Ask what the goal is. Cure, control, or comfort. A newsletter does not get to answer that.
On film, from the National Cancer Institute. Immunotherapy: How the Immune System Fights Cancer (3 min). Three kinds of immunotherapy, in the Institute’s own animation. It says plainly that they do not work for every patient and can cause serious side effects.
When a doctor says the word cancer, the next words come fast. Surgery. Radiation. Chemotherapy. Immunotherapy. Targeted therapy. Hormone therapy. The National Cancer Institute keeps a plain list of those types. This page is that list, written for a kitchen table. It is not a plan for the cancer in your body, and it is not a ranking of which one is best.
A plan may use one of these, or several in a row, or a decision to watch and wait that is still a medical decision. The order below is the order people usually hear the words. It is not an order of strength. Your oncologist is the person who says which names belong on your paper, for the cancer you actually have.
Surgery
Surgery takes out tissue. Some operations remove a lump and a margin of healthy tissue around it. Some remove an organ, or part of one. Some are done to learn what the cancer is, before anyone talks about the rest of the plan. Ask what will be removed, how long you are likely to be in the hospital, who drives you home, and what ordinary life looks like in the first month. Ask what surgery will not do. An operation on one place does not, by itself, answer whether cells have already traveled.
Radiation
Radiation uses carefully aimed energy to damage the DNA of cancer cells. The National Cancer Institute is plain that a low dose, the kind in a dental x-ray, is not the same thing. Treatment doses are higher, and they are aimed. Most people who have it lie on a table while a machine moves. You do not feel the beam the way you feel a cut. Ask how many visits, whether it is external or placed inside the body, and what the skin and the organs next to the target may feel like. There is a longer piece in this paper on the table and the beam.
Drug treatment
Chemotherapy is a family of drugs that travel through the body. The word covers many different medicines, given by vein or as pills. It is often used with surgery or radiation, before them or after them, not instead of a conversation about why. Targeted therapy is different: it aims at a specific change in the cancer cells, and it depends on a test. No test, no promise. Hormone therapy blocks a hormone the cancer uses. It is common in some breast and prostate cancers and irrelevant in others. Ask the name of the drug, what it is for, and which side effects mean you call the same day.
Immunotherapy
Immunotherapy helps the body’s own defenses notice the cancer. The National Cancer Institute’s film on this page describes three approaches, including checkpoint inhibitors, which take a brake off immune cells. It is not a vitamin, and it is not offered for every cancer. It can cause serious side effects when the immune system also bothers healthy organs. Ask whether it is even part of your plan. If someone sells it as a drip you can buy without an oncologist, that is a sale.
What to write down before you leave
- The name of this cancer, and where it is.
- The goal of this treatment: to cure it, to control it, or to keep you comfortable.
- The names of the treatments they are actually proposing, not the whole menu.
- Who you call at night, and which changes mean you do not wait until morning.
Screening is not treatment. A mammogram, a colon test, a low-dose scan of the lungs for people with a heavy smoking history, a Pap test: those look for something early, in people who feel well. Ask which of them still apply at your age. Do not buy a test from an advertisement because this page mentioned the word.
Hang up on a cure
Anyone who calls, knocks, or writes to sell a treatment the oncologist has not named is selling. This paper will not send you to a clinic, a supplement, or a machine. If a new lump, bleeding you cannot explain, a cough that stays, trouble swallowing, or blood in the stool is new for you, call the clinician. Do not wait for the next issue.
Sources to read yourself
A note from the desk
This is general reading, not a diagnosis and not a plan written for you. Before you change how you move, eat, or what you keep in the cabinet, ask your own clinician. Do not stop a prescribed medicine because of something you read.