8 questions to ask before every test your doctor runs

Sometimes it seems like the tests never end.

When your doctor tells you that you need another test it’s important for you to understand why. Next time you hear, “We need to run another test,” ask these eight questions, the answers should help you generate useful dialogue between you and your doctor. 

1. What is the purpose of this particular study or test?
2. What do the results mean?
3. How will the results influence my treatment?
4. Will I need any more tests or studies?
5. How frequently will I need a test or study done?
6. What would be the possible risks if I decide to limit the number of tests I have?
7. The potential benefits?
8. Are there any limitations or possible errors with this test or study?

To illustrate what this dialogue may sound like between you and your doctor I’ve provided two different scenarios. In the first scenario I have just told the patient that I have found a lump in her breast. The test I would like to run is a mammogram.

1. What is the purpose of this particular study or test?
   As your providers we need to further evaluate if what I found is a mass in your breast.
2. What do the results mean?
   Most of the time a mammogram will confirm a finding of a mass or lump.
3. How will the results influence my treatment?
   If we do find the mammogram is abnormal we will need to conduct a biopsy.
4. Will I need any more tests or studies?
   If the mammogram is inconclusive you may need to have more imaging/pictures taken through repeat mammogram or an ultrasound or MRI of your breast.
5. How frequently will I need a test or study done?
   We may need to repeat the mammogram in a few weeks or few months depending on the severity of the situation.
6. What would be the possible risks if I decide to limit the number of tests I have?
   If you decide to limit the number of tests you could potentially delay/miss diagnosis and treatment.
7. The potential benefits?
   Any early diagnosis typically means a better chance for a cure.
8. Are there any limitations or possible errors with this test or study?
   A small percentage of patients/cases could be missed despite extensive testing because there is always a limitation to certain tests/technology. The more complete the evaluation, the better chance to have the right diagnosis and prompt treatment.

If that same patient gets an “abnormal mammogram” I would then recommend to the patient that we biopsy the tissue.

1. What is the purpose of this particular study or test?
   A biopsy will tell us if the affected region is cancer or not cancer.
2. What do the results mean?
   The results will tell us whether the affected region is benign, suspicious, or cancer.
3. How will the results influence my treatment?
   In most cases a benign finding would need no more treatment; a suspicious finding would need either a repeat biopsy or close monitoring; a cancer or malignant finding would possibly need surgery. Sometimes, chemotherapy before surgery could also be considered depended on the size and location of the lump.
4. Will I need any more tests or studies?
   If there is an abnormal lymph node found either by physical exam or mammogram, further CT scan would also be considered.
5. How frequently will I need a test or study done?
   If we decide to repeat the biopsy due to a suspicious finding we would do so right away. If we decide to closely monitor you we will most likely recommend a mammogram or MRI in 1~3months or 3~6months pending level of suspicion.
6. What would be the possible risks if I decide to limit the number of tests I have?
   If you decide to limit the number of tests you could potentially delay/miss diagnosis and treatment.
7. The potential benefits?
   We will be able to initiate appropriate treatment in a timely fashion and best treat the disease which means a better chance for early diagnosis and cure.
8. Are there any limitations or possible errors with this test or study?
   At times a biopsy may not provide an adequate sample amount meaning we can miss the real diagnosis.

Remember, as the patient your understanding is the most important thing. If you don’t like the way a question was answered or you want more information, ask it again, as many times as you need to.

Editors Note: The examples provided in this post are fictional and do not reference an actual patient. If you find yourself undergoing the same tests be sure to ask your doctor about your specific situation.

Cancer: What's in a diagnosis?

When you or someone you love receives a diagnosis of cancer you find out a few things.

First, the type of cancer. These terms you are probably familiar with: breast cancer, cervical cancer, colorectal cancer, lung cancer … the list goes on. In fact, The National Cancer Society reports there are around 200 types of cancer.

The next modifier you receive will most likely be a number, I, II, III or IV. The stage of cancer reflects how far the cancer has spread through your body.

• Stage I indicates that the cancer is small and still contained within the organ of origination. 
• Stage II indicates a larger size than stage I but the cancer is still contained in the organ of origination. In some cases the cancer may have spread to the lymph nodes closest to the affected organ.
• Stage III indicates a larger cancer in which the spread has surpassed the organ of origination and is now affecting the surrounding tissues and the nearby lymph nodes.
• Stage IV indicates that the cancer has spread from the organ of origination into another body organ.

Your physician may also use terms like, “localized,” “regional,” and “distant”. These are simply a different way of categorizing the stage of cancer. A good rule of thumb is, the lower the stage the more localized the cancer.

