Your Cancer Care Team

Your Cancer Care Team

Each individual is unique; each person’s cancer is different. You are the expert in your cancer experience. Together, you and your health care team can work to get the best care for you. Knowing who is on your team will make it easier to efficiently manage your treatment and find resources you need.

Medical oncologist: These doctors are specially trained to diagnose and treat cancer and specialize in the use of chemotherapy and other drugs to treat cancer.

Nurses: You will have the most direct contact with your nurses. Oncology nurses, radiation therapy nurses and oncology nurse practitioners have special training in caring for people with cancer. Nurse practitioners can prescribe medications and diagnose illnesses. Your nurses will be able to answer many of your questions, give medicine, and provide emotional support. They are also usually in charge of implementing the treatment plan your doctor has set up for you.

Surgeon: These doctors perform biopsies (cells or tissues are removed from the body and examined to help with a diagnosis) and surgeries.

Surgical oncologist: These surgeons specialize in treating cancer.

Pathologist: These physicians examine biopsy and tumor tissue and are responsible for the accuracy of laboratory tests. They will provide you and your doctors with information about your tumor that will be used to determine how it will be treated.

Radiologist: These doctors read and interprets x-rays, ultrasounds, CT scans, MRIs and other imaging tests. This member of your team may also perform biopsies during special x-rays or ultrasounds.

Radiation oncologist: These radiologists specialize in the treatment of cancer using radiation.

Dosimetrist: The person will use the radiation oncologist’s prescribed dose of radiation for your tumor to calculate and plan your radiation treatment.

Radiation therapist: The person who will deliver your radiation therapy.

Medical physicist: The person who will be responsible for ensuring your receive the exact dose of radiation prescribed by the radiation oncologist.

Family Doctor or general practitioner: The doctor who provides primary health care for you and your family.

Social worker: A person trained to identify social and emotional needs and provide services necessary to meet them. A social worker can help you and your family find resources to cope with cancer and its treatment.

Pharmacist: The doctor who will prepare and dispense your medications. She or he will be able to explain to you how your medications work.

Psychiatrist and psychologist: Mental health specialists who can help you and your family understand, manage, and cope with feelings, thoughts, worries, and behaviors. Psychiatrists have a medical degree and have the ability to prescribe medication.

Registered dietitian: A person who can help you maintain a healthy diet and get proper nutrition during your treatment and recovery.

Plastic surgeon: The doctor who specializes in cosmetic and/or reconstructive surgery.

Rehabilitation specialist: A person who specializes in helping patients maintain or regain their ability to perform daily activities. Depending on the type of cancer you have, you may see a physical therapist, occupational therapist, counselor, or speech therapist during and after your cancer treatment.

Home health aide: An aide can help you move around or with bathing. She or he may also cook or do some household chores.

Hospice care providers: These individuals provide specialized care to meet the needs of people who have terminal or end-stage cancer. This type of care focuses on providing physical comfort, reducing pain, and giving emotional or spiritual support.

Clergy: Chaplains conduct religious worship and perform other spiritual functions associated with beliefs and religion. Many people find prayer and spiritual counseling can be help them cope with cancer.

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Types of NHL

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Non-Hodgkin Lymphoma

What is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma (NHL) is one of the most common cancers in the United States, accounting for about 4 percent of all cancer cases. More than 95 percent of cases occur in adults but certain types are common among children. NHL is the name of a group of blood cancers that develop in the white blood cells (lymphocytes). There are approximately 60 different subtypes of NHL. Most subtypes fall within two main groups, named for the cell where the lymphoma originates: B-cell lymphomas or T-cell lymphomas. NHL can be either indolent (slow growing) or aggressive (fast growing).

Learn More About Non-Hodgkin Lymphoma

Risk Factors, Signs and Symptoms

Risk Factors

Risk factors are characteristics or exposures of an individual that can increase the likelihood of developing a disease. Certain cancer risk factors, such as smoking, can be changed.

