How to know that you have cancer

How to know that you have cancer

The differential diagnosis

Differential diagnosis is used to confirm suspected cancer and its type and spread. In the coming weeks, the extent and exact nature of the disease will be determined. Exactly what type of cancer is it? How advanced is the disease; is it an early stage or are other parts of the body already affected? In technical language, such scattered accumulations are called metastases or daughter tumors. The more information doctors gather about your cancer and health during differential diagnosis, the better decisions can be made about your treatment afterwards.

How to prepare for the exams

Some investigations take quite a long time to produce a result. Because of this, differential diagnosis can be stressful and nerve-wracking. Also, not every doctor who performs a partial examination immediately informs the patient about what he can detect, but forwards all findings to your supervising doctor. Addressing your condition early can help. Ask the doctors questions. Write down your questions for the doctors treating you before the exams so you don’t forget anything during the appointments. The support of a relative or a good friend can also be a great help. Many loved ones are happy to get involved in the treatment to help out. In addition, four ears in conversation with the doctors hear more.

There can be long waiting times, both for appointments and for the individual examinations. Therefore, you should pack an "examination bag" where you provide yourself with enough to drink, a snack and something to pass the time; a book, series or movies on a laptop or tablet computer, for example.

The most common examinations

There are numerous procedures that doctors use to gather information about your state of health as part of differential diagnostics. At this point, we will give you an overview of the commonly used procedures you are likely to be examined with. If you do not go through one or more of these or are examined with other procedures, it does not mean that something is wrong or you are being deprived of important procedures. Rather, you as the patient are the focus of attention and, based on your state of health, are specifically examined for what the doctors need to know for the best possible treatment.

  • Whole body computed tomography (CT) – A CT is a form of X-ray examination. Unlike a single X-ray, the patient lies in a tube that shines through the body layer by layer, making many individual images one after the other. This gives doctors a much closer look at your body and can also detect tumors or metastases that might have gone unnoticed with other procedures. In some cases, before an examination, so-called contrast agents are injected to make certain areas of the body more visible on the images. Computed tomography scans are performed by radiologists (who are X-ray specialists), either in a separate department in a hospital or in a specialist’s office in the community.
  • Bone scintigraphy – A bone scintigraphy is primarily intended to clarify whether your skeleton is also affected by tumors or metastases. This involves injecting a radioactive contrast medium into a bloodstream, which accumulates primarily in tumors. Doctors can then use a special camera to see if there are any suspicious collections on the images. Because radioactive substances are used in this procedure, it must be performed by doctors and assistants trained for this purpose in a specialist practice or clinic.
  • Lung X-ray – An X-ray examination of the lungs and chest area is a standard procedure. This is to determine or exclude as early as possible whether suspicious tissue sites have settled here as well. Since X-ray machines are widely available, most doctors can perform such an examination.
  • Blood and tumor biopsy – A biopsy is a sample of tissue that is taken from you and thoroughly examined to see if it contains cancer cells. Because a growth in the body is not always a malignant tumor. A blood test can also contribute important results and can itself be examined for cancer cells. As a rule, a biopsy can be performed under local anesthesia on an outpatient basis in a clinic or doctor’s office. If the tissue to be examined is difficult to reach, a short anesthesia may also be necessary. Patients are not always able to drive themselves home afterwards. It is best to talk to the doctor performing the procedure before the procedure to see if you need to anticipate this and plan your travel accordingly.

How to know that you have cancer

The right doctor

You are free to choose your doctor. For your actual cancer treatment, however, it makes sense to place yourself in the hands of a cancer doctor who specializes in your type of cancer. These are known as oncologists in technical terminology. Each type of cancer is different and has its own characteristics. Also, not all types of cancer can be treated with the same treatment methods. That’s why oncologists, specialty clinics and entire cancer centers now specialize in one or a few types of cancer. This makes sense, as it brings together the greatest possible expertise for a disease. Therefore, you should already start thinking about where and with whom you would like to start your actual therapy while you are still being examined.

