What to Do After You Hear the ā€œCā€ Word (Cancer): Your first 3 steps

 A cancer diagnosis comes out of the blue. Many patients are unsure how to proceed after the news. This video covers the very first steps you need to take and gets you started on your information gathering by giving you basic information on the types of cancer treatments you are likely to face.  This information is not intended as medical advice. Talk with your doctor before beginning any new health practice.

Transcript:

Hello everyone!  I am Dr. Lisa Schwartz with Cancer Straight Talk.  Today I’m going to address one of the most immediate needs for cancer patients.  And that is – what happens after you hear that you have a cancer diagnosis.  What do you do after you hear the “C” word?  Who do you talk to?  How do you know what treatment you will need or want?

Well, I am going to take you through the first 3 steps. These may be obvious to some of you and yet not even occur to others.  No two cancer patients are in the same spot emotionally when they get the diagnosis.  Once we talk about those first steps, I’m going to give you the basics on cancer treatments. Your oncologist will be the one to make recommendations to you, but I want you to at least be in a position of having heard the words chemotherapy, radiation, or surgery and how they apply to your cancer treatment decision making.

So the first step may be more difficult than it sounds for some of you, but I would encourage you to talk about it. Tell someone. Tell at least one person who is close to you.  You can stop there if you would like or you can take some time before you tell anyone else. Eventually, I would encourage you to let your family know.  In some cases, your relatives may need to undergo extra screening and get checked themselves.

Why is it so important to share this diagnosis with someone?  One reason is that it really helps to have a shoulder to cry on if that’s what you need to do.  But another reason is that you need someone to remind you who you are. Let me elaborate on that a little.  We all have a personal view of who we are, how we see ourselves in the world, who we are professionally, who we are to our family and friends, how we fit into our community.  We have a picture of ourselves that helps to guide our thoughts and our actions.  Up to this point that picture did not include cancer. But now you are a cancer patient.  But you are still so much more.  You might need your friends and family to remind you of how strong you are, how capable, and that this thing is another event in your life that you will tackle just as you have tackled other things in the past. Use your community.  Depend on someone else for a change.

I had a patient one time that I was seeing for a non-Hodgkin’s lymphoma.  She was a woman in her 60’s and was handling our discussion quite well, in fact, exceptionally well.  It’s not that I had bad news for her, she was going to be fine.  But she just was taking the whole process in stride and with a smile on her face.  Near the end of our conversation, I said, “I just gotta ask you, how is it that you are taking all of this so well?”  She smiled even bigger and said, “Doc, I done had my pity party.  I cried and cried and carried on with my friends and family for a whole day.  But now I have mustered up my faith, and I am ready to get started.”  So my advice to you is to have your pity party, more than once if you need to, and then get on with it.

The second “to do” on your list is to choose a doctor.  The doctors who specialize in taking care of cancer patients are medical oncologists who give chemotherapy, radiation oncologists who give radiation therapy, and surgeons who specialize in cancer surgery.  There are lots of resources you can use to find an oncologist, but the first place to start may be with your primary care physician.  Keep in mind that as well intended as your primary doc may be, he or she is not an expert in cancer medicine.  Your primary doc may have some general ideas of what treatment will be recommended for you but don’t stop there.  You really need to see an oncologist, and if you trust and like your primary care physician, you can ask him or her to recommend an oncologist.  You may also have friends who have dealt with cancer already and can give you a recommendation on a cancer doctor that they liked.  If you live near a medical school, call there to see who specializes in the kind of cancer you have.  Your insurance company should also keep a list of oncologists who accept your insurance in your area.  Ultimately deciding on an oncologist to lead your treatment team (which may include all 3 kinds of cancer doctors) will depend on how comfortable you are in working with that doc and his or her staff.

The last step is the one that probably will take the most time and effort on your part.  And that is to start gathering information.  You now need to become a student and research your cancer and its treatment.  Some of you may not be able to get to this point right away.  You may be frightened or intimidated by the information you find.  The internet is a great resource for finding both factual information about treatments and loads of crap about alternative treatments.  Please stick with reputable sites like the National Cancer Institute and the American Cancer Society. Both of these sites have information written specifically for patients.  It’s pretty general but there should be more than enough for you to review at this point in your journey. 

At the very least, the minimum information you need to know is what are the most common types of treatment for cancer.  Those are chemotherapy, radiation, and surgery.  

 Chemotherapy is a medicine that is usually given in a vein (although there are some chemotherapy pills) and it travels throughout the body.  For this reason, we consider it a “systemic” treatment.  It goes system-wide.  The reason to give a treatment that goes throughout the body is usually because it has spread beyond where surgery or radiation can successfully encompass it all.  This usually means that it has gotten beyond the organ in which it started and the lymph nodes that are around that organ.  Sometimes though we give chemotherapy if the risk of that kind of spread is significant even though we can’t find evidence of that spread at the time of treatment.  To give you an example, a patient with breast cancer that has spread to the lymph nodes under the arm may receive chemotherapy even though there is no evidence that the cancer has spread beyond the lymph nodes.  The reason for this is the risk of the cancer coming back in other places later on is high enough that giving chemotherapy now will decrease the risk of finding disease outside of the breast and lymph nodes later. So in this case, the chemotherapy can be thought of as insurance.  Another reason to give chemotherapy even if the cancer has not spread very much is that you have a very sensitive cancer.  This means that it dies very easily with chemotherapy.

The next type of cancer treatment is radiation. Radiation is considered a “local” treatment meaning it only treats an area where it is directed or aimed.  Radiation is generally not given to very large areas.  It frequently is delivered to the area of the tumor with or without the draining lymph nodes.  There are two types of radiation:  external and internal (which is also called brachytherapy).  External radiation consists of x-rays that are delivered from a linear accelerator (which is the name for a radiation generating machine) that is outside of the body.  Radiation is invisible and doesn’t hurt—like getting a chest x-ray.  There are a lot of abbreviations associated with external beam radiation—like IMRT, VMAT, 3D conformal—all of these describe different ways of delivering the radiation with varying levels of complexity.  The other type of radiation is brachytherapy.  This involves placing a radioactive source either next to or inside of a tumor.  External radiation and brachytherapy may be combined to treat some tumors.  Radiation in general is also frequently combined with chemotherapy.

The last common treatment is surgery—and actually it may be the first treatment you face since most cancers are diagnosed with a biopsy of some sort.  Surgery, like radiation, is also a local treatment.  Cancers that are primarily treated with surgery must be located in a surgically accessible area of the body, small enough to be completely removed by surgery, and not entangled or invading into any structures that cannot be removed.

So that is an introduction.  The first 3 steps after you hear the cancer diagnosis. First tell someone, then choose a doctor, then gather your information.  In the less than 15 minutes that we have spent together, you have started on your journey.  I hope that this information serves you for where you are right now.

 I do have one other thing that can help you at this point.  That’s my free book 10 Questions You Should Ask Your Cancer Doctor. Free. F-R-E-E, free. If you are watching this on YouTube, there should be a link below this video where you can get your copy. If you are watching this on my website, CancerStraightTalk.com, then just go to the homepage or click on the link in the middle of this transcript and download your copy. 

So that’s it for now.  I appreciate the time you’ve taken to watch this video.  If you got something out of it, please hit the “like” button and share it on social media.  That allows me to reach more people with this information.  Until next time, be well.

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