Fighting Cancer with Knowledge and Hope: A Guide for Patients, Families, and Health Care Providers

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alyonabondar.com/components/programmi/come-sapere-se-un-iphone-8-plus-originale.php Zaret, M. Subak-Sharpe, M. The Unfocused Mind in Children and Adults. Thomas E. Brown, Ph. A Guide to Understanding Mental Health. James Whitney Hicks. Ruth H. In-depth conversations with experts on topics that matter. Subscribe to hear when New Releases or Catalogs are ready!

Their interactive tool helps you understand your diagnosis as well as the pros and cons of your treatment options. National Lung Cancer Partnership Their free downloadable booklet helps you figure out which treatment options are best for you, pros and cons of each treatment, side effects and questions to ask your doctor.

The site can help you organize everything from parties to marathons to motorcycle rallies, all in an effort to bolster the battle against lung cancer. Planning to run a LUNGevity marathon? Use their virtual trainer to get ready for the run! Melanoma patients can find tips for undergoing treatment, including advice on easing side effects and ensuring proper nutrition. Melanoma Patients' Information Page Connect with other patients via private chat rooms about treatments, doctor contacts and anything else that's weighing on your mind.

Find selected readings tailored to a patient's specific cancer, a glossary to help you sort through all the medical jargon and staging and prognostic calculators. Skin Cancer Foundation Browse through a list of sun-protective clothing and films for car and home windows that carry the SCF seal of approval, which guarantees that the product has an SPF of 15 or higher, has been thoroughly tested and shouldn't cause irritation.

SCF also recommends that women "go with your own glow. Melanoma Hope Network Get info on how to identify suspicious spots, as well as options for support and treatment if you've been diagnosed. You can also test out TrialFinder, which matches a patient's medical profile with compatible clinical trials as well as notifies patients via email when new treatments become available. The site also features a database of treatment centers that meet the MHN's standards of excellence. Find a free skin cancer screening in your area and get the facts on skin cancer, melanoma, sunscreen and indoor tanning.

Aim at Melanoma Connect with a nurse to get all your questions about melanoma answered through Aim's NurseOnCall hotline. Also read through their Survivor Stories from patients who have recovered from cancer at every stage. Road to Healthy Skin Tour Get a free skin cancer screening aboard a foot customized RV that makes stops across the country. Click on the online calendar to learn when it's rolling into your city. You can also locate genetic counselors near you and connect with other "pre-vivors" FORCE's word for high-risk women in an online chat room.

Ovarian Cancer Research Fund OCRF is dedicated to raising money to fund research for methods of early ovarian cancer detection and finding a cure. Check out the Wall of Hope for inspiration, where women with the disease are honored, as well as for a listing of upcoming fund-raising functions coming to a city near you. Ovarian Cancer National Alliance The alliance works to increase public and professional awareness of ovarian cancer as well as offer education and outreach at state and local levels to spread advocacy nationwide.

The website provides patient kits and Conversation Starter packets to empower newly diagnosed women with credible information that can help them through the challenges that lie ahead. The website allows you to send ovarian cancer facts and symptoms to a friend. Join her and hundreds of others on November 14 in Los Angeles to walk or run for ovarian cancer awareness and raise funds for the Cedars-Sinai Women's Cancer Research Institute. Participants can set up a personalized webpage to track donations and send emails.

Join, donate and "walk" your way to a cure. PanCAN also offers a free clinical trial matching service. Also, find out how to get your U. The National Pancreas Foundation Cook up something good with recipes catered to those with a sensitive pancreas. The NPF gives tips for successful living with pancreatic diseases.

Also learn about alternative therapies like meditation, acupuncture—and laughter! Cancer Challenge Celebrate Halloween and get your pre-pig-out workout with a run! Join the walk to raise funds—plus, connect with other walkers across the country on their online message boards. Thyroid Cancer Survivors' Association Get the facts, treatment options and an individualized person-to-person support system based on your diagnosis and personal preferences. Plus, you can download recipes made for thyroid cancer patients undergoing iodine treatments. American Thyroid Association Search for a thyroid specialist in your state with their interactive map, as well as brochures on thyroid disease, surgeries and tests.

UnitedHealthcare Partners with Youth Hope Association to Help Young Texans Fighting Cancer

LOL holds monthly support groups, provides patients with hospitality baskets and educational information, and organizes survivor teams for marathon running. Frank, M. Frank includes strategies to cope with cancer on a daily basis, as well as patient anecdotes.

Partial proceeds from the book sale are donated to Cancer Care. Fesen, M. It is a highly sophisticated, multibillion dollar system. This book gives tips on developing a strong relationship between you and your doctor, which is vital to receiving quality care. Also get the inside scoop on cancer centers, pharmaceutical companies and insurance. Finally, Dr. Fesen answers 50 questions he gets most often from his patients.

