From Suspicion to Action: The Cancer Patient's Roadmap

A person's first encounter with a suspected cancer diagnosis is disconcerting and adds a great amount of stress to a previously calm and normal life. Often people are lost, unsure of what to do, where to run and who to turn to. 

Information is the best weapon against the unknown, so in this article we offer you an insight into all the stages of a patient's cancer journey.

It is not easy to suspect a cancer diagnosis by yourself. However, there are situations when a person notices some changes in his/her body, and they alarm him/her. Examples of such warning signs may be a suddenly changed mole, an unclear and previously undetected lump in the tissues (in the breast, under the arm, on the neck or in any other place of the body), the appearance of traces of blood from the nipple of the breast, the detection of blood in the stool or urine.

Additionally, a person may be alarmed by a prolonged and permanent change in his/her general condition, for example, rapid and unexplained weight loss, persistent cough, constant fatigue, intense night sweats, inability to eat as before (e.g. difficulty in swallowing, repeated vomiting after eating). It should be noted that the above described conditions are not unambiguous signs of cancer, but they can definitely alert a person. 

First of all, if you have any alarming symptoms, you should not panic. Nor should you go to the "doctor-Google" and look for the cause of your symptoms, as this will only waste time and will not give a clear answer. 

Visiting a medical practitioner is the best step to take if you are experiencing bothersome symptoms and conditions.

Seeing a general practitioner 

The first doctor a person sees, even if he or she suspects cancer, is likely to be a general practitioner. Of course, depending on complaints, availability of doctors, gender and other factors, a person may also see another specialist, such as a gynecologist or urologist, but the most common scenario is to see a GP. At a doctor's appointment, the person shares his or her complaints and suspicions. 

When you get to the doctor, you need to tell him or her about your concerns as thoroughly as possible and not withhold any information. The doctor's task is to listen to the patient, ask clarifying questions to help narrow down the range of potential diagnoses, explain to the patient what suspicions the doctor has, what examinations should be carried out to determine a possible diagnosis, and refer the patient to these examinations or carry them out on his/her own, depending on the possibilities. 

Referral to an oncologist

If the results of the initial examinations carried out by the general practitioner confirm the specialist's suspicion that the patient may have cancer, the doctor must refer the patient to an oncologist for a consultation.

For this purpose, the GP writes a referral document in which he/she indicates all the data about the patient, the results of the patient's examinations and the possible diagnosis that the patient is suspected of having.

The patient may be referred to an oncologist, either at a polyclinic or at a specialized oncology center. In some cases, the patient may be referred directly to an oncologist, bypassing the general practitioner stage: for example, in the format of a paid consultation in private medical centers or cancer hospitals. 

Consultation with an oncologist and detailed examination

In order to confirm or rule out cancer and, in case of confirmation of the disease, to determine the exact stage and type of tumor, the oncologist must perform a thorough examination of the patient, collect a detailed medical history and complaints, as well as prescribe the necessary diagnostic procedures and laboratory tests. 

Collecting the patient's medical history is an important step in the diagnostics and treatment of cancer.

Medical history includes the following important details: 

• Complaints: the doctor should question the patient thoroughly about what has been bothering him or her, for how long and what the patient has been doing to manage his or her condition. 
  

• History of comorbidities: the doctor should ask the patient a series of questions about previous and current illnesses, previous surgeries, allergies, current use of medications.
  

• Hereditary predisposition to cancer: the doctor should clarify whether relatives in several generations have had cancer diagnoses. This is necessary to determine the hereditary risks and the possible connection between family history and the patient's disease. 
  

• Harmful habits: the doctor should ask the patient about his/her current or previous use of tobacco and/or alcohol, as these factors may influence the risk of cancer development.
  

• Professional and environmental risk factors: The doctor should ask the patient about his or her job, trying to identify possible harmful conditions that may have increased the risk of developing cancer. The oncologist may also ask questions about the patient's exposure to possible negative environmental factors (e.g., frequent work in the sun, living in a radiation-unfriendly area). 
  

• Psychosocial history of the patient: the doctor should gather information about the patient's social and psychological situation, including their stress levels, quality of life and needs for psychological support.
  

Collecting the medical history effectively will allow the oncologist to better understand the context of the patient's disease and plan the optimal course of action.

Once the medical history has been collected, the oncologist will begin to plan the patient's examination in order to determine a final diagnosis. The patient may be offered various diagnostic methods, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, endoscopy, biopsy, laboratory tests and others.

