Cancer treatment and follow-up care

When you are diagnosed with cancer, your consultant will speak to you about staging and grading.

Staging

This describes the location of the tumour and whether it has spread to other parts of the body.

Grading

Your cancer will be graded by assessing how aggressive the cells look under a microscope. This will give an idea of how quickly your cancer could grow or spread and will assist with choosing the best treatment choices for you.

You can find more information about staging and grading on the Macmillan website. This includes some of the words your consultant might use to describe your cancer, and what they mean.

Macmillan Cancer Support – Staging and Grading

If you need to have further tests your cancer care team will discuss the next steps with you. If you have any concerns or questions, please contact your cancer care team.

Your cancer type

This section describes some of the common treatments for cancer. You may have one or more of these treatments, but they will not all be appropriate for your type of cancer.

You can find more information about treatment options for your specific cancer on these websites – just search for your cancer type from the list available:

Cancer Research UK – Your cancer type

Macmillan Cancer Support – Cancer types A-Z

Your treatment

Your treatment will depend on various factors including the location of the cancer and whether it has spread to another part of the body. It will also depend on your personal health and circumstances.

The best course of treatment for you will be discussed within a team of specialists called a multidisciplinary team (MDT).

This is a group of health care professionals who make decisions together about the recommended treatment for each patient. See the “people you could meet” section above.

Your clinical nurse specialist or consultant will go through the different treatments and the side effects they may have. Some of the common treatments are described below.

Surgery

Surgery is used to remove cancer tissue. Your cancer team will use all the scans and tests to work out the best approach. Sometimes cancer tissue can be removed through a very small cut (“keyhole”) which might mean only a short stay in hospital. Sometimes it will involve major surgery and a much longer recovery time.

A surgeon who specialises in a specific part of the body will perform the operation. Examples of surgery include removing all or part of the prostate gland to treat prostate cancer, or removing the ovaries to treat ovarian cancer.

You can read more about when surgery is used and how to prepare for surgery on the Macmillan website:

Macmillan Cancer Support – Surgery explained

If you have major surgery and need to stay in hospital, you will be visited by a physiotherapist on the ward. It’s good to get moving as soon as possible. This helps you recover and reduces the chances of other problems, like blood clots.

The side effects and recovery time depend on the type of surgery you have. See our living with cancer page for more information about the effects of cancer treatment on your body.

Chemotherapy

Chemotherapy uses medicine to kill cancer cells. It can sometimes be used to cure cancer completely, and it is often used in combination with other treatments to make them more effective.

The medicine may be given to you through a tube into your vein (usually in a hospital), or with tablets you can take at home.  Your chemotherapy treatment may be spread over several sessions and last several months.

As well as killing cancer cells, chemotherapy drugs can also damage healthy cells, especially your skin and hair. Chemotherapy can make you feel very tired and sick, and often causes hair loss.

Watch a recording of our chemotherapy information session (1 hour), produced by the Dorset Macmillan Cancer Information team and delivered by Louise Watkinson, Oncology Sister, and Amanda Brampton, a Specialist Nurse in Cancer Care.

You can read much more about chemotherapy, how it works, and the possible side effects on the NHS and Cancer Research UK websites:

NHS – Chemotherapy

Cancer Research UK – Chemotherapy

Radiotherapy

Radiotherapy uses radiation (usually x-rays) to kill cancer cells. It can sometimes be used to cure cancer completely, and it is often used in combination with other treatments to make them more effective.

A machine is used to aim the radiation directly at the area of your body where the cancer cells were found. You may be given the radiation in an injection or a drink instead. Sometimes a piece of radioactive metal can be implanted into your body near to the cancer – this is called brachytherapy.

You will need to visit a hospital to be given the radiotherapy, and you may need to go back for repeated sessions over several weeks.

As well as killing cancer cells, radiotherapy can also damage healthy cells. Radiotherapy can make your skin sore, and make you feel tired and sick.

Watch a recording of our radiotherapy information session (34 minutes) produced by the Dorset Macmillan Cancer Information team and delivered by Zoe Greenfield, Quality Manager, and Mandy Sydenham, Macmillan Review Radiographer.

You can read much more about radiotherapy, how it works, and the possible side effects on the NHS and Cancer Research UK websites:

NHS – Radiotherapy

Cancer Research UK – Radiotherapy

Cancer drugs

There are several types of drug used to treat different types of cancer.

Cancer drugs are often used in combination with other types of treatment. Not all cancer drugs will work against all cancers.

Hormone therapy uses medicine to slow down or stop the growth of cancer by lowering the amount of certain hormones in your body. Hormone therapy can sometimes be used to treat breast cancer, prostate cancer, ovarian cancer and womb cancer.

Cancer Research UK – Hormone therapy

Immunotherapy drugs help your body’s immune system to destroy cancer cells. There are several different types, and you may have a blood test to see if immunotherapy could work for you.

Cancer Research UK – What is immunotherapy?

Targeted drugs have been developed to attack cancer cells. Cancer cells look, or grow, differently to normal cells and the drugs work by “targeting” those differences. They are often used to treat melanoma and leukaemia

Cancer Research UK – Targeted cancer drugs

Other cancer treatments

There are many different ways to treat cancer. You can find more information about other types of treatment by clicking on the links below.

Not all treatments will be appropriate for your type of cancer.

Cancer Research UK – Treatment for cancer

Macmillan Cancer Support – Treatments A-Z

Clinical Trials

Following your cancer diagnosis you may be offered the opportunity to take part in a clinical trial. You will be offered information about available trials that you may be eligible for. You do not have to take part, but if, having read about the trial, you are keen for more information, someone from the research team will spend time with you explaining what is involved.