Pressman, M. Davidson knows from experience. This book combines science and personal vignettes to describe "chemo brain," which can leave cancer patients mentally sluggish, strained and overwhelmed, as well as a nine-step plan to help lift the haze after chemo including diet and exercise. Wisenberg reveals the realities of life with cancer and how smarts, style and a self-depricating sense of humor help her fight back against disease.

The book is an extension of her blog of the same name. Neal D. Barnard, M. Reilly, R. Try more than easy recipes and watch Eating Right for Cancer Survival, a companion DVD to arm you with more information on how simple changes can bring big health rewards. Boesky shares a deeply transformative year in her family's life and invites readers to join in their joy, laughter and grief. The Pink Ribbon Diet features recipes with an emphasis on Mediterranean foods with nutrients thought to lower breast-cancer risk and foods that improve biomarkers, indicators of risk.

This book deals with the reconciliation of medicine and spirituality as they apply to the search for cures for everything from cancer to AIDS. Sign up for our Newsletter and join us on the path to wellness. Spring Challenge. No Guesswork. Newsletter Wellness, Meet Inbox. Will be used in accordance with our Privacy Policy. Share via facebook dialog. Share via Twitter. Share via Pinterest. General cancer organizations American Cancer Society ACS provides information on numerous types of cancers, plus an online support group, tips for talking to doctors and upcoming fund-raising events in your community.

Events Brain Tumor Walk Unite your friends around a cause. Breast cancer BreastCancer. Here symptoms caused by the spread of cancer ultimately led to the identification of the primary cancer. Another example of this follows next. A neurologist evaluated him, diagnosed him as having a seizure, and ordered an MRI of his brain. The MRI showed numerous tumors growing in his brain that were characteristic of cancer that had spread from another location in the body.

Tom was admitted to the hospital for further evaluation. Because he was a smoker, a CT scan of his chest was performed, which revealed a tumor in one of his lungs. Biopsy of the tumor revealed lung cancer, and he was diagnosed with stage IV lung cancer because of distant metastases to the brain. Tom received antiseizure medicines, steroids medicines related to cortisone that reduce brain swelling caused by tumors, and brain radiation. After his condition improved, he was discharged from the hospital with plans to treat the rest of his cancer as an outpatient.

Like heart attacks and stroke, cancer emergencies require immediate treatment. Because the possibility of cancer is usually not foremost in the mind of a patient who seeks emergency care, a cancer diagnosis under these circumstances often creates tremendous stress. Martin was a fortynine-year-old man who had been in excellent physical condition until sudden severe shortness of breath and dizziness led him to be rushed by ambulance to our hospital. A chest X-ray and CT scan showed that a large mass in the middle of his chest in a region called the mediastinum was impeding the flow of blood to his lungs and brain.

Martin rapidly 29 Exposing Cancer underwent biopsy of the mass, and it disclosed an aggressive lymphoma. His condition was worsening by the hour, and he needed treatment urgently. Yet he and his wife, Anne, were very analytical, highly intelligent people who wanted to know all about lymphoma and the different treatment options before they would consider treatment.

Their friends also told them to get a second opinion before commencing treatment. They were not sure what to do. I told them firmly that they needed to make a leap of faith and do something extremely important: trust me. Ordinarily, I explained, I would never dissuade a cancer patient from seeking a second opinion. But in this situation, there was no time to get one at another center. It was not even safe to transfer Martin to a larger hospital, for this would unacceptably delay his treatment. Our hospital had the expertise to make him better, I said, and they needed to let us try.

A second opinion could certainly be obtained once Martin was out of danger and discharged from the hospital in better condition. This meeting was one of several between us in just two days, so Martin and Anne were ready to put their trust in me and commence treatment for his cancer. Fortunately, his lymphoma responded beautifully to chemotherapy and immune treatments, and within days of his first treatment he was feeling better.

On discharge, he had a second opinion consultation that agreed with our strategy. Yet whether you are in a hospital or at home, every newly diagnosed cancer patient faces similar immediate issues. Second, you must consider accepting complicated therapies, such as chemotherapy or radiation, that may cause significant side effects. And you and your family have to make decisions about which oncologist and which cancer center to place your trust in. If you need hospitalization, you may need to rely on a new hospital and new health care providers whom you did not seek out in the first place.

All cancer patients should feel confidence in their oncologist, surgeon, and radiation therapist as well as the center in which they will receive treatment. Since this confidence is something that must be deserved and earned, however, you should try to evaluate if the hospital and physicians have the expertise and capability to treat your type of cancer. This usually means asking about the training and experience of the doctors, the reputation and accreditation of the hospital for the treatment of cancer, and whether the hospital has a research program that provides access to clinical trials.

Outpatients who are not experiencing any symptoms from cancer have more time to make these decisions. Great cancer care involves far more than surgery, radiation, and the administration of chemotherapy. Caregivers must always consider the totality of a patient and how cancer will impact his or her life and loved ones.

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Oncology nurses, family therapists, spiritual advisers, and other professionals should be available to assist the oncologist in addressing the many emotional and psychological needs of a cancer patient and his or her family members. Although these needs may seem secondary in the whirlwind of trying to figure out how best to save a life, it is actually at these times that you can take the measure of a cancer program: Are 31 Exposing Cancer you and your loved ones being supported with information, education, and caring professionals who have the time to guide you through this difficult moment in your life?

The answer should be yes. It takes a community of dedicated professionals to care for a cancer patient. This care should be delivered in a pleasant, warm, and welcoming environment. If you are hospitalized and do not feel that the facility you are in is expert enough in your type of cancer, you should inquire about the feasibility of being transferred to a more specialized center. An outpatient can more easily seek other opinions elsewhere. Above all, if you have cancer, you should be made to feel that your oncologist is your advocate and that he or she will tell you where the most appropriate place is for the treatment of your cancer, whether this is a regional hospital or another facility.

Although this point may seem obvious, the reality is that medicine can be complex. Pathology results are sometimes not definitive, biopsies may need to be repeated, and a sample may need to be evaluated by several expert pathologists before a correct diagnosis is rendered. A guiding principle in the practice of oncology is that, with rare exception, absolute proof of a cancer diagnosis must exist before any treatment is initiated. Sometimes the biopsy needs to be sent to outside consultants who require additional time, so a definitive diagnosis may not be obtained for a week or more.

Janet was referred to me after having been told that she had multiple myeloma, a bone marrow cancer. She walked into the examination room quietly in visible pain owing to a recent fracture of a spine bone. Her face was downcast but showed a mixture of physical discomfort and fear. Janet was helped onto the examination table by her husband, Dave, who stood erect and imposing, right beside her.

She let him do most of the talking. He was tough looking. With a fierce gaze, he stared unblinkingly at me as he spoke in short, strong phrases. I told them I would do my best to make her well, because I fight for all my patients as if they were my family.

I quickly focused on her situation. Janet was thought to have multiple myeloma after an abnormal protein was found in her blood and a biopsy of the fractured vertebra showed some of the cells that are typically found in that bone marrow cancer myeloma is discussed in chapter 3. But I was not convinced by the whole picture. Further investigation for myeloma cells in other parts of her body failed to turn up any sign of the disease.

In the end, Janet was spared a cancer diagnosis and remains without evidence of myeloma five years later. Her pain was adequately addressed, her condition improved greatly, and she and her husband were grateful. I was extremely happy for them and breathed a sigh of relief for myself. Because of the enormous weight placed on pathology results, I highly recommend that every cancer patient make certain that his or her oncologist is satisfied with the findings and diagnosis of the pathologist. If there is any uncertainty, have the specimen reviewed by a pathology consultant at another hospital.

The stage of a cancer directly correlates with the likelihood of cure: in general, the higher the stage number, the more widespread the cancer and less favorable the outcome. It is important to realize, however, that the relation between stage and prognosis is not absolute. The staging system for the most common cancers such as breast, lung, and colon cancers recognizes that there is a direct relation between the extent of cancers and their ultimate curability. The extent of a cancer is described by the TNM staging system, in which T stands for the size or extent of the primary Tumor fig.

The tumor T staging of cancer The deeper a cancer grows into the tissues beneath it, the higher the T stage. Each cancer is staged according to its own TNM classification system. The node N staging of cancer The more lymph nodes that harbor cancer, the higher the N stage. In pancreatic cancer, the stage is determined mainly by the size and extent of the tumor rather than whether there is lymph node involvement. For example, cancers that extend beyond the pancreas but not into nearby arteries would be classified as T3, stage II, whereas cancers that do involve major arteries are classified as T4, stage III.

It is important to understand that although cancer tends to spread first to nearby lymph nodes and then to more distant sites in the body, it does not always follow such an orderly or obvious path. A person may be diagnosed with an early-stage cancer, not involving any lymph nodes, and still develop stage IV disease years later. The explanation for this is that cancer cells either bypassed the lymph nodes and spread through the bloodstream or did pass through the lymph nodes but left no traces behind.

