Many people with cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor - to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask the doctor or nurse to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat cancer include surgeons, medical oncologists, hematologists, and radiation oncologists.

Getting a Second Opinion

Before starting treatment, you may want a second opinion about your diagnosis and treatment plan. Many insurance companies will cover a second opinion if your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. But some people with cancer need treatment right away. To make sure, you should discuss this delay with your doctor.

There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
• Nonprofit organizations with an interest in cancer may be of help.

Treatment Methods

The treatment plan depends mainly on the type of cancer and the stage of the disease.

Doctors also consider the patient's age and general health. Often, the goal of treatment is to cure the cancer. In other cases, the goal is to control the disease or to reduce symptoms for as long as possible. The treatment plan may change over time.

Most treatment plans include surgery, radiation therapy, or chemotherapy. Some involve hormone therapy or biological therapy. In addition, stem cell transplantation may be used so that a patient can receive very high doses of chemotherapy or radiation therapy.

Some cancers respond best to a single type of treatment. Others may respond best to a combination of treatments.

Treatments may work in a specific area (local therapy) or throughout the body (systemic therapy):

• Local therapy removes or destroys cancer in just one part of the body. Surgery to remove a tumor is local therapy. Radiation to shrink or destroy a tumor also is usually local therapy.
• Systemic therapy sends drugs or substances through the bloodstream to destroy cancer cells all over the body. It kills or slows the growth of cancer cells that may have spread beyond the original tumor. Chemotherapy, hormone therapy, and biological therapy are usually systemic therapy.

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to decide on a treatment plan that is best for you.

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Before treatment starts, the health care team will explain possible side effects and suggest ways to help you manage them. This team may include nurses, a dietitian, a physical therapist, and others. The NCI provides booklets about cancer treatments and coping with side effects. These include Radiation Therapy and You, Chemotherapy and You, Biological Therapy, and Eating Hints for Cancer Patients.

At any stage of cancer, supportive care is available to relieve the side effects of therapy, to control pain and other symptoms, and to ease emotional and practical problems.

You may want to talk to the doctor about taking part in a clinical trial (a research study of new treatment methods). The section on "The Promise of Cancer Research" has more information about clinical trials.

You may want to ask the doctor these questions before treatment begins:

• What is my diagnosis?
• Has the cancer spread? If so, where? What is the stage of the disease?
• What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Why?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment? How can side effects be managed?
• Will infertility be a side effect of my treatment? Can anything be done about that? Should I consider storing sperm or eggs?
• What can I do to prepare for treatment?
• How often will I have treatments? How long will my treatment last?
• Will I have to change my normal activities? If so, for how long?
• What is the treatment likely to cost? Will my insurance cover the costs?
• What new treatments are under study? Would a clinical trial be appropriate for me?

Surgery

In most cases, the surgeon removes the tumor and some tissue around it. Removing nearby tissue may help prevent the tumor from growing back. The surgeon may also remove some nearby lymph nodes.

The side effects of surgery depend mainly on the size and location of the tumor, and the type of operation. It takes time to heal after surgery. The time needed to recover is different for each type of surgery. It is also different for each person. It is common to feel tired or weak for a while.

Most people are uncomfortable for the first few days after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with the doctor or nurse. The doctor can adjust the plan if you need more pain relief.

Some people worry that having surgery (or even a biopsy) for cancer will spread the disease. This seldom happens. Surgeons use special methods and take many steps to prevent cancer cells from spreading. For example, if they must remove tissue from more than one area, they use different tools for each one. This approach helps reduce the chance that cancer cells will spread to healthy tissue.

Similarly, some people worry that exposing cancer to air during surgery will cause the disease to spread. This is not true. Air does not make cancer spread.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Doctors use several types of radiation therapy. Some people receive a combination of treatments:

• External radiation: The radiation comes from a large machine outside the body. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
• Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes that are put in or near the tissue. The patient usually stays in the hospital. The implants generally remain in place for several days.
• Systemic radiation: The radiation comes from liquid or capsules containing radioactive material that travels throughout the body. The patient swallows the liquid or capsules or receives an injection. This type of radiation therapy can be used to treat cancer or control pain from cancer that has spread to the bone. Only a few types of cancer are currently treated in this way.