You can find more information about clinical trials here:

Clinical Research Studies in Wessex

Cancer Research UK – Find a clinical trial

If your cancer cannot be cured

Sadly, sometimes cancer cannot be cured. Many people with incurable cancer can live good quality lives with the right support.

You may be given treatment to manage your symptoms. For example, this could include a course of radiotherapy to shrink your tumour to help with pain or movement. Cancer treatments can cause side-effects, so your consultant will help to find the best options for you.

For more information about advanced cancer and planning for the future:

Macmillan Cancer Support – If you have advanced cancer

Visit our palliative and end of life care page to read more about how we support people with incurable illness.

Follow-up care

You will have regular check-ups and your consultant will monitor your progress. You will have a care plan detailing your follow-up care based on the type of cancer and treatment you have had.

Your follow-up appointments may be by telephone or video call to minimise hospital visits. You can watch this video about how you can make the most of a virtual consultation

Treatment summary

At the end of your treatment, your cancer team will create a summary of the treatment you have had. This may be after a certain phase of treatment, or after you finish all your treatment.

Your cancer team will give you a copy of your treatment summary. They will also send it to your GP.

The summary will include information about:

• the diagnostic tests you had
• your cancer and treatment
• possible side effects of treatment
• any symptoms to look out for
• details of follow-up appointments and tests you may need
• contact details for your cancer team
• treatment plans from other involved health care professionals

If cancer returns

Your cancer care team should inform you of the signs and symptoms to look out for. You should always speak to your cancer care team if you are worried about your cancer returning or if you have any questions.

These symptoms do not mean the cancer has returned. They may be due to side effects of treatment or completely unrelated to your condition. By contacting your clinical team, they will be able to advise and reassure you. If necessary, they can arrange any checks you may need.

Putting you in control

Patient-led follow-up care puts you in control of your care. It allows you to take a leading role in your cancer recovery with help from your specialist cancer team. There are lots of things you can do to look after your own health during and after cancer treatment. These include physical activity and healthy eating.

Your specialist will discuss your follow-up care at the end of your cancer treatment. If you both agree that patient-led follow-up care is best for you, you will not have to come to hospital for routine appointments.

Katy Kennedy, Breast Nurse Specialist at Dorset County Hospital, has written this patient leaflet packed with information about patient-led follow-up care for breast cancer patients.

Online healthcare

The hospitals in Dorset, Hampshire, and the Isle of Wight are introducing remote monitoring systems to help manage your care.

These systems will have a patient portal. Some hospitals already have remote monitoring systems, and the others are working to get them in place.

Once you have given your consent to use the patient portal:
• You will get secure access to the patient portal, which is password protected.
• You can access this via the internet to support the management of your healthcare.
• You will be able to check the date of your surveillance tests and access your test results.
• You can raise any symptoms that are worrying you with your clinical team. It is better to let your clinical team know at the time you become aware of these symptoms.

Aspects of your care will continue:
• Routine tests, for example blood tests, mammograms, and X-rays.
• Your test results will be checked by your clinical team.
• If your test results are abnormal, you will be given an outpatient appointment or asked to have the tests again.

Your follow-up care

Macmillan Cancer Support have made a leaflet about how you can take an active role in your care. It describes types of support that your healthcare team may call the Recovery Package.

This leaflet looks at some of the support you can ask for after a cancer diagnosis, what options may be available to you for your follow-up care and what information you need, and ways you can look after yourself.

Your support and follow-up care – Macmillan Cancer Support

When you have completed treatment for your cancer, patient-led follow-up care will give you:

• Everything you need to know to self-manage and live as healthy and active a lifestyle as possible.
• Information about signs and symptoms to look out for, that might mean your cancer has come back.
• Rapid access back to your specialist cancer team, including telephone advice and support.

This session is an essential part of enrolment on to the patient portal.

You will be invited to a Health and Wellbeing Event. Voluntary and community organisations will be able to provide advice and support to you and your family. You can find more information about practical and emotional support on our living with cancer page.

Holistic Needs Assessment

You will be asked to complete a Holistic Needs Assessment (HNA). This helps to recognise any concerns or problems you might have, or what is important to you, such as:

• work,
• dealing with the physical and emotional effects of cancer, or
• concerns about relationships or family life.

You can discuss this with your clinical team. They will be able to offer advice to help you manage your care or direct you to other support or resources. It is up to you how much or how little you choose to access.

Cancer Care Review

A Cancer Care Review (CCR) is a conversation between you and your GP or practice nurse. A CCR focusses on key times when you may feel vulnerable in your cancer journey and should be completed:

• within 3 months of your cancer diagnosis to let you know of the support available from your GP, and
• within 12 months of your cancer treatment.

It is necessary to know what is important to you about your care. You will be able to:

• talk about your cancer experience and concerns.
• understand what support is available in your community.
• receive the information you need to begin supported self-management.

It can be helpful for you to have time to prepare for your CCR conversation. Your GP or practice nurse will aim to discuss:

• your diagnosis.
• your cancer treatment and its possible effects.
• your prescription entitlements and most likely a review of your medications.
• your and your carers’ information needs.
• physical activity advice and signposting to local support services.
• signposting to other organisations.

Living with cancer

Living with cancer can be difficult, but there is help and support available to meet your needs.

On our living with cancer page you will find information to help you manage the emotional and physical effects of cancer.