Questions to Ask Your Oncologist
At the time of diagnosis, before the start of treatment
- What type of cancer do I have?
- What is the stage of cancer?
- Is it curable?
- Is the diagnostic workup complete or do I need to get more tests done?
- How many specialists would I require for treatment?
- What is the prognosis of my disease?
- What is the expected survival?
At the time of start of treatment
- What are the various treatment options available?
- How many different treatment modalities will be used?
- Will the treatment be with a curative intent?
- What are the possible side effects of treatment?
- How many treatment sessions I have to take?
- What will be the time interval between treatment sessions?
- Should I continue other medicines I am taking now?
- Will the treatment affect my fertility?
- Do I have any dietary restrictions while on treatment?
At the end of treatment
- Are there any delayed side effects of treatment?
- What are the chances of my cancer returning back?
- How frequently I have to come for follow up?
- Are there any tests to be done on follow-up visits?
- What symptoms should I be cautious of?
Answers to Some Common Questions from Oncologist
What is the stage of my cancer?
Staging helps to determine the disease prognosis and to select an appropriate treatment strategy. The AJCC (American Joint Committee on Cancer) or TNM is the most commonly used system for staging cancer.
The system utilizes 3 parameters (represented by letters – T, N, and M) for assigning a stage to cancer. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, “M” for “Metastasis”.
Numbers. and/or letters after T (0, is, 1, 2, 3, etc), N (0,1, etc), and M (0 and 1) provide more details about each of these parameters. Once T, N, and M categories are determined, this information is combined to assign an overall stage (from 0 to IV) to the disease.
What are the investigations I need to get done?
FOR DIAGNOSIS CONFIRMATION
First, we have to confirm the type of cancer with a needle test (FNAC or biopsy). Biopsy sample is generally collected from the suspected areas observed during the imaging. Depending on the size and location of the suspicious area, a fine needle biopsy, a core needle biopsy, or a surgical biopsy technique is utilized. Sometimes, IHC (immunohistochemistry) testing may be required to be done on biopsy sample to confirm the diagnosis.
Imaging tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease locoregionally and to distant body parts, and assess the stage of the disease. One or more of the following may be required-
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose the spread of disease to distant body parts. It is usually combined with a CT scan (PET/CT).
Bone Scan: In this test, a radioactive material is injected into the vein of the patient, which gets accumulated in the areas of bones affected by the disease, which are then detected with the help of radioactivity detectors. In this way, it may help to detect the spread of cancer to bones.
What will be treatment modality(ies) used? How many specialists will be required?
Cancer treatment is a multidisciplinary decision taken on individual patient basis, taking into consideration type of cancer, stage of disease, performance status of patient, patient’s preference, along with other factors. Broadly, the treatment modalities used commonly are-
a) Chemotherapy, Targeted Therapy, Hormonal Therapy, etc
c) Radiation Therapy
d) Palliative Therapy
Apart from these, other modalities may be required depending upon systems involved.
Final treatment plan determines the specialists who will be involved in treatment.
4. Is the disease curable? What is the expected survival?
By cure, we mean that the disease has been completely eliminated from the body. But it doesn’t mean that it won’t come back. Curability and survival depend on the stage of disease and the treatment modality(ies) used. Usually early stage disease has a higher chance of cure and greater survival compared to advanced stage, but this doesn’t always hold true. Many other factors also play a role.