Doctors often recommend that you take a painkiller only ‘when you need it’ (whatever that means)! People who are told to do this often wait until their pain is excruciating before taking the next dose. This is a very bad way to take painkillers since, if you do this, you will never have good pain control. You will spend most of your time feeling frightened and anxious because you know that the pain is going to come back, and it will take a bigger dose to control it when it does. It is much better to work out how long it is before your pain just starts to come back and to take your painkiller regularly that often.

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No sophisticated research or statistical methods would be necessary if we were looking only for major improvements in treatment. It is a fact that the greatest advances in cancer treatment have been made simply by trying a completely new type of treatment in a series of patients. Here are some examples concerning chemotherapy.

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Conditions or circumstances that increase your risk-chance—of getting cancer are called risk factors. The presence absence of risk factors tells you something about your char developing a certain type of cancer; it does not tell you whether or not you will get cancer. Many people with risk factors live to an old age and never develop cancer. Many people with no known risk factors do develop cancer.

Different types of cancer have different risk factors. Examples risk factors include family history (breast, colon, prostate can heavy alcohol consumption (liver, throat, esophagus, mouth), and cigarette smoking (lung, cervix, mouth).

Why Are Cancer Risk Factors Important?

Risk factors for cancer are important because some can be modified, allowing you to reduce your overall risk. Twin bro whose father died young of malignant melanoma have the same high risk of sun-induced skin cancer on the basis of their strong family history. One brother works inside and uses sunscreen f fully whenever he goes outside. He has a lower overall risk of developing malignant melanoma than does his brother, works as a pool lifeguard and is lax about sun protection, smokers who develop tongue cancer have an increased risk of developing throat cancer. The person who quits smoking t much lower risk of developing a second cancer of the head or neck than does the person who continues to smoke.

Knowledge of your risk factors may affect the way you screened for certain cancers, thus offering the opportunity for earlier detection and treatment. The presence of risk factors may the risk-benefit equation in favor of more frequent screening the institution of preventive treatment for certain types of cancer.

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Studies are being done with treatments that will improve the durability (length of time) of remission. Find out about trials available to you by

•requesting information on the latest trials related to your type of cancer by contacting the Cancer Information Service 131120. This number will connect you to the Cancer Council, Society or Foundation in your state.

•asking your oncologist or surgeon

•contacting major cancer centers or hospitals that may be conducting trials which have been featured in the media (radio, TV or newspapers)

What If My Oncologist Discourages Me from Investigating or Participating in a Clinical Trial?

Discuss with your oncologist why he or she opposes your participating in a clinical trial. Consider getting a second opinion from an oncologist who encourages participation in clinical trials but does not participate personally.

It is possible that your oncologist discourages you because he or she is uncomfortable with clinical trials or does not want to “lose you” as a patient to the oncologists running the trial. One would like to hope, rather, that it is because your doctor has your physical and emotional health in mind.

What Is “Informed Consent”?

Informed consent is your written approval to receive treatment after
you have received information that allows you to understand

• the nature of the treatment

• the purpose of the treatment

• the benefits, short-term and long-term •the risks, short-term and long-term

• the expense, short-term and long-term

Once I Participate in a Clinical Trial, Am I Obligated to Stay in the Trial?

No. Participation in a clinical trial is totally up to you. You сan drop out of the study at any moment without jeopardizing your medical care. You have every right to do what is best for you, physically or emotionally. If, during the study, it becomes obvious that the treatment is not good for you, you will be removed from the study.

However, agreeing to participate in a clinical trial implies a level of commitment. It takes manpower, equipment, and money to г a clinical trial. Information is lost and costs are increased when participants drop out.

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Yes. If you have a recurrence, the assumption is that some cancer cells were not killed by your original treatment and have been hiding for months or years, undetected by all your checkup tests until they multiplied enough to cause you to have detectable cancer.

If I Can Have Undetectable Cancer Cells That Become a Problem Years Later, How Can I Ever Know That I Am Really Free of Cancer?

A big fear of cancer survivors after successful treatment is the fear of recurrence from cancer cells that are not detectable during the period of clinical remission.

It is impossible to guarantee that every last cancer cell is gone. From a realistic, practical point of view, it is only important to know whether you have any cancer cells in your body if

•these cells can cause a problem to you in the future, and

• there is something you can do now to treat these cells or prevent them from developing into significant cancer

Even if you do harbor silent cancer cells, for-all practical poses you are now cancer-free and can remain so for the rest of your life. Our bodies are believed to have an immune surveillance, system that can help prevent the development of detectable recurrent cancer by destroying cancer cells that appear in s numbers.

Cancer cells that current technology cannot detect are affecting your life in any way as long as they remain undetectable. The only danger in this situation is letting your own thought worries about undetected cancer cells affect you in a negative way. It does not help you to worry about the possibility of something you cannot know or do anything about. Survivorship includes accepting the uncertainty of whether any cancer cells are left. See your remission as meaning that you are completely cancer-f unless there is concrete evidence to the contrary.