Your therapist or lead oncologist is your personal contact who monitors, organizes and adjusts your therapy as needed. As part of your treatment, it is not unusual for you to be treated in different departments, each with their own specialists. Therefore, all results and findings will come together with your head physician. He may be a specialist in private practice or based in a hospital or cancer center. Because he is also the person you can turn to if you have any questions, wishes or concerns, you should feel comfortable and in good hands with him.

Certified cancer centers

Many cancer therapies are now possible on an outpatient basis. Hospital stays are often only necessary for individual examinations or an operation. Even though you may have to travel a long distance on a regular basis, when choosing a doctor and clinic, you should choose a cancer center that specializes in your type of tumor certified cancer center take into consideration. For this purpose, various certified inpatient and outpatient facilities, such as clinics with specialized oncology departments and practices of established oncologists, join forces and work closely together during treatment. The doctors and nursing staff there are very experienced due to their specialization in one or a few cancer diseases.

The German Cancer Society (DKG) sets high standards for facilities and physicians who wish to obtain a corresponding certificate. In Germany, more than 1300 cancer centers are currently certified by the DKG. An overview of which Certified cancer centers what they are specialized in, can be found on the OncoMap of the German Cancer Society.

So, in certified cancer centers, experience with cancer patients and certain types of cancer are pooled, which in the end benefits you. This includes psycho-oncological services, which cancer centers must offer in order to receive an official certificate. Even if the treatment requires a further journey, it is worth it in the end.

Clinical trials

It is possible that your oncologist may suggest that you participate in a clinical trial. In such a study, researchers and doctors test new treatments or drugs that they believe will better treat one or more types of cancer. Every procedure and every drug must be proven effective and safe in a clinical trial before physicians are officially allowed to use it. Especially for patients whose disease is already more advanced, new procedures in clinical trials can offer a way. By participating in a trial, patients gain access to procedures that may offer improved treatment options before they are approved. Speak to your treating physician specifically about whether there are ongoing or planned clinical trials for which you may be eligible. You can also go on the search yourself and bring it to the attention of your oncologist. If he or she believes from a professional standpoint that one of these studies may be particularly promising for you, he or she will make a request on your behalf to the directors or. Ask the coordinators of the study if it is possible to participate. In order for each clinical trial to deliver a meaningful result in the end, participation is always tied to certain requirements that you must meet.

Procedure of clinical trials

Studies are also used to determine possible side effects of new drugs or methods, the extent of which is not always known in advance. For the most meaningful result, a clinical trial usually compares two groups of patients. One will receive the new drug to be tested and the other will receive a tested and already approved drug. There is a possibility that participants will not receive the new drug, but will be placed in the comparison group. This is given to a therapy that has already been approved and is used to directly compare the effectiveness of the treatments studied. A study follows a well-defined protocol to which participants must adhere. It can also be stressful to attend the many additional clinic and examination appointments. But these are necessary to check your health and effectiveness.

Your participation is always voluntary, and you can withdraw from the study at any time. However, always talk to your treating physician first before doing so.

How to know that you have cancer

The tumor conference

Once you have chosen a doctor to administer and monitor your treatment, he or she will receive the results of all your tests over the last few weeks. With this data, your oncologist will confer with other specialists to choose the best therapy for you. This discussion between specialists is also called a "tumor conference".

The qualified initial opinion

The specialists in the tumor conference will discuss together which therapy is most suitable for you. If there is a prospect of completely removing the cancer, this is called a curative or "curative" approach. Unfortunately, this is not possible in every case. Many circumstances play a role in whether a cancer is curable or not. When doctors have no way to cure their patients, their efforts are directed at making their patients’ remaining time as long and worth living as possible. This is called a "palliative" approach.

