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When diagnosed with cancer, initial thoughts:

Being told about the diagnosis of cancer is a challenging passing phase to handle. Naturally, during the process of cancer diagnosis and deciding on treatment, apprehensions fill the mind. Presented below are the steps to cope-up with the situation to undergo the treatment effectively. Naturally, one would be in a hurry to get the treatment immediately. However, it is worth to halt for some time mentally, take a breather and get ready for possible prolonged treatment ahead. This approach helps in undergoing the treatment more efficiently as well as improves the chances of cure. A step towards cure starts at the very moment of diagnosis of cancer.

The first and critical question that comes to the mind on diagnosis – Is my cancer curable?

Strictly speaking, no one can answer this question, including the most experienced oncologist anywhere in the world. However, by default, the answer to yourself should be "YES, IT IS CURABLE". There are two reasons for the "YES" answer. One is, cancer is no longer the disease that it was (when the theme used to be "it's curable if detected early") following recent advances in the treatment of cancer. One should focus on getting on with the therapy and going back to everyday life as early as possible. Second, the more you answer to yourself "YES", even thousands of time, the more you contribute to the cure. It's not about getting rid of it (a thought process that will give tension), but living with it & handling it meticulously at ease (thought process that will relax the body system and makes you stronger in getting rid of cancer cells). The more you relax starting from the time of diagnosis better are the chance of cancer receding, leading to a cure and improved quality of life. This attitude also eases confusion, dilemma and inner fear.

Every word in the above paragraph is powerful, effective and with a long-lasting effect. It's worth reading above paragraph, again and again, before-during-after treatment, to get the full impact on your mind.

The next question: How far the situation is urgent?

  • Cancer cells are rebel cells of the body. They are cells which do not follow the rules of the body and hence normal cells that are gone astray. These rebel cells may require 10-15 years to reach the level of diagnosis by presently available scans. Even early-stage cancer (Stage 1) would have taken many years to grow before it shows up in tests. (That is why lifestyle changes and community measures are the right way to prevent cancer in a person and reduce the cancer burden in the society)
  • It does not matter waiting for a couple of weeks for establishing diagnosis and staging before starting the appropriate treatment (except for a few emergencies). Studies have shown that the required delay hasn't affected the desired results, except in rare situations. Initiating the right treatment is more important than starting the therapy in a hurry.

Preparing to meet the oncologist (s) and the consultation(s):

  • Have all the reports ready and sequentially filed for the appointment. The most important are imaging (CT/PETCT/MRI) CD's plus reports & biopsy report, including receptor studies, if available.
  • Have a list of questions you want to ask during consultation. It would be best if you understand that there are no definite answers to some doubts and persisting with those questions will divert attention from other important things.
  • The first consultation deals mostly with chances of response to treatment. Almost all oncologists decide on the types of treatment based on available international guidelines added to their experience. Sometimes, more than one option for treatment may be available. If you opt for any treatment outside these recommendations and choice, many oncologists may be reluctant to follow that path (since it may become questionable at a later date).
  • In the present day, many patients do get the doubt that hospitals are doing unnecessary investigations and treatment. However, hospitals and doctors have a responsibility of balancing your affordability and doing mandatory tests plus treatments as per guidelines. No doctor would like to be in a situation where a procedure "not done" gets questioned in the future.
  • Usually, cancer therapy is a two or more combination of surgery, chemotherapy and radiation therapy. A particular course of treatment will be prescribed, based on the close interaction of these three or more specialists. You may have to meet all the three at a time or one after another.
  • Once the decision taken about the available options of treatment, it's best to entrust to your doctor the complexity of treatment. Your focus should be on; 1) keeping watch on your symptoms and bodily functions and reporting it if there are any changes; 2) your actions that are required to help in control & cure. For this, the first step is – physical activity and management of mind and emotions (see below).
  • It is essential to take down the phone numbers of all contact persons of your treatment team on the first day itself. There is a well-organized reporting system in the treatment team, which in turn will keep the consultants updated.

Simultaneously, do tests to have complete data on cancer status and general health.

  • It's essential not to worry about the test results. Else, process and waiting for every test result becomes painful.
  • Stage of cancer helps for deciding the type of treatment and not to decide on or to give decisive information about the cure for you.
  • In early-stage cancer, chances of cure are better, yet in a few, it can come back. In the advanced stage, even though the possibility of healing may come down, still control and cure are possible. It creates a lot of mental anguish to explore this statistical chance and apply to self. Also, fearing about it can bring down the chances of coming back to normal by reducing the immunity level.
  • Standard essential tests usually recommended are:
    • Detailed CT scan
    • PET-CT (Positron Emission Tomography-CT) scan is the one where one gets the information about the whole body in detail, at one go.
    • MRI is another test which might be needed.
    • Recently, there are several tests available for a detailed examination of biopsy samples for diagnosis and receptor status. Nowadays, the evaluation of biopsy is becoming more sophisticated to identify the specific type of cancer and may take some time before the conclusion. These tests get completed at one go or one after another. Occasionally, a difference of opinion may persist, and clinically decision is taken (which later may or may not turn out to be different).
  • Why so many tests?: Different scans and tests give different patterns of information. Combinations of all, when put together, form the basis of the scheme of management of cancer for you. Also, standard examinations to test the status of body organs, such as cardiac, liver and renal functions, are done. The findings of these tests can influence treatment.
  • Possibly other tests may also include evaluation of the body's inflammation & immunological response, in certain situations

Second opinion

  • One needs to be clear about all treatment aspects before starting the treatment. You have the option of taking opinion from other oncologists. Views of different oncologists are rarely identical, since, in medicine, a range of treatments are recommended based on several factors. However, the opinion of all oncologists is in line with international guidelines fitting to the logistical, local and financial situation. Finally, one needs to choose a course of treatment after taking into consideration personal preference, financial and logistical aspects. Expensive treatment is not necessarily significantly better, since lots of probabilities come into picture in the final result. Here, the decision you need to take. Choosing an appropriate therapy within the constraints of financial ability would be a wise decision. An oncologist will not advise a particular treatment which is not acceptable. Usually, the difference in results between a fair treatment and expensive one may not be much. For example, in radiotherapy, since the control and cure rate are similar with recommended techniques, the difference lies within acceptable side effects.
  • All effective treatments will have some side effects. If one desires a safe treatment, then one cannot expect reasonable cure and control. In cancer, the treatment is all about giving the treatment with proper timing. Second and third opportunity may not be as rewarding as the first opportunity. The oncologist may not be able to offer you the safe treatment that you desire, even with consent, if it is not within the range of international guidelines.