The side effects of radiation therapy depend mainly on the dose and type of radiation you receive and the part of your body that is treated. For example, radiation to your abdomen can cause nausea, vomiting, and diarrhea. Your skin in the treated area may become red, dry, and tender. You also may lose your hair in the treated area.

You may become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Fortunately, most side effects go away in time. In the meantime, there are ways to reduce discomfort. If you have a side effect that is especially severe, the doctor may suggest a break in your treatment.

Chemotherapy

Chemotherapy is the use of drugs that kill cancer cells. Most patients receive chemotherapy by mouth or through a vein. Either way, the drugs enter the bloodstream and can affect cancer cells all over the body.

Chemotherapy is usually given in cycles. People receive treatment for one or more days. Then they have a recovery period of several days or weeks before the next treatment session.

Most people have their treatment in an outpatient part of the hospital, at the doctor's office, or at home. Some may need to stay in the hospital during chemotherapy.

Side effects depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

• Blood cells: When drugs damage healthy blood cells, you are more likely to get infections, to bruise or bleed easily, and to feel very weak and tired.
• Cells in hair roots: Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
• Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

Some drugs can affect fertility. Women may be unable to become pregnant, and men may not be able to father a child.

Although the side effects of chemotherapy can be distressing, most of them are temporary. Your doctor can usually treat or control them.

Hormone Therapy

Some cancers need hormones to grow. Hormone therapy keeps cancer cells from getting or using the hormones they need. It is systemic therapy.

Hormone therapy uses drugs or surgery:

• Drugs: The doctor gives medicine that stops the production of certain hormones or prevents the hormones from working.
• Surgery: The surgeon removes organs (such as the ovaries or testicles) that make hormones.

The side effects of hormone therapy depend on the type of therapy. They include weight gain, hot flashes, nausea, and changes in fertility. In women, hormone therapy may make menstrual periods stop or become irregular and may cause vaginal dryness. In men, hormone therapy may cause impotence, loss of sexual desire, and breast growth or tenderness.

Biological Therapy

Biological therapy is another type of systemic therapy. It helps the immune system (the body's natural defense system) fight cancer. For example, certain patients with bladder cancer receive BCG solution after surgery. The doctor uses a catheter to put the solution in the bladder. The solution contains live, weakened bacteria that stimulate the immune system to kill cancer cells. BCG can cause side effects. It can irritate the bladder. Some people may have nausea, a low-grade fever, or chills.

Most other types of biological therapy are given through a vein. The biological therapy travels through the bloodstream. Some people get a rash where the therapy is injected. Some have flu-like symptoms such as fever, chills, headache, muscle aches, fatigue, weakness, and nausea. Biological therapy also can cause more serious side effects, such as changes in blood pressure and breathing problems. Biological therapy is usually given at the doctor's office, clinic, or hospital.

Stem Cell Transplantation

Transplantation of blood-forming stem cells enables patients to receive high doses of chemotherapy, radiation, or both. The high doses destroy both cancer cells and normal blood cells in the bone marrow. After the treatment, the patient receives healthy, blood-forming stem cells through a flexible tube placed in a large vein. New blood cells develop from the transplanted stem cells. Stem cells may be taken from the patient before the high-dose treatment, or they may come from another person. Patients stay in the hospital for this treatment.

The side effects of high-dose therapy and stem cell transplantation include infection and bleeding. In addition, graft-versus-host disease (GVHD) may occur in people who receive stem cells from a donor. In GVHD, the donated stem cells attack the patient's tissues. Most often, GVHD affects the liver, skin, or digestive tract. GVHD can be severe or even fatal. It can occur any time after the transplant, even years later. Drugs may help prevent, treat, or control GVHD.

The NCI offers a fact sheet called "Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers."