Chemotherapy and Radiation For Dummies
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After you've been diagnosed with cancer, tests can provide important information that determines what sort of treatment will work best for you. So roll up your sleeve for that blood test, schedule that biopsy, and make that appointment for an imaging scan. No cheating allowed! You want the best information available from these tests so that you and your doctor can make the best treatment plan possible.

Having blood drawn

You most certainly will be sent to a laboratory for blood tests, both before chemotherapy and radiation begin and throughout treatment.

If you are worried that your veins will neglect to pop up and make themselves easily available to the technician, try playing a little air guitar in the parking lot before you go in the building, or even in the hall before you go in the laboratory. Pick the arm the technician most likely will stick and swing it in full circles, backwards and forwards, to make sure the blood is flowing freely.

Some people are nervous about needles because they associate them with pain. Depending on your past experiences, you may think that having blood drawn is no big deal, or you may think it's terribly painful. Sometimes, putting an experience in perspective can help you think differently about it. Compared to having a baby without drugs, slamming your hand in the closet door, or having a broken bone reset, having blood drawn isn't so terrible. Maybe you can consider it comparable to that momentary discomfort that you feel when you accidentally hit your "funny bone." The sensation is strong at first and then ebbs.

No one ever said that you have to watch the technician draw your blood. Look at the ceiling, look at the opposite wall, look back over your shoulder at a colorful calendar. To avoid feeling queasy, look anywhere but at your arm or hand.

Stretching out on a table

High-tech pictures provide invaluable information about the size, shape, and location of a tumor. Several different kinds of imaging scans may aid your doctor in planning the best treatment for you.

For some scans, you may be injected with a small amount of radioactive material to better highlight the tissue or organs being scanned. If that's the case, your doctor will tell you about any short-term restrictions you must follow until the material leaves your body.

Some of the tests take time, and others can be completed fairly quickly — it all depends on the type and purpose of the scan, the age of the equipment used, and whether the technician sees something that requires a second look. After the scan, you may be asked to stick around long enough so the technician and the doctor can be certain they have all the images they need.

Imaging scans don't hurt, though lying still on a hard table can become uncomfortable if the scan takes a while.

Some of the imaging machines are noisy, making whirring or clicking noises throughout the scan. You may be offered a choice of radio stations to be piped in through speakers near your head, but often the sounds of the machine will prevent you from concentrating on anything else.

Here are the basics about five different imaging techniques:

  • Computer-assisted tomography scan: Better known as a CT or CAT (for computed axial tomography) scan, this type of test uses a computer linked to an x-ray machine. The scan provides cross-section images of your bones, soft tissue, organs, brain, and blood vessels. These images, or "slices," reveal the size and location of a tumor.
  • Positron emission tomography scan: Also known as a PET scan, this scan may do a better job than a CT scan of finding some (but not all) types of cancer cells and determining what actions those cells are taking. (A machine that does both CT scanning and PET scanning now is available, combining the best of both, but few medical centers have the machine at this time.)
    Also, PET scans sometimes are used to help stage cancer, assess response to treatment, or, in the case of a possible recurrence, show the difference between scar tissue and active cancer tissue. PET scans also are useful for planning radiation therapy.
    Before the scan, you may be injected with a radioactive tracer, but the amount of radiation is small and will quickly leave your body. Drink a lot of water throughout the day to help your body eliminate it.
  • Radionuclide scan: In some instances, you may be asked to swallow, or have an injection of, a radioactive substance. A scanner measures radioactivity levels in your organs, which allows the doctor to detect abnormal areas based on the amount of radioactivity.
  • Ultrasonography: Ultrasound uses high-frequency sound waves that scan the body and then bounce back to produce an image called a sonogram. To produce the images, a technician rubs a chilled gel on your skin and then moves a small imaging wand back and forth over your skin, through the gel. The images appear on a monitor and can be printed to provide specific information for your doctor.
  • Magnetic resonance imaging: Also known as an MRI, magnetic resonance imaging uses a magnet linked to a computer to produce detailed images of the body. These images also can be viewed on a monitor and printed.
    Many MRI machines require that you lie inside a narrow metal tube. If you're not claustrophobic, that's not a problem. From time to time, the technician will announce how many minutes more remain to complete the scan. Also, you will be given a buzzer, or panic button, to summon the technician if you become uneasy. If that happens, by all means press the button! You won't be the first person to do so — or the last.
    Neglecting to notify the one person who can relieve your anxiety will only add to it. Your rational mind may continue to insist that you are perfectly fine, but if your adrenaline starts pumping and your emotions insist that you are in a "fight or flight" situation, summon the technician and take a minute to calm yourself. No one will think less of you.
    Nor does such an interruption mean you have to start all over, as long as you are willing to resume after calming yourself. Normally, if you ask to stop, the technician will tell you just how much time is needed to complete the scan, and you may decide whether to continue. If you choose to leave, you may have to start all over another day.

