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Lung Cancer Guide photo Understanding The Issues

Lung Cancer Form



You can print out this form to help you answer the questions

Members of my family and others close to me who have the same kind of cancer I have.:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

That person's experience with lung cancer and how it affected me or how I felt about it:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

The symptoms I have:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

The type of lung cancer I have:
(If you don't know, ask your doctor or nurse and have them write it down for you).

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

The following are the tests I have had and the results of those tests:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

The results of my biopsy:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

The result of my sputum cytology:

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________



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