Specialty Area: Medical Oncology

Description of Specialty: The investigation and treatment of cancer of various organs.

1. Diagnosis: Bladder Cancer

Questions that should be asked:

1. Is my cancer superficial or is it deeply invasive?
2. What is the stage of my cancer?
3. Is this a curable stage?
4. Is my cancer localized or is the bladder diffusely involved?
5. How will I be followed for recurrence of my cancer or for response of my cancer to treatment?
6. Are there specialists in other disciplines who may be able to work with you to help me and who should be consulted now?
7. What may be the eventual risks or toxicities of your recommendations?
8. Are there research studies for my type and stage of bladder cancer that are actively recruiting patients and for which I might be eligible?
9. Do you participate in research studies for cancer patients?

2. Diagnosis: Brain Cancer

Questions that should be asked:

1. What is the name of my type of tumor?
2. Is this type of tumor generally curable by surgery or radiation treatment?
3. How will I be monitored for response to treatment or for recurrence of my tumor?
4. Does chemotherapy have value in my type of brain tumor?
5. What are the problems for which I should call you?
6. Under what circumstances should I call my regular physician?
7. Are there research protocols, here or elsewhere, that are actively recruiting patients and for which I might be eligible?
8. Do you suggest that patients with tumors like mine participate in research studies?
9. Are there support groups for patients with tumors like mine?

3. Diagnosis: Breast Cancer

Questions that should be asked:

1. What is the stage of my breast cancer?
2. Were the hormone receptors elevated or not?
3. What are the chances that the treatment I have already had has cured my cancer?
4. Does the treatment you recommend increase the chances of cure?
5. By how much does the chance of cure increase if I accept your recommendations?
6. What are the late toxicities or complications of the treatment you recommend?
7. Do you participate in clinical trials of new treatments for breast cancer?
8. Am I eligible for any clinical studies that are actively recruiting new patients?
9. Do you recommend that I participate in a clinical trial?
10. If I have trouble with the treatment you recommend, under what circumstances should I call you and under what circumstances should I call my regular doctor?
11. How will I be monitored for response of my cancer to treatment or for recurrence of my cancer?
12. Are members of my family at high risk for the development of breast or other cancers?
13. What kind of genetic testing or cancer screening do you advise for my family members?

4. Diagnosis: Cervical Cancer

Questions that should be asked:

1. Is my cancer pre-invasive (or in-situ) or is it invasive?
2. Is the treatment you are recommending aggressive or conservative?
3. What are the risks of recurrence after the treatment you suggest and what will my options for therapy be if I have a recurrence at that time?
4. What long-term complications can be expected after the treatment you suggest?
5. What are the risks of second cancers or leukemia after the treatment you suggest?
6. Are you a gynecologic oncologist?
7. Are cases like mine most often managed by a gynecologic oncologist?
8. How will I be monitored for response of my cancer to treatment or for recurrence of my cancer?
9. Do you participate in research studies for cancer patients?

5. Diagnosis: Colon or Rectal Cancer

Questions that should be asked:

1. Is my tumor one of the colon or the rectum?
2. Are there other specialists besides yourself who should be asked to comment on my case (e.g., a colorectal surgeon or radiation oncologist)?
3. What is the stage of my cancer?
4. What are the chances of curing cancers that are diagnosed in this stage?
5. How does the treatment you suggest affect my chance of cure?
6. How does it affect the pattern of recurrence of my kind of cancer?
7. Do you participate in clinical trials in colon and rectal cancer?
8. Are there ongoing studies that are available to patients with tumors like mine?
9. Would you suggest that I participate in a clinical trial?
10. What are the long-term risks of the treatment you suggest?
11. Are there curative options available to me if this treatment fails to control my tumor?
12. What are the risks of a family of member developing colorectal cancer?
13. Do you suggest genetic testing for me or my family to determine if my cancer is heritable?
14. Are there screening studies that should be performed on my family members?

6. Diagnosis: Esophageal Cancer

Questions that should be asked:

1. Is my cancer an adenocarcinoma, an epidermoid cancer, or another type?
2. Does my tumor appear localized to the esophagus?
3. Will a CT scan or endoscopic ultrasound be helpful in determining whether I should have surgery?
4. Are there physicians in other disciplines who can work with you and render an opinion about the kind of therapy I should have?
5. Do you participate in or are you aware of clinical trials that are actively recruiting patients like me?
6. Should I participate in a clinical trial?
7. Is the treatment you recommend for me palliative or curative?
8. If I agree to the treatment you recommend, would you give me an indication of the likelihood of cure or palliation?
9. What long-term complications do you anticipate from the treatment you recommend for me?

7. Diagnosis: Head and Neck Cancer

Questions that should be asked:

1. What is the site of origin of my cancer?
2. Is there evidence of lymph node involvement or distant spread?
3. What are the chances of cure with the treatment you recommend?
4. Are there physicians in other disciplines who may be able to work with you and render an opinion about treatment for me?
5. What are the long-term complications or consequences of the treatment you suggest?
6. Are there clinical trials that are actively recruiting patients with cancers like mine in which you participate or of which you are aware?
7. Should I participate in a clinical trial?

