How do doctors know cancer hasn't spread?


Question from Bren: I have a very deep fear that my cancer may have spread. How are the doctors able to say for certain that it hasn't when they don't seem to really check anywhere but the lymph nodes?
Answers - Rosalind Kleban, L.C.S.W. I will answer this from the psychological point of view and then will ask Dr. Weiss to go over it from a medical slant. Having fears of the cancer spreading is common and very normal. We see it all the time. It's very important to bring that to the attention of your doctor because the anxiety that you may suffer is enormous and the best place for that to be relieved is with your physician, so you need to do that sooner rather than later.

Hopefully your physician can do what needs to be done to answer your questions satisfactorily and explain the rationale for why he/she is doing or not doing certain tests. But you need to be as clear as you can be about what frightens you and why you are thinking about those things. With a companion, go to your physician and have those things explained. I think it is important to go with a friend to make sure that you understood the answers and that the physician attended to your questions. Often patients are intimidated and they don't get to all of their questions, so you need someone to make sure that you are getting what you need from your physician.
Marisa Weiss, M.D. At initial diagnosis your doctor will conduct certain tests to assess the extent of the disease that can be detected using various tests depending on your situation, the results of your pathology report, and any signs or symptoms that you may be experiencing. All of this information is collected and your individual situation is assessed. Based on this evaluation, treatment recommendations are made. Then, after you have finished prescribed therapies, it is very normal to want a 'clean bill of heath.' It would be great if there were a perfect test that could provide this reassurance. In reality, there is no perfect test and, in general, over time your doctor usually does not conduct whole body studies to continue to make sure that everything appears normal. This is because doing a lot of tests repeatedly over time has not been proven to be helpful.

But being followed carefully by your team of doctors and other health care professionals with physical exams and a lot of good listening to you, along with strategic use of imaging studies and a schedule of follow-up that you feel confident in—all of these things can provide you with more peace of mind than feeling like after treatment you will be abandoned by your health care team without any plan for careful surveillance.
Rosalind Kleban, L.C.S.W. It's very common—almost to be expected—that after treatment is over for a period of time patients become hyper-vigilant about signs and symptoms of the cancer's return. People no longer suffer from ordinary chest colds, body aches...everything is assumed by the vulnerable patient to be cancer. The woman who is prone to migraines her entire life suddenly, after treatment, is worried that her cancer had spread to her brain.

I see it as the secret side effect of a cancer diagnosis, the feeling that every physical symptom may be a new cancer. Most people around you see that the treatment is over. The subject is closed. But patients live with insecurity about their health for quite some time after treatment, and feeling that every ache and pain is cancer is part of it. After a reasonable period of time, all symptoms should be reported to your physician, who should see that your questions are answered. With time and working with your physician, you will go back to have a better understanding of your body. A cold is just a cold and an ache is a sore muscle.

On Wednesday, June 19, 2002, our Ask-the-Expert Online Conference was called Dealing with Breast Cancer Fears. Rosalind Kleban, L.C.S.W. and Marisa Weiss, M.D. answered your questions about aspects of breast cancer that cause concern.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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