That’s why cancer treatment isn’t just about finding new cures. An equally important approach is to control a cancer throughout your life. For example, the number of so-called long-term survivors continues to rise, who receive treatment for life but experience fewer and fewer side effects in the process. Of course, doctors are primarily concerned with constantly improving the quality of life of all patients.

At the end of the tumor conference with the other doctors, your lead doctor will have a detailed plan for how best to treat you. This result of the differential diagnosis is also called "qualified initial opinion". If your disease allows it, he or she may even suggest multiple therapies. He will explain all the options to you in great detail and answer all your questions. It may well be that your doctor recommends that you participate in a clinical trial. If you have come across a trial that you think might be a good fit for you, be sure to talk about it with your doctor. In this discussion, you and your doctor will determine the course of action for the next weeks and months.

It is also perfectly fine if you do not want to deal with your illness. In this case, you can trust in the knowledge of your doctors, who will do their utmost to make your treatment a success.

Your right to a second opinion

You may feel unsure whether the therapy suggested to you is really the best option for you. If you don’t have a good feeling, you can get a second opinion from another doctor. In most cases, health insurance will cover the costs involved, but not always. If you want to hear a second opinion, you should consult with your health insurance provider ahead of time. How to avoid a nasty surprise. Privately insured patients in particular should always check with their health insurer before making appointments.

How to know that you have cancer


Cancer treatment takes a lot of energy. On the one hand, there are the effects of the disease itself that burden you. Because the treatment methods are effective, but also rich in side effects. On the other hand, you still have to cope with very practical problems of everyday life. What applications do I need to make? What claims do I have? Am I financially secured during my treatment? We give an overview.

A contact person is available to you for every step during your treatment. This is your senior oncologist, who is your go-to person for all medical concerns. If you are looking for an exchange with other patients, there are many self-help groups. If you’re not sure where to start looking for help, there are free counseling centers that can point you in the right direction.

How to know that you have cancer

Communication: talking about the cancer

Every person deals with the diagnosis of cancer differently. Some people would first like to come to terms with the new situation and collect themselves. Others turn straight to close confidants to look for solutions and support together. Both are right ways. You can read here how the discussions can be conducted in a gentle and helpful manner.

When to tell whom?

Your closest family members will probably know from the beginning. But when is the time to tell a wider circle of family and friends that you have cancer?? Right at the beginning: There is no right or wrong time. You are not obliged to tell anyone else about your diagnosis, neither family nor friends or colleagues. At the same time, you do not have to bear the burden alone. First give yourself the time you need to process your diagnosis. You may also already need the sharing or help of someone close to you to do so. No one path is better than another, only you provide direction.

Some patients consider waiting for all the examinations to be completed before they can be sure. However, this can take several weeks. Being alone with your fears, worries and hopes during this time can be very stressful. The exchange with familiar people helps most patients through this time. How many people that is will be different for each person. Some patients simply find it too difficult to confide in people close to them. It may be too early for them to accept their diagnosis and tell their loved ones about it. However, patients in such a situation can benefit from sharing their concerns. There are numerous addresses that cancer patients can turn to free of charge in search of places to go, assistance and psychosocial support.

Your employer must be notified as soon as you learn there will be absences or extended absences due to investigations and treatments. However, you do not have to tell them your diagnosis, this is subject to data protection and your decision.

How to find the right words

Think about the people you want to share your changed situation with. Equally important is how much information you want to share and with whom. This decision is entirely up to you. Once you’ve established that, you can use the conversations to ask for the help and support you need – or to set the boundaries you need. The more openly and clearly you address both, the better the chances are that those around you will be able to treat you the way you need to be treated. Some patients don’t want to be treated any differently than before, especially in the workplace. You have full control over this.
If you have decided to involve someone, it is best to talk to each other in a quiet environment. Public places like a cozy cafe are less suitable for this purpose. Depending on how close you are to the person you are talking to, there should be room for strong feelings. Think about an appropriate way to start the conversation beforehand. If you know your cancer is curable or not life-threatening, you should also share this information as early as possible.

