Frequently a medical oncologist will also be your lead doctor, the person whom you ask questions when no one else seems to be the right person. However we will be concentrating here on this doctor's role as the administrator of chemotherapy. This doctor is usually the doctor you see most during your months and possibly years of treatments.

Chemotherapy is used both as part of the tri-modal attack on EC along with radiation and surgery as well as a standalone treatment. Chemotherapy has "legs". It can be used when the other tri-modal treatments are exhausted. If all goes well, surgery is over in less than a day. When complications arise, this day may be repeated and replayed several times but essentially the intent is to remove the cancer and rebuild the body in a form that will allow you to live the rest of your life with as few concessions to the damage EC inflicted as possible. Radiation is generally over in a month or less. Continued use of radiation is not possible because radiation itself will cause cancer if too much is used. Typically about 70% of a person's lifetime maximum exposure to short wavelength x-rays is used. It cannot be repeated without going well over the maximum doses. This leaves chemotherapy as the long term treatment.

For many EC-patients, chemotherapy is the only treatment. There is little use in surgery if the EC tumor has metastasized to other organs. The best hope is to find a tolerable form of chemotherapy which destroys the tumors without also ruining the rest of the body. At this point, medicine cannot predict which chemotherapeutic agents will work before hand. Nor can medicine predict which chemotherapeutic agents will trigger adverse reactions. Administering these drugs must be done and the results monitored to see if they are having useful results without too serious side effects. It is not at all unusual for an EC-patient to try several combinations before one or another drug has beneficial effects. Unfortunately, more times than we would like to believe, chemotherapy is not sufficient to kill the tumor before the tumor kills us.

Early on Questions

1. What chemotherapeutic agents and protocols will be used?
2. With surgery:
• Will chemotherapy be used prior to surgery? Will it be used subsequent to surgery? Will it be used both prior and subsequent to surgery? Why?
• Will chemotherapy be used with radiation? How will the two treatments be coordinated?
3. Without surgery:
• Will chemotherapy be teamed up with radiation?
• How will the treatment be monitored?
• What will be the treatment plan? Will I be getting infusions continuously? Will I be getting treatments on a schedule at a clinic/hospital?
4. Do I need to have chemotherapy where I have surgery or can it be administered at a clinic/hospital near where I live?
5. What is the purpose of this chemotherapy? Can I expect a potential cure? Is the purpose to treat EC like a chronic disease?
6. How will my progress be monitored? How often will I have tests like a CT scan or a PET scan?
7. When do we give up on a particular chemotherapeutic agent and try something else?
8. Are there markers that indicate how I am doing? How often will I need blood work? What happens if my white or red blood cell counts fall too low?
9. Are there special considerations if I am anemic? I have heard something about a condition when white blood cells fall too low called "febrile neutropenia." Will I have to monitor low grade fevers I used to ignore?
10. What are the risks of serious side effects? How likely am I to suffer
• Serious hearing loss or tinnitus?
• Blindness or loss of visual acuity?
• Mental problems?
• Loss of motor and sensory control in my limbs (peripheral neuropathy)?
• Organ damage?
11. What questions should I have asked but neglected?

Chemotherapy for Palliative Care

12. Is this chemotherapy being given as a cure or primarily to allow me to swallow better?