Making treatment decisions

Hearing that you have cancer almost always makes people feel like they have to start treatment as soon as possible. However, you usually have plenty of time to think through your options. Here is some information to help you better understand cancer treatment so you can make the best possible decision.

The number and kinds of cancer treatment choices you have depend on:

• The type of cancer you have
• The stage (extent) of the cancer
• And your age, overall health and personal needs.

At Gundersen, you are a key part of your cancer care team. This means that we want you to talk about what treatment choices are best for you and ask as many questions as you need. Make sure you understand your options. Hearing that you have cancer almost always makes people feel like they have to start treatment as soon as possible. However, you usually have plenty of time to think through all of your options so you can make the best possible choice.

How is cancer treated?

The major types of treatment for cancer are surgery, radiation and chemotherapy. You might also have heard about hormone therapies, biologic therapies, targeted therapies and stem cell transplants.

What treatment will be best for me?

Your team at Gundersen will base your cancer treatment on your situation. Certain types of cancer respond better to certain types of treatment. Knowing the exact type of cancer you have is important in deciding which treatments will work the best. The cancer's stage (how much cancer there is and where it is) will affect treatment options, too.

Your health, lifestyle and personal preferences will also play a part in deciding which treatment plan is best for you. Some types of treatment might work better for you than others, so be sure you understand your options. Don't be afraid to ask questions. It's your right to know what treatments are most likely to help and what their side effects may be.

What is the goal of my treatment?

Before starting treatment, ask about the goal of treatment. Is the purpose of the treatment to cure the cancer, control it or treat problems it's causing? This is a key part of the decision-making process. Sometimes the goal of treatment can change over time.

What is remission?

Remission is a period of time when the cancer is responding to treatment or is under control. Some people think that remission means the cancer has been cured, but that's not always the case.

Complete remission means that all the signs and symptoms go away and cancer cells can't be found with any of the tests used for that cancer. It's also possible to have a partial remission. That's when the cancer shrinks, but it still causes symptoms or can be detected on tests.

Remissions can last from weeks to years. Complete remissions may go on for years and over time be considered cured. If the cancer returns, more treatment might lead to another remission. A cancer that has recurred (come back) may respond to a different type of treatment, such as a different group of drugs or radiation versus surgery.

What is staging?

Staging is the process of finding out how much cancer there is and how far it has spread. Staging the cancer is a key step in making treatment choices. It also gives your cancer care team a better idea of your chances for recovery. The staging process takes time, but it's how you and your cancer care team learn which treatments are likely to work best before you start treatment.

A staging system is a way for your cancer care team to sum up the extent of the cancer. The TNM system is the one used most often. It gives three key pieces of information:

• T usually describes the size of the main tumor and whether it has spread to nearby tissues and organs.
• N describes how far the cancer has spread to nearby lymph nodes.
• M shows whether the cancer has spread (metastasized) to other parts of the body.

Letters or numbers after the T, N and M give more details about each of these factors. For instance, a tumor staged as T1, N0, M0 is a tumor that is very small, has not spread to the lymph nodes and has not spread to distant parts of the body.

Once the TNM descriptions have been found, they are grouped together into a simpler set of stages, in most cancers stage 0 through stage IV (0-4). As a rule, the lower the number, the less the cancer has spread. A stage IV (4) means a more serious, widespread cancer.

After looking at your test results, your doctor will tell you the stage of your cancer. Be sure to ask your doctor any questions you have about what the stage of your cancer means and how it affects your treatment options. Contact your team at Gundersen if you need help understanding the stage of your cancer.