Cancer

Bladder cancer

At the moment there is no reliable screening test for bladder cancer. Doctors are looking into whether home testing for blood in the urine would be a reliable test. Testing for blood in the urine would not be a useful screening test for the general population because blood in urine can be caused by other conditions apart from cancer. For example, a urine infection or kidney problems. Ask your doctor if you can have regular check ups if you are considered at particular risk.

Anyone who sees blood in their urine should be examined for bladder cancer. Even if the symptoms go away, ask to be examined.

If you have early stage bladder cancer, you will need to have the tumours in your bladder removed. This is done during an operation, called a cystoscopy, under spinal, epidural or general anaesthetic. Ask your doctor what follow-up treatment will involve and possible side effects are.

Bladder cancer may spread to other parts of the body including the lungs and liver. Ask your doctor about the specific symptoms of cancer spread and what can be done to prevent it.

Advanced bladder cancer can require chemotherapy, radiotherapy or surgery, or a combination of these. It can be difficult to decide which treatment to try. Ask your doctor about the possible effect on your quality of life while having treatment and whether the possible benefits are worth it. Ask if there are any alternatives.

Bowel cancer

Surgery is needed to deal with eight out of 10 cases. The cancer is cut out, the colon is stuck together and, in the majority of cases, normal bowel function is restored. Ask what options you have in order to remove the tumour.

In some cases, particularly if the cancer is close to the anus, this may not be possible. In such situations, the colon is brought to the surface of the skin on the abdomen with an opening known as a stoma. Check that your surgeon is qualified in colorectal cancer; ask what a stoma is and whether you will need one.

A small bag worn over the stoma will collect the waste products. This is known as a colostomy. With advances in surgical technique, the formation of permanent stomas is much less common. Ask if you will need any further treatment after the operation and what your options are.

Radiotherapy is often used to treat cancers of the rectum and this may be given prior to surgery or a course of treatment following the operation. Ask when and where treatment will take place and if you will need to have surgery after your course of radiotherapy.

Fact sheets are available on all chemotherapy drugs and treatment options from the Bowel Cancer UK advisory service; call 08708 50 60 50. Ask your doctor for any further information, such as who will prescribe the drugs and which ones will be used.

There have been many advances in chemotherapy treatments in recent years with the emphasis on maintaining your lifestyle. Ask what the expected recovery time is after the course has been completed.

Breast cancer

Once your doctor has all the relevant information they will consider the best treatment for you. Ask your doctor to explain to you step by step what your programme of treatment involves and why it is the best option in your case. Ask for a second opinion if you are not satisfied.

Surgery is usually the first treatment for most women with breast cancer. In some cases, chemotherapy or hormone therapy may be offered so that surgery can be less extensive, or even avoided altogether. Ask your doctor about your prognosis with and without these treatments is - and what the likely success rate is.

There are two types of surgery: a partial mastectomy where the tumour is removed with a small amount of surrounding tissue or about a quarter of the breast is removed. A total mastectomy involves the removal of all breast tissue, including the nipple. For invasive cancer it is recommended that some or all of the lymph nodes in the armpit are removed. Ask your doctor whether breast-conserving surgery is appropriate in your case and the survival rates compared to mastectomy.

If a mastectomy is necessary: Ask your doctor about the possible effect on your body image and enquire about reconstructive surgery and prosthesis.

Surgery to remove some or all of the lymph nodes under your arm may cause a blockage that results in a build-up of fluid in the tissue of your arm. This is called lymphoedema. Having radiotherapy to the armpit can have a similar effect. Ask your doctor about the short- and long-term effects of surgery and radiotherapy.

Chemotherapy drugs have different effects and the same dosage and combination can affect women quite differently. Ask your doctor how you can minimise some of the more common side effects and whether you should take any particular supplements to avoid developing infections and anaemia.

Treatment for breast cancer can go on for years and involves lots of methods, each with their own impact. Ask your doctor about the recovery periods between each stage and how you will need to adapt treatment to your work, family and other responsibilities.

Even in recovery, you will need to be highly aware of changes in your breasts to avoid any recurrence. Ask your doctor for advice on self-examination and guidance on whether any other unrelated medical treatments should be avoided, for example, hormone replacement therapy.

Cervical cancer

Surgery is usually the first treatment for cancer of the cervix in its early stages. Radiotherapy is as effective as surgery but the side effects are greater so surgery is usually used. Ask what the success rates for surgery performed at this stage of cervical cancer are at your local hospital.

If it is thought that some cancer cells may still be left after the surgery, you may be advised to have radiotherapy afterwards to reduce the chance of the cancer coming back. Ask what sort of ongoing monitoring will be required and when you will be in the all clear.

Radiotherapy is used if there is a high risk that the cancer may come back. It is often used to treat cervical cancer in conjunction with chemotherapy. Ask how long you will need to undergo this treatment and about the possible long-term effects of both treatments on your well-being and fertility.

