored during your chemotherapy to keep track of your blood counts and organ function, particularly your kidney and liver. With the start of each treatment, your drug doses will be determined based on your tolerance to the treatment.

For more general information about chemotherapy, go to
http://www.wehealny.org/healthinfo/chemotherapy/index.html
http://cancernet.nci.nih.gov/peb/chemo_you/index.html

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What can I expect when my treatment is completed?
If you received potentially curative treatment, you will be examined regularly by your physician, who will use the information gained from the medical history, physical examination, laboratory data, and radiologic testing to determine whether or not there is any evidence of cancer recurrence in the future.

If you received palliative treatment to control or shrink your cancer, and you stop having treatments, we would use similar techniques to determine if there is evidence of cancer growth to new or existing sites.

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What can I expect if my treatment is not working?
If it is determined that your treatment is no longer working, then consideration will be given as to the potential benefit from different types of treatments, as well as the risks associated with these treatments. It is not uncommon for patients to get another opinion about treatment options. You should raise this issue with your health care providers, because the best second opinions are obtained when people involved in your care collaborate with each other.

If there are no known treatment options for your clinical situation, then consideration may be given to participating in early clinical trials, phase I/II, of experimental drugs. Another consideration would be to shift the intent of treatment from trying to treat the cancer to focusing on symptom management, often called palliative care. These are difficult decisions and they are best made in an open discussion that balance the comparative benefits and likely outcomes of the various approaches.

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