Other cancer risk factors, such as a person’s age or family history, cannot be. Having one or even many risk factors does not mean that a person will definitely get the disease, and many people who are diagnosed with non-Hodgkin lymphoma have few if any risk factors.

The following are risk factors that have been associated with non-Hodgkin lymphoma (NHL):

Age
Although people of any age can be diagnosed with NHL, people are often diagnosed when they are 60 or older.

Gender
NHL occurs more frequently in men than women, but there are certain types of NHL more common in women. Reasons for this are not known.

Geography
NHL is more common in North America and northern Europe, and least common in Asian countries. Worldwide, NHL is more common in developed countries.

Race and Ethnicity
In the United States, whites are more prone to developing NHL than African Americans or Asian Americans/Pacific Islanders.

Radiation Exposure
Exposure to atomic bombs and nuclear reactor accidents can increase your risk of developing a number of cancers, including NHL, leukemia, and thyroid cancers. People treated with radiation therapy for certain cancers also have a slightly increased risk of developing NHL.

Chemical Exposure
Exposure to chemicals such as benzene, certain herbicides (weed killers) and insecticides (insect killers) may be linked to an increased risk of NHL. In addition, chemotherapy drugs used in the treatment of other cancers may increase the risk of developing NHL. It is not clear whether the association between chemotherapy drugs and the development of NHL is related to the original cancer itself or a side effect of treatment.

Learn More About Risk Factors and Signs & Symptoms

Diagnosis and Staging

Diagnosis

Doctors are able to diagnose lymphomas based on how they look under a microscope, the chromosome features of the lymphoma cells, and the presence of certain chemicals on the surface of the cells. In order to make an accurate diagnosis, your doctor will perform a physical exam, and may order blood tests, biopsies, and imaging tests to confirm the exact type and stage of your disease. Sometimes, non-Hodgkin lymphomas may be difficult to diagnose. Consult with your doctor to ensure that accurate testing is completed to receive the right treatment for you.

In order to diagnose NHL, your doctor will order several tests, including a physical exam, blood tests, biopsies, and imaging tests to confirm the exact type and stage of your disease. This will help the doctor determine the best treatment options for you. Two kinds of biopsies are used to diagnose NHL:

  • Lymph Node Biopsy – The doctor will remove a piece of the lymph node and examine it under a microscope. This is the only way to know for sure if the swelling is caused by cancer. 
  • Bone Marrow Biopsy – The doctor will insert a needle into your hipbone to check to see if lymphoma cells have travelled and are present in your bone marrow. 

If a biopsy confirms an NHL diagnosis, your doctor may recommend additional tests to find out how far the disease has spread. These other tests could include a chest x-ray, CT scan, MRI, PET scan, or blood tests. NHL can be difficult to diagnose and may require multiple tests.

Learn More About Non-Hodgkin Lymphoma Staging

Treatment and Side Effects Management

Treatment

Your doctor will recommend treatment options based on the stage of your NHL, your overall health and your treatment preferences. In all cases, treatment should be individualized for you.

If your disease is diagnosed early, categorized as an indolent (slow growing), and you have no symptoms, your doctor may recommend a watch and wait approach. This means your doctor may not recommend any treatment at the time of diagnosis.

If immediate treatment is required, there are a number of options. It may be helpful to create a treatment plan to address the short- and long-term goals of managing your cancer. Talk through the options with your doctors in order to develop a treatment plan that is right for you. It is okay to seek a second opinion to discuss your diagnosis or treatment options.

When you talk with your doctors, ask questions if you do not understand any aspect of treatment or the medical terms they are using. One of the best ways to improve communication with your health care team is to prepare questions before your visits. It is also helpful to write down notes when your doctor talks so you can remember what was said. You may want to bring a friend or family member to take notes for you.

Questions to Ask Your Doctor:

  • What stage is my NHL?
  • What type of treatment do you recommend at this time?
  • How often and where will the treatment take place? Will I have to stay overnight in the hospital for any part of the treatment? 
  • What are the goals of my treatment?
  • What are the side effects of treatment?
  • Will I need someone to take care of me at any point during this treatment?
  • Do you recommend a clinical trial at this time?
  • How will my cancer affect my quality of life?
  • What will my treatment cost and how much will my insurance cover?