The choice of diagnostic methods will depend on the type of suspected cancer, as well as on the internationally accepted and country-specific standards of examination for the tumor in question. The examinations can be carried out both in the oncology center and in other hospitals to which the doctor will refer the patient additionally. 

Confirmation of diagnosis and treatment 

After the patient has undergone all the examinations prescribed by the doctor, the most important and crucial step is setting a diagnosis.

The patient comes for a second consultation with an oncologist, where the doctor carefully evaluates the patient's examination findings and confirms or rules out a cancer diagnosis. If cancer is ruled out, the patient is referred back to the general practitioner together with the results of his/her tests in order to obtain further specialist consultations and to investigate the causes of the patient's condition. 

If a cancer diagnosis is confirmed, the oncologist will stage the disease and plan a treatment strategy, which also has its own internationally approved standards. While discussing the diagnosis with the patient, the doctor should explain the choice of treatment tactics and tell the patient what steps will be taken in order to achieve persistent remission or stabilization.

Cancer treatment can last from one month to a year or more. The length of treatment will depend on the stage of the disease and the type of tumor. Throughout the treatment process, the patient may interact with various medical specialists such as oncologist, chemotherapy specialist, surgeon, radiation oncologist, palliative care doctor, narrow specialists (neurologist, gastroenterologist, etc.). 

During the course of treatment, the patient will undergo interim examinations and tests that will show the progress of treatment and how the patient's body is responding to the therapy. If the results of intermediate examinations show that the treatment is not having sufficient effect, the patient may be offered a change of therapy to achieve better results.

Surveillance

The development of world science makes it possible to achieve better results in the treatment of cancer every year. Many patients achieve a permanent remission and no longer have to deal with cancer treatment for the rest of their lives. However, this does not mean that a patient who has achieved remission forgets his or her path to the oncologist forever. 

For patients who have undergone cancer treatment, there are standardized follow-up periods within which the patient will see an oncologist and undergo a number of check-ups. This is to ensure that, should the disease return, treatment for cancer relapse is initiated as quickly as possible, because early start of treatment will increase the chances of a favorable outcome and reduce the impact of the disease on quality of life and its duration. 

After several years of follow-up with an oncologist, the patient is transferred to the supervision of a general practitioner. The frequency of check-ups also decreases with each year of relapse-free life. 

Hospice care

Despite the fact that advances in the treatment of cancer are significant, sometimes there are situations when therapy fails and the cancer progresses, leading to the patient's demise. If all possible cancer treatment options have been exhausted, the patient will need comfortable professional care for the rest of his or her life. This can be achieved through hospice care. 

Hospice is a medical facility that provides palliative care to cancer patients and people with terminal illnesses. In the hospice, patients receive 24-hour medical care designed to provide comfort and improve quality of life. This may include pain therapy, relief of symptoms associated with the illness, assistance with personal hygiene and eating.

Also, through the hospice service, patients and their carers can receive psychological support from palliative care professionals to help them cope with the emotional stresses associated with illness and near death. 

Hospice workers help patients and their families deal with practical issues related to the illness, including organizing the patient's home care, financial issues and preparing for the end of life. Patient referrals to hospice care can be made by either a medical oncologist or a general practitioner based on the advice of a medical oncologist. 

In addition, hospice services can provide care for non-terminal patients undergoing cancer treatment. For example, a patient may be referred to a hospice to manage symptoms of intoxication or other adverse reactions associated with cancer treatment. This hospice stay is temporary and will end as soon as the problem that brought the patient to the hospice is resolved. 

Social support 

Patients with cancer are entitled to social care and support.

In the case of severe forms of cancer that lead to significant impairments in the functioning of the body, the patient with cancer may get a disability group. Additionally, the patient may get disability if he or she has undergone surgery to remove a part of a limb or organ, or in case of certain other consequences of cancer treatment. 

The disability group is determined by special medical commissions, to which the patient is referred by an oncologist or general practitioner. 

Various social benefits and allowances may be available to a cancer patient with disability, including travel and accommodation allowances, access to medical services and payment for medication. 

Generally, cancer patients are also entitled to various types of medical and social support, including palliative care, psychological support, and rehabilitation, according to the laws of the country where they live. 

Cancer patients are also entitled to long-term sick leave and paid leave during treatment or rehabilitation. It is important to note that the available benefits and social support measures may vary by country and regional regulations. 

Each of the described steps of the cancer patient journey is undoubtedly difficult in its own way. The GoTreatCancer project is ready to go through any of these steps together with its clients and provide the best possible support on the cancer journey.