New treatments are being developed by scientists all the time. Ask your doctor about new developments and how you might be able to get involved in clinical trials.

Cervical cancer may return so regular smear tests are essential. Ask your doctor what aspects of your lifestyle can be changed to minimise the risks of recurrence.

Endometrial cancer

Most cancers of the womb are discovered at an early stage and are cured by a hysterectomy (surgical removal of the womb). Ask your doctor for a second medical opinion if you are not satisfied with the recommended course of treatment.

A hysterectomy is a major operation with a significant convalescence period. Ask your doctor what exercises you can do to aid recovery and when it will be safe to resume normal levels of activity such as driving and mild exercise.

There is no reason why you cannot resume a normal sex life following a hysterectomy. Ask your doctor when it is safe to have intercourse again.

Radiotherapy may be given after the operation if your doctor feels there is any risk of the cancer coming back. Radiotherapy may be used instead of surgery if the cancer cannot be removed surgically, or if the woman is not fit enough to have an operation. Ask your doctor about the side effects of treatment and how best you can offset them.

If the cancer has spread to other parts of the body, treatment with a female hormone, called progesterone, may be able to shrink the cancer and control symptoms. Ask your doctor how your age, health and type of tumour can affect the chances of success.

After your treatment has been completed your doctor will want you to have regular check-ups and possibly x-rays. These will often continue for several years. Ask your doctor what symptoms of recurrence you should look out for.

Kidney cancer

If one of the inherited syndromes that increases the risk of kidney cancer runs in your family, you may be offered screening. This means having a scan every year. Further genetic tests may become available in the future. Ask if your family history makes you a candidate for regular screening.

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. But there are particular symptoms that mean your GP should refer you to a specialist straight away. Ask your doctor to talk it through with you and decide together whether you need to see a specialist and if so, how soon.

There are various methods used to test if you have kidney cancer. Ask what the tests involve and how long it will be before you get the results.

Treatment depends on the severity of the cancer. It can range from chemotherapy and radiotherapy to removal of the kidney. Ask your doctor about the benefits and risks of all the treatments deemed suitable in your case and what impact they can have on your lifestyle.

In serious cases the kidney and or the cancer may need to be removed followed by careful monitoring. Ask what the success rates of this surgery are, whether they outweigh the risks involved and what the follow-up will consist of.

Surgery and treatment can affect people in different ways depending on their age, general health and outlook. Ask your doctor for details of associations that can put you in touch with fellow sufferers.

Kidney cancer can come back despite treatment. Ask if there is anything you can do to improve your chances of remaining in remission and what the next options are should the cancer return.

Lung cancer

If you smoke you are at much greater risk of getting lung cancer. There is also evidence to suggest that even preventative practices like eating fresh fruit and vegetables will not reduce the risk for smokers. Ask if your doctor can give you any advice and support on how to give up smoking.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The Department of Health has produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. These Government guidelines on referrals for lung cancer came into force in April 2000. Ask to see these guidelines.

Primary lung cancer starts in the lungs. There are several different types of primary lung cancer. These are divided into three main types: 'oat cell' or small cell, non-small cell and mesothelioma. Ask your doctor to explain the three main types of primary lung cancer.

Secondary lung cancer is cancer that has started somewhere else in the body (for example, the breast or bowel) and spread to the lungs. The choice of treatment depends on where the cancer started. Ask your doctor to explain secondary lung cancer.

Small cell or 'oat cell' cancer is the most common form. It often spreads quite early on. Even if the doctor cannot see any spread on your scans, it is likely that some cancer cells will have broken away and travelled through the bloodstream or lymph system. If your doctor has diagnosed small cell cancer, ask whether he or she thinks it has spread.

If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, raise any concerns you may have. Ask your doctor to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

If you are diagnosed with lung cancer you will be referred to hospital for surgery - usually removal of the lung. This will be followed by chemotherapy or radiotherapy to kill any cancer cells which may have spread to other parts of the body. Ask your GP what form of treatment they will recommend for you, and why.

Oesophageal cancer

Cancer of the oesophagus or gullet can be treated using surgery, radiotherapy and chemotherapy. The choice of treatment will depend upon the stage of the cancer, its position and size, as well as your age and general health. The treatments can be used alone or in combination. Ask about your diagnosis: where exactly is the cancer and what type is it?

Staging investigations will nearly always include a CT scan, an endoluminal ultrasound Scan (EUS), sometimes a staging laparoscopy and occasionally a PET scan. If these tests are not available you should ask to be referred to a centre which does have them. Ask about the type(s) of treatment you are to be given.

Will you have single modality treatment (ie surgery) or combination treatment (ie chemotherapy and surgery) and the reasons for any decisions? Ask your doctor to explain why he has recommended a course of action and what the likely success rate is.

