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Prakash Chandran (Host):  We know not all cancer is the same. But neither is all breast cancer or lung cancer or prostate cancer. It’s important to also understand the origin, path and type of cancer to make your cancer care plan. I’m Prakash Chandran and in this episode of Northfield Hospital and Clinics podcast series, we’ll talk about the cancer diagnosis process. Here with us to discuss is Patty Kark, a Breast Care Nurse Navigator at Northfield Hospital and Clinics and Jodi Wieczorek, the Director of the Cancer Care and Infusion Center and the Advanced Practice Registered Nurse at Northfield Hospital. Patty and Jodi thanks for educating us here today. So, Jodi, let’s start with you. How do doctors actually understand a person’s cancer in the first place?

Jodi Wieczorek, APRN, AGCHNS-BC, ACHPN, OCN (Guest):  When a person with cancer comes to the doctors or the Advanced Practice Nurse to learn about their cancer, the story that brought them to the clinic is very important. How did it present? What happened to you that you came to this place of a cancer diagnosis? Doctors look also at the type of cancer cells, what tissues are involved and how and where they grow in your body. The tumor’s place of origin, where it started from and the path that it grows in your body affects how it’s treated and your prognosis.

For example, a tumor that starts in a person’s liver might be completely different type of cancer with a different treatment and prognosis compared to a tumor that spreads to the liver from another place in the body, like from the breast or colon.

Host:  Okay, that makes sense. So Patty, once the cancer is diagnosed, what’s involved in the work up afterwards?

Patty Kark, RN (Guest):  Because cancer treatment is so specific, many times additional workup is needed prior to beginning a cancer treatment. This workup could include scans, bloodwork, biopsies, genetic testing even surgery and also visiting with medical oncologists and or radiation oncologists and this can take some time and we understand that it’s hard to wait for the answers but it’s so important that we get this information up front because it’s necessary for prescribing the best treatment regimen and for getting the best outcomes.

Host:  Yeah you know I know that it’s a time where people just really want answers and so I’m curious as to what a person, Jodi, should expect when they meet with their oncologist for the first time.

Jodi:  I appreciate that and to trail around with what Patty just said, when you see an cancer doctor for the first time; it may not be to begin treatment. It may be to get more diagnostic information or more information about you as a person. What is your physical history? Do you have other serious illnesses that would impact the choices you might make for your treatment or how you might tolerate your treatment? What is your current condition? And then also some things about you as a person. Are you a mom taking care of children? Are you a caregiver for another family member who has a chronic illness or requires more help. What sort of support do you have? What are some of your life goals? Some of your life priorities, career and financial considerations that all become a part of this treatment plan that your provider will make with you. Because all of those factors can impact the success and impact the quality of life of the person going through this treatment.

Host:  Yeah, that makes a lot of sense. I really like how you take that holistic and comprehensive approach to the treatment so not just treating the cancer itself but the environment or taking into account the environment that a person is in because all of that really matters. Patty, I want to move over to you. We’ve heard about staging and grading. I’m curious as to maybe a little bit more about what they are and why they are important.

Patty:  This is a great question because it’s one of the first questions that patients have when they are diagnosed with cancer. They want to know what stage they are at. So, we just explain to them that the grading of the cancer it describes the appearance of the cancer cells. It describes how aggressive they look under the microscope and it’s just reflective of how fast the cancer could be growing and the grade is determined at the time of the biopsy when we receive the pathology report back, that will give us the grade.

And the stage, now that describes – takes into consideration a few things. The size of the tumor. It also takes into consideration if it’s spread to nearby lymph nodes or if it has spread to any other areas of the body or metastasized. Now this can take more time to determine as other scans or biopsies or again maybe even surgery needs to be done first before the staging can be determined. But both the grading and the staging of the cancer are very important pieces of information that the oncologist and the care team uses to determine again, the best treatment options for the patient.

Host:  You know I imagine that the patient is thinking at this point okay, how do we go about getting this fixed and treated. Do we need to go through chemotherapy? Is there surgery involved? So, Jodi, maybe you can tell us the difference between the two surgery and chemotherapy and how it correlates to how cancer is treated?

Jodi:  Sure. I think that one of the most important concepts about what treatment or combination of treatments are chosen is whether the cancer needs to be treated locally like right at a spot or whether the treatment needs to more systemic where it goes all over the body. So, when you think about chemotherapy or biotherapies or hormonal therapies; those are called systemic treatments. Those are treatments that somehow get into you either by an IV site and given intravenously or you take it in by mouth or it is given some what and it circulates – it’s metabolized, and it circulates all through your body and it goes to all those places where your cancer might be and helps get rid of those cells.

Another treatment might be a local treatment. That would be something like surgery. It goes to a specific spot where a tumor is or also radiation therapy. It’s aimed at a very local spot in the patient’s body or the person’s body to really go locally at the spot where the cancer is. The recipes for people for their treatment are different again, based on all of the information we’ve talked about with stage and grade and where it’s travelled, and one person might only have one of those treatments. Somebody else may have two or three of those treatments depending upon what the doctors know about your specific type of cancer.

Host:  And just in wrapping up here, Patty we will move over to you. I’m always curious about when someone gets their diagnosis, it’s obviously an event that’s very scary, something that maybe they don’t know how to proceed forward. Both of you deal with this on a day to day basis. And I’m curious as to if you have formulated any best practices or any advice that you might give to someone listening to this that may have just been diagnosed. Patty, we’ll start with you.

Patty:  Well as a Breast Nurse Navigator, many times I have called the patient with this diagnosis and what I try to do is give them some information and always have the next appointment ready for them so that they know what their next step is, and they know when they are going to take that next step. And educate them as much as possible at such a hard time for them. So, that’s what I like to do. I like to instill in them just for them to know that I as a navigator, the nurses here, the staff here, the doctors, the oncologists, the whole team is going to come around to them and walk them through this in a very step wide fashion. So, that’s what I do as a navigator. So, Jodi probably has a great answer to this also.

Jodi:  Patty I think that you answered perfectly. I think my most important message to somebody who is going through this treatment is that we are here and ready to step in and help. This is a safe place. I think the care team wants to hear how you are feeling as a cancer patient or a cancer patient’s family member and what questions you have. It is safe. It is safe to ask those questions to us so that we know how best to help and how best to help you because no two people are the same. No two cancer diagnoses are the same and the recipes that we use to treat people who have cancer over time are different. They are individualized to you. There’s a lot of double checking and a lot of things that we do to make sure that things are just how they need to be for you to be successful.

Host:  Well that’s very assuring and I really appreciate both of you educating us here today. Learn more about cancer care at Northfield Hospital & Clinics at our website at www.northfieldhospital.org. My guests today have been Patty Kark and Jodi Wieczorek. I’m Prakash Chandran. Thanks so much for listening.