Surgery or not

I tend to believe this depends on the doctor for one thing and perhaps on the location and/or stage of the tumor itself.  However, I'm not a doctor, so perhaps I'm wrong.  I have learned through communicating with other anal cancer survivors for 7 years that each person's case is individual.  My colorectal surgeon told me immediately after she made her preliminary diagnosis that I would receive chemo/radiation, with no mention of surgery. 

Martha

Cancer treatment decisions: 5 steps to help you decide

Partnering with your doctor to make decisions about your cancer treatment may make you feel more confident as you begin your cancer treatment. Find out how to get involved.

You've just been diagnosed with cancer. Your mind is reeling. And now your doctor wants you to sort through cancer treatment options and help decide on a plan.

But how do you decide on a cancer treatment plan? Here are five steps to guide you in becoming a partner with your doctor in determining and guiding your cancer treatment.

Step 1: Set your ground rules

Before exploring treatment options, establish some ground rules. You'll be more comfortable with any cancer treatment decisions you make if you:

Decide how much you want to know. While most people want to know exactly what their treatment is and their survival chances, others don't. If you don't want to know all the details, let your doctor know.

Decide how you want to make your treatment decisions. You might want to take the lead in the decision-making process. Or you might want to turn all decisions over to your doctor. You might also be somewhere in the middle, sharing the decision process with your doctor.

It may help to think about how you've handled difficult decisions in the past. And it may help to have a close friend or family member at your appointments to help you decide.

Have realistic expectations. Your doctor can give you estimates about what you can expect to get from each type of treatment. Exactly what side effects you may be willing to put up with will depend on what the benefits of the treatment are likely to be. Communicate your preferences with your doctor.

Keep the focus on you. Don't let yourself be pressured into a particular treatment option. Pick what you feel most comfortable with.

Accept help. You'll need support throughout your treatment. Support can come from your doctor, your friends and your family.

If you don't feel supported in your decision-making, contact groups such as the American Cancer Society, which can put you in touch with cancer survivors who may be able to help you through this process.

It might help to write down your expectations and preferences before you meet with your doctor. That might help you better express your hopes for and feelings about your cancer treatment.

Step 2: Decide on a goal

Deciding what you want out of treatment can help you narrow your treatment choices. Are you hoping for a cure, stabilization or solely symptom relief?

Depending on your cancer type and stage, your goals for treatment might be:

Cure. When you're first diagnosed, it's likely you'll be interested in treatments that cure cancer. When a cure is possible, you may be willing to endure more short-term side effects in return for the chance at a cure.

Control. If your cancer is at a later stage or if previous treatments have been unsuccessful, you might adjust your goal to controlling your cancer. Different treatments may attempt to temporarily shrink or stop your cancer from growing. If this is your goal, you might not be willing to endure the side effects of harsher treatments.

Comfort. If you have an advanced stage of cancer or one that hasn't responded to treatments, you might decide that comfort is most important to you. You and your doctor will work together to make sure you are free of pain and other symptoms.

Step 3: Research your treatment options

To make a reasonable treatment decision, keep in mind the type of cancer you have, its stage, and what treatment options are available and how likely these treatments are to work under these circumstances. Talk to your doctor about trustworthy websites, books and patient education materials to supplement your discussions.

Cancer treatments are sometimes used in conjunction with each other. For example, it's common to pair surgery or radiation with chemotherapy. Doctors sometimes refer to a treatment that's used after the primary treatment as an adjuvant therapy.

Step 4: Analyze the benefits versus the risks

Compare the benefits and risks of the different cancer treatments to decide which treatments fall within your goals. Rate the treatments you're considering based on the pros and cons of each.

Some aspects you'll want to consider for each treatment include:

Side effects. Take time to review the side effects of each treatment and decide whether they'll be worth enduring or too much to handle. Your doctor can give you a good idea of how common the various side effects are for each treatment and explain options for managing side effects to make treatment more tolerable.

How treatment affects your life. Consider how treatment will affect your everyday life. Will you need a day off work or several weeks off? How will your role in your family change? Will you need to travel for your treatment?

The financial costs of treatment. Investigate what types of treatment will be covered by your insurance. If a treatment or aspect of a treatment isn't covered, can you afford it? Call your insurance company to be sure.

Your health in general. If you have other health conditions, ask your doctor how treatment will affect those conditions. For example, corticosteroids are commonly used in people with cancer. This could complicate diabetes treatment and affect your risk of cataracts, hypertension and osteoporosis.

Your personal values and goals will make a difference in what treatments are best for you. Only you can decide what type of treatment will fit best in your life. But you don't have to make a choice and stick with it. It's very possible that you may change your mind during treatment, and that's fine.

Step 5: Communicate with your doctor

Effective communication with your doctor is the best way to make sure you're getting the information you need to make an informed decision. To make communicating with your doctor easier, try to:

Speak up when you don't understand. If you need further explanation or clarification, tell your doctor. If you don't speak up, your doctor may think you understand.

Write your questions in advance. Appointments can be stressful and emotional. Don't expect to remember all the questions you want to ask.

Record your conversations. Try to keep track of what your doctor tells you by taking notes. You might also ask if it's OK to record the conversation on a recorder. This record will be a good reference if you have questions later.

Bring someone with you. If you feel comfortable sharing your medical information with a friend or family member, bring along someone to take notes. Then you'll have another person you can talk through your treatment decisions with.

Keep copies of your medical records. Ask for copies of your medical records and bring them to each appointment.

Don't expect you and your doctor to fully understand each other after one meeting — it may take a few conversations before you both feel as if you're on the same page.

Other things to keep in mind

As you're making your treatment decisions with your doctor, keep these points in mind:

Take your time. Although a cancer diagnosis might make you feel like you have to make immediate decisions to begin therapy, in most situations you have time to make choices. Ask your doctor how much time you have to decide.

You can always change your mind. Making a treatment decision now doesn't bind you to that option. Tell your doctor if you're having second thoughts. Significant side effects may make you want to change your treatment plan.

You can seek a second opinion. Don't be afraid of offending your doctor if you want to get a second opinion. Most doctors understand the need for a second opinion when facing a major decision.

You don't have to be involved with treatment decisions. If you prefer, tell your doctor you'd rather not be involved in the decision-making process. You can always get involved later when you feel more comfortable with the situation. Let your doctor know who you want to make decisions about your care.

You don't have to have treatment. Some people choose not to have treatment at all. People with very advanced cancers sometimes find they'd rather treat the pain and other side effects of their cancer so that they can make the best of the time they have remaining.

If you choose not to be treated, you can always change your mind. Forgoing treatment doesn't mean you'll be left on your own — many ways of controlling side effects exist.

Which treatment is best for you? There's no 100 percent right or wrong answer. But being involved with your treatment plan may give you greater peace of mind and can let you focus your energy on what you need to do most — keeping yourself healthy throughout your treatment.