With every cancer diagnosis you will also receive a treatment plan where you and your physician will talk in-depth about the benefits and risks of all your options and inevitably your chance of beating cancer. While we say that the lower stage the higher an individual’s survival chances the reality is that we are continually making strides in the treatment of late stage cancer.

In all cancer diagnoses it’s important that you work with your entire care team to develop an integrated approach to treatment, combining the latest advances in science with healthy life options.

You might also like:

• Lynns #1 lesson: There are no stupid questions
• Who is a cancer survivor? What's in a name?
• Integrative care basic and what others are saying

Lynn's #1 lesson: There are no stupid questions

It’s a scary thing when you’re told your husband has cancer. Jim had just had a cystoscopy to check for bladder cancer. He had it done under sedation. The doctor came out into the waiting room and called me aside. His words, "It’s cancer.” My words, “What do we do now?” And the roller coaster ride began. Jim was scheduled for surgery and had the requisite tests done, including donating his own blood for the surgery. We were just a couple of days away from surgery when the urologist asked if we had seen an oncologist. We were dumfounded. No one had mentioned it and we certainly hadn’t even thought of it. When you find out you have cancer you just want to get it fixed as fast as possible. Surgery was cancelled. We saw an oncologist. Jim opted for chemotherapy before surgery hoping the chemo would rid him of the cancer tumors and removal of his bladder and prostate wouldn’t be necessary.

My point in telling this scenario is “we” – cancer patients and caregivers – don’t know what questions to ask when we get the diagnosis. We just want to address this terrifying disease immediately. Take time and ask the questions. Make an appointment with the oncologist, ask any questions you can think of. If you think they’re stupid, ask them anyway. And if the doctor thinks they’re stupid questions, get a different doctor. You have that right.

Jim’s bladder cancer eventually resulted in surgery and the removal of his bladder and prostate. He has a urostomy. As his caregiver I was taught how to care for his ostomy. Scared! You bet I was! I’m not a queasy type person so that didn’t bother me, but , oh my gosh, I didn’t want to hurt him and how would I know if anything was wrong? Again! Ask questions. Call the ostomy nurse, call the infusion center, call the doctor on call. You have every right to make those calls and don’t feel stupid!

Fast forward a couple of years, Jim has a recurrence of cancer. Cells are in a lymph node and there are abnormal cells in his urethra. He begins chemotherapy again. The second time around we’re a little more aware of what we need to do. I need to keep Jim as strong as possible with good nutrition, addressing side effects from the chemo and always being vigilant about infection. Jim and I have gone through this together. We’ve gone to doctor appointments together, (two sets of ears are better than one), we’ve spent hours together at the infusion center, playing Blokus, reading and, for Jim, sleeping. We take each day as it comes, addressing what needs to be done that day. And each day is a celebration as long as we are together.

Who is a cancer survivor? What's in a name?

The National Cancer Institute, along with many other health organizations, define a Cancer Survivor as anyone diagnosed with cancer – from the moment of diagnosis until the end of life (and that end could happen years after diagnosis and be caused by something besides cancer). In addition, The National Coalition for Cancer Survivorship (NCCS) has expanded the term to include family, friends and caregivers.

Survivorship is a popular term now in the cancer community. Yellow bracelets scream LIVESTRONG, event participants refresh at Survivors’ Villages at Susan G. Komen races, and there are even medical journals focused solely on survivorship issues.

Twelve million Americans alive today have been diagnosed with cancer, and those numbers are increasing each year due to:

• Earlier diagnosis through screening
• More effective treatment
• Prevention of secondary disease and disease recurrence
• Decreases in mortality from other causes

There are many definitions of the word survivor, including:

• One who lives through an affliction
• To carry on despite hardships or trauma
• To remain alive or in existence

It turns out that the term cancer survivor evokes a wide range of reactions, similar to the reactions towards battle and war metaphors (i.e., fighting cancer or battling the disease) when describing cancer. How can one label describe everyone diagnosed with cancer, from those with early stage disease who are treated and may be considered cured to those in hospice care at the last stages of life? Some argue it cannot and that we need to find better, more descriptive and accurate terms. Others embrace the title of survivor and fully identify with it.

My feeling is that you can welcome or reject the label. As someone who has worked with cancer patients and their families for 30 years, I am just thrilled that researchers, clinicians and finding agencies are FINALLY paying attention to all the challenges that accompany a diagnosis of and treatment for cancer.

What are your thoughts? How do you feel about the term "cancer survivor?"