Learn More About Treatment Options and Side Effect Management

Cancer Diagnosis? What You Need to Know

What Now?

When you have a cancer diagnosis, it is normal to feel frightened, sad and worried. People who have had cancer often talk about experiencing three feelings: loss of control, unwanted aloneness and loss of hope.

Here you’ll find helpful information, resources and support services to help you when you have a cancer diagnosis. The resources, tips and guides listed in this section can help you gain a sense of control as you face decisions about your treatment and care. We can help you navigate the health care system so you can manage the tests, doctor’s appointments, and insurance issues.

An Important First Step When You Have a Cancer Diagnosis

Here at the Cancer Support Community you can find that you are not alone, regain a sense of control, and learn there is always hope.

The next few weeks will be a busy time, as you face decisions about your treatment and care. Navigating the health care system – the tests, doctor’s appointments, figuring out insurance and more – can feel overwhelming. But, it is ok to ask for help.

One of the first things to do is think about who in your life is a helping presence. It might be your spouse or partner, friends, faith community, support group or co-workers. Make a list of specific ways they can help.

If you are unsure of what to ask people to do, below are some questions to consider:

  • Who would I like to talk with about treatment decisions? Or join me at appointments? 
  • Who can help me with practical support, such as figuring out work leave, meals, family care, driving or cost of care questions? 
  • Who can help serve as a point person to keep other people updated?
  • Are there other people in my life that will also need help? Who can help them? 

People on your health care team, particularly a nurse or social worker, can help you find resources for social, emotional and practical support.

Choosing Your Health Care Team for Cancer Treatment

An important decision you will make about your cancer treatment is choosing a doctor, a team and a cancer center that has the expertise to treat your cancer.

As you learn about your cancer diagnosis and treatment options, ask your doctor how soon you need to make a treatment decision. You may seek a second or even third opinion. Being able to talk openly and feel comfortable with your doctor, nurse, social worker, and other office or health care team staff is important. Here are some questions to consider asking as you choose your team:

About your cancer diagnosis:

  • What type of cancer do I have?
  • What stage is my cancer? What does that mean?
  • What symptoms of cancer might I experience?
  • What other types of tests will I need? 
  • Where can I get a second opinion?

About your cancer treatment:

  • How much experience do you have in treating my specific type of cancer? Are you board certified as an oncologist or are you certified in another specialty?
  • Are you associated with a major medical center, medical school or comprehensive cancer center?
  • What are the treatment goals (is it to cure the cancer, control the cancer, or relieve symptoms)?
  • Which treatment do you recommend, and why? 
  • Are there treatment options are available for me?
  • What are the risks and benefits of each treatment option?
  • What side effects might I experience, and how can they be managed or prevented?
  • What treatments and other services are covered by my insurance? What options are there to help cover costs? 
  • Where can I get a second opinion?
  • Are there any clinical trials here or somewhere else that might be appropriate for me?
  • What emotional and practical support services are available to me and my loved ones?

Making the Most of Your Doctors’ Visits

It is ok to ask any questions you have. You have the right to understand medical terms and cancer treatment options. You have the right to make choices about your treatment and care, even if the opinion of your doctor is different.

Talking about how you feel—and what you do or do not understand—helps both you and your doctor take care of your health. Your visits can go by quickly. Here are some suggestions to help before, during and after:

  • Before the visit, take a few minutes to think about and write down any questions you have
  • Bring a friend or family member with you to help take notes—or ask a nurse.
  • If your doctor prescribes new medications, follow-up tests, or other things you need to do after the visit, write this information down. Once your doctor is done, read your notes back to the doctor or nurse. This will help to catch any information you may have missed or didn’t understand.
  • Always ask questions if you have them. If you don’t have any questions at that time, ask who you can reach out to if you have questions later on. 
  • Write down the time and date of your next appointment.