8. Diagnosis: Kidney Cancer

Questions that should be asked:

1. Is my cancer localized to the kidney or is there evidence of distant spread of my tumor?
2. If my cancer is localized, was the renal vein involved or was the capsule of the kidney invaded?
3. What is the stage of my cancer?
4. What are the chances of cure for my cancer with surgery alone?
5. Where is my tumor likely to recur?
6. How do you recommend that I be followed for evidence of tumor recurrence?
7. What is the histologic name of my cancer?
8. Are there clinical trials of treatments for my cancer for which I might be a candidate?
9. Would you suggest that I investigate these trials further and consider participating?
10. What is the therapeutic intent of the treatment you recommend?
11. Will it lengthen my life or is the therapeutic intent "symptom relief" alone?
12. Is the treatment "curative" or "palliative?"

9. Diagnosis: Leukemia

Questions that should be asked:

1. What type of leukemia do I have?
2. What is my chance of cure with chemotherapy?
3. What are the relevant prognostic factors that lead you to that estimate?
4. Is bone marrow transplantation an important option for me?
5. At what point in my treatment would you suggest marrow transplantation?
6. At what point in my treatment should I consider being seen at a tertiary referral center that specializes in leukemia treatment?
7. Would my outlook for cure be better if I go to a tertiary center now?
8. Should I have family and friends contact the Red Cross about their "directed donor program" now?
9. Are there clinical trials for which I might be a candidate?
10. Do you participate in research studies for cancer patients?
11. Should I consider participating in a clinical trial?

10. Diagnosis: Lymphoma

Questions that should be asked:

1. What histologic type of lymphoma do I have?
2. What is the stage of my lymphoma?
3. Considering my stage of lymphoma and my prognostic factors according to the International Classification Index, what is my chance of cure with conventional chemotherapy?
4. Am I candidate for an ongoing clinical trial?
5. Do you suggest that I consider participating in a clinical trial?
6. Do you participate in research studies for cancer patients?
7. At what point would high-dose chemotherapy with peripheral blood stem cell rescue be a good option for me?
8. Are there any additional diagnostic tests that should be done at this point to assist in my follow-up after completion of therapy?
9. What special studies were performed on my diagnostic biopsy to help in precisely classifying my lymphoma and in assessing the proper therapy for me?

11. Diagnosis: Malignant Melanoma

Questions that should be asked:

1. What is the Breslow thickness of my melanoma?
2. What is the stage of my melanoma?
3. Should I be referred to a surgeon who specializes in surgical treatment of malignant melanoma?
4. Do you advise a "sentinel lymph node biopsy" for a melanoma like mine?
5. What are the chances for surgical cure for my case?
6. Is there any additional treatment that has proven to be beneficial in cases like mine?
7. Where is my melanoma most likely to spread?
8. How will I be monitored for recurrence of my cancer?
9. Are there clinical trials for which I might be a candidate?
10. Should I participate in an ongoing clinical trial?
11. Do you participate in research studies for cancer patients?
12. Are members of my family at high risk for malignant melanoma or another kind of cancer?
13. What kind of genetic testing or cancer screening do you advise?

12. Diagnosis: Multiple Myeloma

Questions that should be asked:

1. What specific type of immunoglobulin are my myeloma cells producing?
2. What is the stage of my multiple myeloma?
3. If I accept the treatment you recommend, what is my estimated chance of surviving 3-5 years?
4. What ancillary measures should be used in assisting me during the chemotherapy you recommend for me?
5. How will you decide if the treatment you recommend is working?
6. Am I a candidate for a clinical trial?
7. Do you participate in research studies for cancer patients?
8. Do you recommend that I participate in an ongoing study?
9. Are there circumstances in which you would recommend high-dose therapy for a patient with multiple myeloma like mine?
10. At what point would you recommend that I consult with a physician who specializes in high-dose therapy?
11. Is there any disadvantage to my long-term survival if I accept no anti-cancer therapy at this particular time?
12. If I accept a "watch and wait" approach now, what circumstances would dictate that I undergo active therapy?

13. Diagnosis: Ovarian Cancer

Questions that should be asked:

1. What is the stage of my cancer?
2. Was my operation carried out by a gynecologic oncologist?
3. What are the chances of cure when a case like mine is treated surgically by a gynecologic oncologist?
4. Do I require chemotherapy?
5. What are the chances of 3-year survival with chemotherapy in a case like mine?
6. What are the chances of cure?
7. Will I require a second-look operation or an attempt at "optimal debulking" at a later time, as you see my case now?
8. Are there clinical trials for which I might be a candidate that are ongoing currently?
9. Do you recommend that I participate in a clinical trial?
10. Are there physicians in other disciplines who should be asked to comment on my case at the present time?
11. How will you decide when my chemotherapy should end?
12. How will I be followed for recurrence of my cancer?

