Finding out you have cancer brings many changes for you and your loved ones. You probably have lots of questions:

  • Can it be cured?
  • What are the best treatment options?
  • Will treatment hurt or make me feel bad?
  • How long will treatment take?
  • Will I have to stay in a hospital?
  • Will I be able to keep my job?
  • How much will cancer treatment cost?

Here, we answer many questions about cancer and cancer treatment. We also tell you what you can expect from the people and services that are there to help you cope with cancer. To help you prepare for visits with your health care team, we offer ideas for questions you may want to ask. We hope this information will help you and your family as you work through your fears and concerns about cancer and cancer treatment.

Please keep in mind that this is not meant to replace the advice of your doctor or nurse. Talking with them is the best way to understand what’s going on with your body and how treatment will work.

What is a cancer diagnosis?

Diagnosis is not the same as detection. Cancer may be detected when symptoms or abnormalities, such as a lump or growth, are recognized by a patient or doctor. After a cancer is detected, it still must be carefully diagnosed.

A diagnosis is an identification of a particular type of cancer. When making a diagnosis, the initial signs and symptoms are investigated through a variety of tests in order to identify whether cancer is causing them and, if so, what type of cancer it is. For example, breast cancer may be detected when a patient notices a lump, but it must be carefully evaluated with a number of tests in order to determine an accurate diagnosis. The diagnosis describes what type of breast cancer it is (i.e. “ductal” if it started in the ducts of the breast or “lobular” if it started in the lobes) and how advanced it is.

What is a cancer stage?

Following a diagnosis of cancer, the most important step is to accurately determine the stage of cancer. Stage describes how far the cancer has spread. (Some cancers, such as leukemia, may not be staged.) Each stage of cancer may be treated differently. In order for you to begin evaluating and discussing treatment options with your healthcare team, you need to know the correct stage of your cancer.

  • Stage 0 – precancer
  • Stage 1 – small cancer found only in the organ where it started
  • Stage 2 – larger cancer that may or may not have spread to the lymph nodes
  • Stage 3 – larger cancer that is also in the lymph nodes
  • Stage 4 – cancer in a different organ from where it started

How is prognosis determined?

Some of the factors that affect prognosis include:

  • The type of cancer and where it is in your body
  • The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body
  • The cancer’s grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread.
  • Certain traits of the cancer cells
  • Your age and how healthy you were before cancer
  • How you respond to treatment

How is cancer diagnosed?

A person’s signs and symptoms are not enough to know whether they have cancer. (See Signs and Symptoms of Cancer for more on this.) If your health care provider suspects cancer you will need more tests, such as x-rays, blood tests, or a biopsy. In most cases a biopsy is the only way to be sure whether cancer is present.

To do a biopsy a piece of the lump (tumor) or abnormal area is taken out and sent to the lab. There, a doctor who specializes in diagnosing diseases (called a pathologist) looks at the cells under a microscope to see if cancer cells are present. If there are cancer cells, the doctor tries to figure out what type of cancer it is and how fast it’s likely to grow.

Imaging tests can measure the size of the cancer and can often show if it has spread to nearby tissues. Blood tests can tell providers about your overall health, show how well your organs are working, and give information about blood cancers.

How does diagnosis determine treatment?

Doctors consider each patient as an individual with personal preferences, and then make recommendations based on things like their own personal experience, current research, the goal of treatment (cure or control), and current cancer treatment guidelines .

One source of guidelines is the National Comprehensive Cancer Network (NCCN), an alliance of leading cancer centers around the world. Panels of experts from these centers sort through the research evidence and combine that with their own knowledge and experience to come up with the best available treatment options for each cancer, and usually for each stage and characteristic of a person’s particular cancer.

These findings are published in NCCN Clinical Practice Guidelines in Oncology, which provide a standard for care in the field of oncology. The guidelines address cancer treatment, cancer detection, risk assessment and reduction, and supportive care. They are updated on a regular basis.

The NCCN guidelines help patients and cancer care providers make the best choices about cancer care. They aren’t perfect, and they don’t apply in every case. But they do offer a roadmap to making sometimes difficult and increasingly complicated decisions.

NCCN Patient Treatment Guidelines are available at www.nccn.com, a website devoted to patients, caregivers, and their families.

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