If you are in remission, and you and your doctors have do everything reasonable to kill any remaining silent cancer cells, you should assume that you are cancer-free and focus on ways to keep yourself healthy.

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• involvement in clinical research

• interpretation of the available data (different doctors can draw different conclusions from the same data)

The treatments being used most often in their medical center or locale (standard of care for the community) may also affect doctors’ approaches.

If you get conflicting advice, have each oncologist explain his or her advice in light of the controversy. You can determine how simple or elaborate an explanation you want or need (you do not have to learn everything about car repair to make a decision about which mechanic to use). After sorting through the various recommendations, you will feel either that there is one “best” choice or that there is more than one “right” choice.

For example, you may be in remission and your doctor feels that you have had enough treatment. If you pursue a second opinion, another oncologist may recommend an extra two months of chemotherapy “just to be safe.” Much as you would like to be done with treatment, you want to do what is best in the long run.

One possible outcome of this scenario is that you weigh the risks and benefits of each option as explained by both doctors, and proceed with the original advice. You will feel more confident about the decision to stop treatments, because you looked at your options. Consider the similar case of people buying a house who fall in love with the first one they see. The school district, floor plan, and price seem perfect. The house “feels right,” down to the telephone outlets. Still, most people would check out other houses on the market to reinforce their impression. If they find an even better house, one that “really feels right,” they will be happy that they did not sign a contract on the first house. If they come back to buy the first, they will feel surer of the decision.

Getting a second opinion and working through your options at the completion of your treatments will make you feel more comfortable when, later; you read or hear about other patients with your type of cancer who pursued one of the other treatment options. You will be more relaxed, knowing that you investigated and rejected those options as not the best for you.

Another outcome could be that the doctors providing the conflicting advice discuss the situation, after which they come to one recommendation. Or they may conclude that your options are equally good, in which case other factors (preferred doctor, treatment location, financial concerns, etc.) will determine your final decision. When there are a number of right ways to treat you, you will feel that this resolution of conflicting opinions steered you to the best treatment for you.

The most stressful outcome is that the doctors continue to disagree after discussion with you and with each other. Whom do you believe? How do you decide what is best to do? Additional second opinions (third and fourth opinions) may resolve the conflict. How you feel (your intuition) may help guide you to the best treatment choice for you. Discussing the situation with your internist may help. Usually you will end up proceeding with one option as the best of a number of options. Since not everyone can be right, you may have to dismiss the advice of one or more of the doctors in order to proceed.

There are always options at each phase of your journey with cancer. Knowledge of your options allows you to make the best choice for you with the information available.

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• find out the status of your cancer. Is your cancer completely gone as far as we can tell? If your cancer is not gone, where is it?

•evaluate your current condition (your physical and emotional limits, both temporary and permanent). How are your kidneys? Lungs? Heart? Weight?

• make a decision about whether further treatment will offer any benefit in terms of maximizing control of your cancer now or decreasing the chance of its coming back

• begin to learn how to live most fully within any new limits

• learn what you can do to accelerate your recovery

• find out what you can do to prevent future problems, such as use sunscreen or undergo periodic colon tests

•begin the adjustment of changing from being a patient under active cancer treatment to being a patient with a history of cancer who is seen for checkups geared to the special needs of someone who survived your type of cancer

• begin your lifelong routine of cancer follow-up

What Is Restaging?

Restaging is the evaluation after your treatment is completed, to determine

• how much cancer is left, if any

• whether there are any new areas of cancer

How Is Restaging Done?

Your restaging is orchestrated by your oncologist, who will

• talk to you about any symptoms or problems you are having

• examine you (“do a physical exam”)

• order various tests and studies, such as blood tests, X rays, and scans, or bone marrow biopsies

Sometimes surgery is advised as part of your restaging. This may be expected, such as “second-look” surgeries for certain types of ovarian cancer. Or you may need surgery because there is still something on your scan or your exam, and because there is no other way to determine whether it is cancer or a scar. As blood tests and imaging studies become more and more sophisticated, surgery is used less frequently for restaging.

Why Is Restaging Important?

Restaging allows your doctors to

• evaluate your response to the treatments

• determine whether further treatment is indicated

• redetermine your prognosis

Will My Restaging Comprise All of the Same Tests as My Original Staging?

The tests used to restage you will depend on the type of cancer you had, which tests were abnormal when you were first diagnosed, and what new tests have become available since then. In many cases all the tests that were done when you were first diagnosed will be repeated. Sometimes fewer tests are needed. Rarely, more tests are needed.

When Should I Be Restaged?

Most cancer treatments continue to have effects on cancer cells for a while after the last treatment is administered. Therefore, restaging is undertaken when your treatment has had ample time to have its maximum effect.

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