Hearing your story
This is a very important step. Knowing the course of events of any problems and how they affect you really helps us know where to look next to make a diagnosis. A number of members the team will therefore want to ask you about your symptoms, any past medical history, medicines you take and any history of illness in the family. It is also useful for us to hear how you manage these symptoms day to day and to know who the important people in your life are.
Your treatment plan
Your MDT will meet to discuss and plan your treatment, and will talk to you and your family about what they’re recommending. It’s important that you understand what your treatment involves so feel free to ask your team any questions you may have.
You’ll also receive written information about your diagnosis and treatment to help you make choices about your care. If there is anything you don’t understand or have any questions about the written information, please ask the team looking after you.
Some treatments are intensive and we may need to do some ‘MOT’ type tests before we start to make sure someone is well enough to proceed, this will often involve doing checks on the heart (e.g. perform an echocardiogram) or kidneys, to make sure they have no previously unknown problems with these organs. The test required will vary with the type of treatment you need.
The combinations of the tests below and some other specialised tests will help us to find out if there is a cancer present and which type of cancer. Occasionally this is still not possible and the team will discuss the best plan with you. Once we know the cancer type we will be able to start to discuss with you how it can be treated. This will also be guided by the information provided by the radiological scans performed, as treatments depend on where the cancers are found in the body. This often involves using medicines that are good at getting rid of cells that are dividing quickly, these medicines are referred to as chemotherapy. High doses of X-rays are also good at getting rid of certain groups of cancers and can be used as radiotherapy. For some cancers, surgery may be required ( trying to remove part or all of the cancer).
Once we have heard your story this will help guide where it would be helpful to perform a physical examination, for example, listening to your heart and lungs with a stethoscope and examining your abdomen.
Whichever area of your body that needs to be examined we can talk through why this is helpful and exactly what is involved. Additionally if you feel more comfortable we offer for another member of staff to be present as the nurse or doctor performs the examination.
Next we will often need to take some blood samples. This can give us information about how a person’s body is working, and if the cancer is cause any of the organs in the body difficulty. It can also sometime detect abnormal cells themselves, for instance in some blood cancers such as leukaemias. Other tests look for chemicals that certain types of cancers can produce which help suggest a particular cancer diagnosis.
These are very sensitive ways of taking pictures of the inside of the body often with X-rays (X-rays and CT scans), sound waves (ultrasound) and magnetic fields (MRI scans). They can help us identify where the abnormal cells are to be found in the body and how many there are and what problems they are they causing.
X-rays are a form of medical radiation that help us take pictures of different areas of the body. Used in the right way they are safe. They are often useful at looking at the chest and lungs, and are very good at looking at problems affecting bones.
The use of sound waves can help build up a picture of areas just under the skin e.g. lymph nodes, but are also good at looking at muscles including the heart (looking at the heart is called an echocardiogram).
This is a very useful machine that takes X-rays from different positions around the body and with the aid of a computer builds up a 3-D picture of the areas scanned.
This combines a CT scanning machine with giving patients a special ‘tracer’ into a vein which goes to areas of the body that are working harder or ‘metabolically active’. Cancers often need to use a lot of sugar as they are working hard, which can therefore show up on the scan. But also areas of inflammation and infection can show up as positive. Therefore it is a very useful test but areas showing up as positive do not always mean these are affected by cancer, we have special doctors who are trained to decide which areas are involved by cancer by interpreting the scan.
These scans look at different bones in the body, to look for those involved by cancer cells and again uses a special ‘tracer’ to identify bones that have abnormal cells within them.
Once we know where the abnormal cells are within the body we need to know for sure where the cells have come from and how they are behaving. The best way to do this is look at the cells in more detail in the laboratory e.g. under a microscope. This requires that we take a sample of the cells, known as a biopsy. These biopsies can often be done with a local anaesthetic to numb the area being biopsied and then a special needle is used to take the sample of the cells from the numb area. If the area requiring the biopsy is harder to get to occasionally people will need to have a general anaesthetic where they are asleep during the procedure.
Once the biopsy arrives in the lab special tests will be performed to get as much information as possible from the cells. This can normally take up to a week or so to do. Some particularly specialised tests make take longer. Occasionally the biopsy does not give a clear result and your team will discuss with you the best next step, which could include a further biopsy.
We may offer you the opportunity to take part in clinical research as part of your treatment. This could be a study where a few extra blood samples are collected from you, or a trial where changes are made to your treatment. Clinical research is really important as it allows us to learn more about your disease and helps us to develop better ways of detecting and treating it. All clinical trials are approved by an ethics committee to ensure that your best interests are protected at all times. Any information that we collect will be submitted using a trial number, so the people running the trial will never know your name or personal details. You will never be forced to take part in a trial and your doctors or nurses won’t mind if you would prefer not to sign up to the trial. We offer trials to as many people as possible, but there may not be one available for you at the time that you are receiving treatment.