Take the time to talk. Your interlocutor may need some time to collect himself or herself. People react very differently when they learn that a trusted person has cancer. They may ask questions, get angry, or be overwhelmed by their feelings. Give them space to do this. Others do not know how to react in the first moment and remain silent. Don’t let this discourage you, because most of your family, friends and acquaintances want to and will be there for you. You may be too shocked and overwhelmed at first to act or react as you would have wanted to.

If you want to tell someone about your situation but doubt you can handle the conversation, you can also consider asking one of your closest confidants to do so. In your current situation, it is right and important for you to pay attention to your own needs and not to overextend yourself. Your family will understand and take tasks like this off your shoulders. It is important that you always speak clearly and openly about what can be done to help you.

How you tell your children

Talking to your own children about a cancer diagnosis is the biggest challenge for many parents. You don’t want to burden your children with the anxiety that often accompanies a cancer diagnosis and that they may even be going through themselves. Then they keep silent and try to pretend that everything is as usual. In most cases, children notice on their own if something is not right. Mom is more often irritable or Dad is suddenly tired all the time. The effects of cancer treatment can be felt in different areas of everyday life. If children don’t know why such changes occur, they may, in the worst case, blame themselves for them. That’s why children should be told as early as possible what’s going on with mom or dad. Of course, this does not have to be a full presentation of the diagnosis. Simple and age-appropriate explanations already help children understand the situation. Also discuss your treatment and the expected side effects. Many children take it well when they are included. You ask questions and try to help in everyday life.

Despite your explanation, however, your children will also worry and may become frightened. Take time regularly to talk with them and listen to their concerns if they confide in you and want to talk about them. Do not force anything. Some children do not take the changes well and become withdrawn. If you are still noticing sleep and eating disorders, sudden drops in grades at school, or even contact with friends is becoming less frequent, your child may need the help of an expert. You can also contact your senior oncologist, the clinic social service or your pediatrician on behalf of your child to get psychological support.

What loved ones of sufferers can do to help

As a relative/friend, you probably want to do as much as you can to support your partner’s treatment. This is a good thing, and in fact, the support of loved ones and close confidants is an indispensable support during this time.
Cancer patients deal with the shock in very different ways and process the situation in their own unique way. Some people are literally rushed by new information and have a great need to talk about their situation. Others withdraw and distance themselves, wanting to put the disease out of their minds as best they can. Especially in the period directly after the first diagnosis, the shock is still deep-seated. Many patients need time to process the situation, which can also manifest itself in their behavior. For example, it may be that your loved one/friend will

  • Denies the disease and acts as if everything is as usual.
  • Withdraws from you and other contacts so as not to talk about the cancer.
  • React with anger and irritability. It is hard to predict how a cancer patient will deal with the diagnosis. It is important for you as a family member: Do not take it personally. These or other possible behaviors will help you process and accept the circumstances. The best help you can give in this situation is understanding and compassion. Show that you are there when you are needed. Sometimes a patient does not manage to free himself from the feeling of fear or powerlessness. If you feel overwhelmed, lonely or at a loss, there are counseling centers you can turn to. Later in the course of the disease, there will always be days when your partner’s mood darkens. Likewise, some days will seem as if everything is as it always was. Rejoice together in the good days, and show understanding in the bad ones.

It is difficult to predict how a cancer patient will deal with the diagnosis. The important thing for you as a loved one is: Don’t take it personally. These or other possible behaviors help to process and accept the circumstances. The best help you can give in this situation is understanding and compassion. Show that you are there when you are needed. Sometimes a patient does not manage to free himself from the feelings of fear and powerlessness. If you feel overwhelmed, lonely or at a loss, there are counseling centers you can turn to. Later in the course of the disease, there will be days when your partner’s mood darkens. In the same way, some days will seem as if everything is as usual. Rejoice together over the good days, and show understanding on the bad ones.


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