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Patients are seen by appointment upon referral from their primary physician. Physicians should call (401) 729-2700.

A cancer diagnosis can no doubt bring uncertainty and questions into your life. It's easy to feel a little bit out of control right now. With decisions to make about future treatment and care, figuring out where to begin and what to do next can be confusing. It's important to remember that you are not alone. Your health care team is ready to create the best plan with you. Here are some commonly asked questions:

What is Cancer?

Learning about your cancer is the first step in gaining knowledge and control over your situation. Your physician and other members of your health care team can supply you with trustworthy information and resources.

Cancer is not a disease, but a group of diseases characterized by the abnormal growth of cells. This abnormal cell growth can result in the formation of malignant (cancerous) lumps, masses, or tumors in the body. In some cancers, such as leukemia, the cancer cells do not form tumors. Known as hematological malignancies, they form instead specifically in the blood or bone marrow. Cancer type refers to the organ or type of cell where the cancer started.

One difference between cancerous and non-cancerous conditions is that cancer can spread from where it started to different parts of the body. This process is called metastasis.

What happens after I have been diagnosed?

Take time to learn as much as you can about your type of cancer. Ask a lot of questions. Your physician can help you understand your diagnosis and treatment goals. After understanding your diagnosis, the next step is for your medical team to determine if your cancer has spread to any other parts of your body (metastasized). This will help to indicate what stage of cancer you have.

Each stage may require a different treatment approach. Some cancers, such as leukemia, may not have stages. To pinpoint the exact stage, your doctor may order scans of different parts of your body, perform a clinical examination, and/or run various tests.

How many doctors will I need to see?

You will most likely assemble a medical team of experts responsible for different aspects of your care. Communicating with every member of your health care team is important. They will help you understand your diagnosis and will encourage you to be involved in your care.

The members of your team may vary, depending upon your diagnosis and treatment plan. You may interact with physicians, nurses, pharmacists, and technicians. Together, they will provide you with comprehensive treatment, care, and answers to your questions.

What are the different stages on Cancer?

Cancer staging systems describe how far cancer has spread anatomically and attempt to put patients with similar prognosis and treatment in the same staging group. Since prognosis and treatment depend quite a bit on the stage, you can see how important it is to know what stage you have! At the same time, other factors, including your general health, your own preference, and the results of biochemical tests on your cancer cells will contribute to determining the prognosis and treatment. So while the stage is important, it is not everything.

The concept of stage is applicable to almost all cancers except for most forms of leukemia. Since leukemias involve all of the blood, they are not anatomically localized like other cancers, so the concept of staging doesn't make as much sense for them. A few forms of leukemia do have staging systems which reflect various measures of how advanced the disease is. For most solid tumors, there are two related cancer staging systems, the Overall Stage Grouping, and the TNM system.

Overall Stage Grouping

Stage 0 Pre-cancer

Stage 1 Small cancer found only in the organ where it started.

Stage 2 Larger cancer that may or may not have spread to the lymph nodes.

Stage 3 Larger cancer that is also in the lymph nodes.

Stage 4 Cancer in a different organ from where it started.

TNM Staging

In the TNM system, TNM stands for Tumor, Nodes and Metastases. Each of these is categorized separately and classified with a number to give the total stage. Thus a T1N1M0 cancer means the patient has a T1 tumor, N1 lymph node involvement, and no distant metastases. Of course the definitions of T, N and M are specific to each cancer, but it is possible to give a general idea of what they mean.

T: Tumor classifies the extent of the primary tumor, and is normally given as T0 through T4. T0 represents a tumor that has not even started to invade the local tissues. This is called "In Situ". T4 on the other hand represents a large primary tumor that has probably invaded other organs by direct extension, and which is usually inoperable.

N: Lymph Nodes classifies the amount of regional lymph node involvement. It is important to understand that only the lymph nodes draining the area of the primary tumor are considered in this classification. Involvement of distant lymph nodes is considered to be metastatic disease. The definition of just which lymph nodes are regional depends on the type of cancer. N0 means no lymph node involvement while N4 means extensive involvement. In general more extensive involvement means some combination of more nodes involved, greater enlargement of the involved nodes, and more distant (but still regional) node involvement.

M: Metastasis is either M0, if there are no metastases or M1, if there are metastases. As with the other system, the exact definitions for T and N are different for each different kind of cancer. As you can see, the TNM system is more precise than the I through IV system and certainly has a lot more categories. The two systems are actually related. The I through IV groupings are actually defined using the TNM system. For example, stage II non-small cell lung cancer means a T1 or T2 primary tumor with N1 lymph node involvement, and no metastases (M0).

How can I maintain my emotional health?

Do not feel alone - get support, so you avoid feeling emotionally or psychologically overwhelmed. Here are some ideas to help you cope.

  • Find a family member or friend who can keep others informed about you: Staying on top of well-meant phone calls and e-mails can be exhausting and time consuming. Look for someone in your support network who can be the clearinghouse for communication or create your own free web page at http://www.caring4cancer.com.
  • Let your friends' and family's talents shine: It is normal to feel hesitant about asking your family and friends to pitch in with cleaning, cooking or childcare. Take comfort that these people want to help by doing something meaningful for you. Ask a family member or friend to coordinate this effort and relieve you of this responsibility.
  • Nurture your emotional and spiritual well-being by doing activities that have special meaning to you: This may include spending time with close family members and friends, listening to music, being close to nature, meditating and praying, or pursuing a special hobby.

Where can I go for more information?

There are many resources for newly diagnosed cancer patients. Ask your health care professional for reliable pamphlets, magazine articles, and other materials.

The Internet contains a vast amount of cancer-related information. It is very important to know which sources are accurate, up to date and are reputable. Ask your doctors where to look online and what resources they recommend.

Other cancer patients can be a valuable source of practical information and support.

How can I get organized?

Set up systems to manage all the information you will be gathering related to your diagnosis, treatment, scheduling, insurance coverage, and so on. Educational materials, health records, appointment reminders, and insurance forms all need a place where you can find them easily.