If the idea of lying in a narrow metal tube while a noisy machine takes pictures of your insides scares you as much as having cancer in the first place, ask your doctor where you might have the test with an MRI machine that has open sides.

Undergoing a biopsy

Having tissue removed is practically standard procedure for anyone with cancer. This tissue removal is called a biopsy, which is another type of test that provides information about your cancer. For instance, a biopsy reveals the cellular composition of a tumor, and that information may hold clues to the virulence of the tumor.

Biopsies of tumors also provide what is known as a grade, or an indication of the degree to which malignant cells resemble healthy cells. In other words, the grade denotes the aggressiveness of the cancer cells. A tumor can be graded from 1 to 3 or 4. Low-grade malignancies tend to be less aggressive; high-grade tumors are more so.

Also, along with other tests, biopsies help your doctor determine the stage, or the extent, of your cancer. You can have a very early stage cancer that is high grade, or aggressive.

How is the tissue removed during a biopsy? One of three ways, depending on the type of cancer you have:

  • Needle biopsy: A doctor inserts a long, hollow needle at the site of the tumor to remove a small amount of tissue. You may feel pressure, but a local anesthesia prevents you from feeling any pain. Typically, needle biopsies are brief, and they take place in a doctor's office, outpatient surgery suite, or radiology department.
    Though you have to be present for a needle biopsy, you do not have to watch. The needle is big, and closing your eyes may make you more comfortable about the experience.
  • Surgical biopsy: If your doctor suspects that you have a cancerous tumor, the surgeon may remove a small part of the tumor for further tests. Surgical biopsies take place at an outpatient surgical center or a hospital. Generally speaking, surgical biopsies require an IV drip and then a trip to the operating room where you likely will receive local anesthesia. You also may be lightly sedated.
  • Endoscopy biopsy: An endoscopy is a test that allows the doctor to examine areas inside the body through a long lighted tube. The equipment allows the doctor to take pictures and, sometimes, to remove suspicious tissue or cells. Endoscopy tests take place at an outpatient surgical center or a hospital, and you will be lightly sedated.

Before a surgical biopsy or endoscopy biopsy, your doctor will tell you how much time to allow for the procedure, and whether you will feel like heading to work or going on about your day afterward. Also, she may prescribe a mild pain reliever for you and/or recommend that you use ice on the incision to keep down any swelling.

What your doctor may not tell you is that frozen peas work better than ice. Before the biopsy, buy a big bag of frozen peas. Divide the peas into individual plastic sandwich bags and throw them back in the freezer. You'll find that a bag of frozen peas more easily takes on the shape of your biopsied body part than any bag of ice. Usually the icing routine is 20 minutes on and 20 minutes off, but check with your doctor about that. You can refreeze your bags of peas over and over.

It's normal to be nervous about any kind of medical test, and it's impossible to ignore that biopsies are most often scheduled to investigate or confirm the presence of cancer. That said, the tests themselves are done under the strictest of controlled circumstances with the highest attention possible paid to safety measures. In other words, it is highly unlikely — highly unlikely — that a biopsy will cause cancer to spread.

About This Article

This article is from the book:

About the book authors:

Alan P. Lyss, MD, is a medical oncologist. Humberto M. Fagundes, MD, is a radiation oncologist. Patricia Corrigan is a professional writer and cancer survivor.

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