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Stages, Grades and Scores of Prostate Cancer

Staging

If prostate cancer is diagnosed, the doctor needs to determine the stage, or extent, of the cancer to plan the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body.

  • Stage I: The cancer cannot be felt during a digital rectal exam or seen on a sonogram. It is found through a prostate biopsy or during surgery for another reason. The cancer is only in the prostate.
  • Stage II: The tumor is more advanced or a higher grade than stage I, but the tumor is only in the prostate. It may be felt during a digital rectal exam or seen on a sonogram.
  • Stage III: The tumor extends beyond the prostate wall. The tumor may have invaded the seminal vesicles, which sit on top of the prostate, but cancer cells have not spread to the lymph nodes.
  • Stage IV: The tumor may have invaded the bladder, rectum or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Grades and Scores

As part of the staging process, a pathologist will assign a score to the prostate cancer based on how the cancer cells look under a microscope. Pathologists score prostate cancer according to the Gleason grade. The Gleason score indicates how aggressive the prostate cancer appears to be. A higher number means that the cancer is more aggressive and likely to spread. The Gleason score is determined by adding the two most common grades seen in a sample by the pathologist. Grades range from 3 (least aggressive) to 5 (most aggressive) and scores range from 6 (least aggressive) to 10 (most aggressive).

  • A Gleason score of 6 is often considered low risk prostate cancer
  • A Gleason score of 7 is often considered intermediate risk prostate cancer
  • A Gleason score of 8-10 is often considered high risk prostate cancer

Why Do I Need Support?

Whether you are someone with cancer or someone close to you has cancer, it can be very helpful to talk with others in a similar situation who will understand what you are going through. Support from others who understand can help to improve your ability to cope, your ability to feel more into control over your situation and give you a sense of hope.

You may feel that support groups or counseling are not for you – or the idea of speaking with strangers would be uncomfortable. The truth is, even if your friends and family are supportive, they have their own experiences that are unique to them. This is a time when emotional and social support can help you find ways to talk about and understand what you’re going through.

The Cancer Support Community can help connect you to a community of support. People who have been affected by cancer often feel anxious, sad angry or even confused about what they are feeling. That’s OK and normal. Part of the challenge is accepting that you need support. You shouldn’t have to feel you have to do this alone. We can help you get connected to support groups, helpful resources, one-on-one counseling, online bulletin boards and other ways to connect with others whether it be face to face, online or over the phone.

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Tools to Help

The Cancer Support Community, a nonprofit organization with more than 30 years of experience delivering the highest quality cancer related education, emotional and social support to people impacted by cancer. CSC can help you develop a customized plan for coping with your situation using CancerSupportSourceSM (CSS) a brief survey that will help open the conversation about your unique needs and wants.

Research supports that asking people about how they are coping and what their needs are is an important first step in identifying important concerns, which can lead to improved quality of life, the ability to stay on treatment and overall patient satisfaction.

An integrated distress screening program like CSS can help identify concerns that need to be addressed early on in diagnosis before they become a barrier to care.

To learn more about how we can help you create a plan for social and emotional support and to learn more about cancer and how to cope, call our helpline at 888-793-9355 or visit an affiliate near you.

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Distress Screening – Professionals Only

CancerSupportSource® (CSS) is the first comprehensive distress screening program developed for community-based hospitals, physician practices and advocacy organizations to integrate screening, referral and follow-up care, through a single, streamlined, program.

Routine screening for social and emotional distress is a key component to comprehensive quality cancer care and is a recommendation of the 2008 Institute of Medicine’s Report, Cancer Care for the Whole Patient, Meeting Psychosocial Health Needs and also the new patient-centered standards from the American College of Surgeon’s Commission on Cancer which state that beginning in 2015, all cancer patients must be screened for distress if seen in an accredited cancer center.

CSS helps cancer centers meet those critical standards easily and effectively. CSS is more than a screening tool—it enables providers to create a vital program linking patient-reported needs with in-house and community support services.

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