14. Diagnosis: Pancreatic Cancer

Questions that should be asked:

1. Is there evidence that my cancer has spread outside of my pancreas?
2. Is there any chance of cure for my pancreatic cancer with aggressive surgery?
3. Is treatment with chemotherapy and/or radiation therapy likely to prolong my life?
4. Is the goal of my treatment to lengthen my life or to relieve symptoms?
5. At what point do you recommend that your patients with pancreatic cancer see a pain specialist?
6. At what point are your patients referred to a hospice program?
7. Are there clinical trials for which I might be a candidate?
8. Do you participate in research studies for cancer patients?
9. Do you recommend that I participate in a clinical trial at this time?

15. Diagnosis: Prostate Cancer

Questions that should be asked:

1. What is my PSA level?
2. What is the stage of my prostate cancer?
3. What is the evidence that treatment of my prostate cancer at this stage will improve the duration of my survival?
4. What are the arguments against a "watch and wait" approach?
5. Is the treatment you are recommending curative or palliative?
6. What are the alternatives?
7. What are the long-term complications that this treatment might cause?
8. Are there physicians in other disciplines who might want an opportunity to consult on my case and whose opinion I should seek in order to make a fully informed decision?
9. Are there clinical trials for which I might be a candidate that are actively accruing patients at this time?
10. Do you participate in research studies for cancer patients?
11. Would you suggest that I consider participating in a clinical trial?

16. Diagnosis: Skin Cancer

Questions that should be asked:

1. What is the histologic type of my skin cancer?
2. Are there alternatives to surgical treatment that might produce an excellent cosmetic result?
3. By whom should I be followed post-operatively for the development of cancer in other pre-cancerous skin lesions?
4. Should any pre-cancerous lesions be removed or treated nonsurgically now?
5. What precautions should I take to inhibit the development of other skin cancers in the future?

17. Diagnosis: Sarcoma

Questions that should be asked:

1. What histologic type of sarcoma do I have?
2. Is it low, intermediate, or high grade histologically?
3. In what organ did my sarcoma originate?
4. Is there any evidence that it has spread from it's site of origin?
5. What is the recurrence rate of my sarcoma with radical surgery alone?
6. At what point should I be evaluated at a major cancer center that treats a substantial number of cases of sarcoma/year?
7. Are there other treatments that should be combined with surgery to give me the best chance of cure?
8. Are there clinical trials for which I might be a candidate that are actively accruing patients?
9. Do you participate in research studies for cancer patients?
10. Should I participate in a clinical trial?
11. Is my case able to be cured at this time?
12. To what extent does the treatment you recommend enhance the duration of my survival?

18. Diagnosis: Stomach Cancer

Questions that should be asked:

1. What is the histologic type of my stomach cancer?
2. What is the stage of my cancer?
3. What are the chances of cure for stomach cancer in this stage?
4. What is the value of surgery in my stage of stomach cancer?
5. Are there other techniques of treatment besides surgery that should be combined to increase the chance of cure for my cancer?
6. Are there physicians in other disciplines who should be consulted to comment about my case so that I am not neglecting a potentially valuable type of treatment now?
7. Is the treatment of my cancer curative or palliative?
8. How will I be followed for recurrence of my cancer?
9. Are there clinical trials that are actively seeking patients currently?
10. Do you recommend that I consider participating in a clinical trial at this time?

19. Diagnosis: Uterine Cancer

Questions that should be asked:

1. What histologic type of cancer do I have?
2. What is the grade of my cancer?
3. What is it's stage?
4. Are there several types of "standard treatment" for my stage and grade of cancer or is there only one accepted "standard treatment?"
5. Are there physicians in other specialties who should consult on my case at this time in order to give me the best possible chance of cure?
6. What are the early and late complications related to the treatment you propose?
7. Are there other gynecologists, radiation oncologists, or medical oncologists who specialize in the type of treatment you recommend for my uterine cancer?
8. Am I a candidate for an ongoing clinical trial?
9. Do you suggest that I consider participating in a clinical trial?
10. What are the chances of cure for a uterine cancer of the stage and grade of my tumor?
11. Is the treatment you propose curative or palliative?

20. Diagnosis: Cancer of unknown primary site

Questions that should be asked:

1. What is the histologic type of my cancer?
2. If my tumor is "poorly differentiated," what special stains were performed on my tumor to determine its potential site of origin?
3. What does the oncologic literature say about the value of further diagnostic testing to find a site of origin for my cancer?
4. Is my cancer localized or widespread?
5. What is the duration of my survival likely to be with treatment for cancer of unknown primary site?
6. Are there cases in which you advise "symptomatic and supportive" medications rather than anti-cancer medications?
7. On what basis are you recommending one style of therapy over the other in my case?

Alan P. Lyss, M.D. Clinical Associate Professor, Department of Medicine Washington University School of Medicine St. Louis, MO.