Other treatments may be used to ease any swallowing difficulties you may have. These include: inserting a tube into the oesophagus to keep it open, stretching the oesophagus, and a laser treatment called photodynamic therapy. Ask whether your case is going to be discussed in a multi-disciplinary team meeting and if so, which is the cancer centre that serves that team.

This is important as patients should only have surgery for oesophageal, stomach, pancreatic and liver cancer in recognised cancer centres as defined by their Local Cancer Network. Ask to meet the specialist nurse for upper GI cancer.

If there is not one you are in the wrong hospital and should be transferred.

If you are told your cancer is incurable ask for a detailed explanation.

If you are unhappy with the explanation ask to be referred for a second opinion urgently.

Ask about hospital mortality.

If you are having surgery for oesophageal, gastric, pancreatic or liver cancer you should ask what the hospital mortality for the team operating was over the last three years.

Ask your doctor how long the planned treatments take to work and whether they will affect your diet.

The most common type of surgery is where the section of the oesophagus containing the tumour is removed and the stomach is joined to the remaining length of oesophagus. During these operations the top part of the stomach is usually also removed. Ask how this is likely to affect what you can eat and how much.

Sometimes an operation to remove the cancer may be underway when the surgeon discovers that the tumour is not suitable for removal, perhaps because it has gone through the wall of the oesophagus and has spread. If this happens, the surgeon may insert a tube to make eating and swallowing easier. Ask your doctor about the recovery period and the possible side effects of this surgery.

If the radiotherapy is given to the upper end of the oesophagus, it may reduce the amount of saliva produced by the salivary glands either temporarily or permanently. This may cause a dry mouth, which can make eating difficult. Ask your doctor to recommend nutritious drinks you can buy over the counter to provide you with essential nutrients.

Ovarian cancer

Surgery is the initial treatment for almost all women with ovarian cancer. Depending on the extent of the cancer, the ovaries, the fallopian tubes and the womb may all be removed. But often this won't be known until the operation itself. Ask your doctor about all the possible scenarios before surgery.

Depending on how extensive your surgery is your recovery time may vary. Ask your doctor how long it will be before you can resume normal activity.

Surgery is rarely used in isolation and a full treatment plan will be created for you. Ask if you can speak to both a surgeon and a cancer specialist before your treatment plan is finalised.

Chemotherapy can be used to treat ovarian cancer. In most cases it is given after surgery. Doctors may recommend a combination of chemotherapy drugs. Ask your doctor about your individual chance of recurrence, what are the chances of a cure without the chemotherapy and how much the chemotherapy is likely to help.

Doctors rarely use radiotherapy in the treatment of early ovarian cancer. Sometimes, they use radiotherapy to help with symptoms that arise as a result of advanced cancers. Ask your doctor how long your period of radiotherapy is likely to last and what side effects you can expect.

After your treatment is finished, you will have regular check-ups and possible scans or x-rays. These will probably continue for several years. Ask your doctor how long it will be before you can say you are cured.

Prostate cancer

Hormone therapy works wherever the cancer is in the body. It does not work indefinitely and is not a cure, but all being well it will keep the cancer in check for some time. Ask what the recurrence rates are and how long it will be before you can say you are cured.

In both locally advanced and advanced prostate cancer, treatment will probably involve hormone therapy, either on its own or in addition to some other treatment. Elderly men with locally advanced prostate cancer may initially be offered monitoring instead of direct treatment. Ask your doctor what treatment you will be eligible for depending on your age and state of health.

When a cancer is aggressive or is locally advanced you may have surgery or radiotherapy plus hormone therapy. Ask your doctor what effect these treatments could have on your general health, sex life and fertility.

Though prostate cancer is unusual because it does not respond well to chemotherapy in the early stages, chemotherapy can still help. Ask your doctor whether it would be useful in your case to delay the cancer's progress.

Whatever treatment you have your progress will be closely monitored. Ask your GP whether you will be able to have your regular tests carried out at the hospital or at the GPs surgery.

Testicular cancer

If ultrasound or blood tests confirm testicular cancer, the affected testicle will usually be removed surgically. Ask your doctor what the success rates are at preventing the cancer from coming back after the testicle has been removed.

In the rare instance that a tumour develops in a man with only one testicle it is sometimes possible to use chemotherapy to avoid losing it but in serious cases surgery is the only option. Ask your doctor about the possibility of inserting an artificial testicle at the time of surgery.

X-rays and scans are then performed to see if the cancer is spreading. If caught early enough, no further treatment may be needed. If it has spread, chemotherapy is usually given for between two and three months. Ask about the side effects on your fertility, sex life and general quality of life.

Being more aware of changes in your testicles are vital to early detection of a recurrence. Ask your doctor how to perform self-examination.

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