Researchers are developing methods based on the genetic profile of a cancer that will enable oncologists to predict more accurately which early cancers have the potential to return and which can be cured by surgical removal alone. In general, the lower the stage, the better the chances are that a cancer can be cured. Yet the fact that cancer relapses affect some individuals with low stages of cancer forms the basis for administering cancer treatments even after surgery has removed all visible evidence of the disease.

The TNM staging system does not apply to cancers of the brain or to the blood and lymph cancers leukemia, lymphoma, and multiple myeloma. These cancers have their own unique staging systems because they behave very differently from the more common cancers. For example, in leukemia, the cancer cells circulate in the bloodstream throughout the body; they would all be metastatic under the TNM system. To learn more about the staging of blood cancers, visit the web sites listed in appendix 2.

This is natural. In fact, few people die of cancer soon after they are diagnosed, although rapidly fatal cancers can occur. More people are living longer with cancer than ever before, and a cornucopia of new drugs being tested today offers real hope to cancer patients. Statistics on all persons diagnosed with cancer in the United States from to indicate that 63 percent survived at least five years many are presumed cured. Still, not enough people do survive cancer for long enough, and we cannot escape the present-day reality that cancer claims far too many lives.

And second, if the cancer is not considered curable, what is the estimated survival? It is vital for patients and their loved ones to have a clear understanding of whether the cancer they are confronting is likely to be cured. Some cancers are cured with surgery or radiation alone; others require chemotherapy; still others, such as the blood and lymph cancers, may require a stem-cell transplant to achieve cure. If the cancer is potentially curable, then you will need to discuss the recommended treatments, their side effects, and how treatment will affect all facets of your life.

If cure is not a likely possibility, then you will need to discuss all of the above plus another crucial element: the goals of treatment. Is long-term disease control a realistic goal? Is short-term comfort and relief of suffering a more appropriate objective? Will a goal intermediate between these two be more achievable? The treatment of curable cancers and those not likely to be cured are discussed in chapter 6. One month before our meeting, Mitch developed sudden abdominal pain and turned yellow, the sign of jaundice, indicating trouble in the flow of bile through the bile ducts.

He was admitted to our hospital, where testing showed gallstones both in his gallbladder and lodged in the common bile duct, the main river of bile flow. Gastroenterologists relieved the obstruction in the duct with a stent, and he was soon off for routine surgery to remove his gallbladder. Immediately on viewing the gallbladder, however, the surgeon could tell that it was very abnormal. Frozen section pathology done on the spot in the operating room showed cancer.

Suspicious areas in the liver and in nearby lymph nodes showed the same. The gallbladder was removed, but Mitch awoke to devastating news. The surgeon was a very nice fellow. They ran some extra tests but turned me down for an operation. He gave me six months and told me that I should get my affairs in order.

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He also said that I should find an oncologist and try some chemotherapy. So, here I am. I must tell you that I feel great, just took my boat out for four days. What do you think? Who could receive such a penetrating gaze from a fellow human? Why should this exceptional person or anyone for that matter have to confront a deadly cancer?

The average survival for stage IV gallbladder cancer is on the order of twelve months, and some patients can live substantially longer. A lot will depend on the aggressiveness of the cancer and how it responds to treatment. An MRI showed that the liver metastases were shrinking; a tumor marker named CA , measured from a blood sample, declined from 5, to the lower the better, normal is less than After a year of nearly weekly chemotherapy treatments, he was able to stop them and enter a period of observation; his cancer was detectable but not growing.

Unfortunately, soon afterward, his CA level began to climb. I knew he was no longer comfortable waiting. Miraculously to me! After eight months of treatment, his hands and feet were becoming uncomfortably numb, so therapy was halted. Still, Mitch was ever pleasant, rolling with the tides of his cancer as any good sailor would. Not surprisingly, however, the CA began to rise as soon as therapy ceased. Over the course of a year without treatment, while under close monitoring of his symptoms and the status of his cancer by CT scans and MRIs, the marker rose to over 10, We were in uncharted territory.

I recommended that we find an appropriate clinical trial for him, testing an investigational anticancer drug; he preferred to pursue that at a later time. He appeared so well and I had such reluctance to submit him again to the side effects of chemotherapy that I recommended surgery just to prove that what we were seeing on the scans was active cancer.

During this time, Mitch never lost his composure, never lost his sense of gratitude, never stopped boating, working, or helping other people. And he has never stopped being an inspiration to me and all those who know him. Eventually, weight loss and other mild symptoms began to creep in and force my hand. We went back to gemcitabine and added Tarceva, a pill that is FDA approved for pancreatic cancer but has modest benefits in the eyes of most oncologists for that related cancer. Again to my amazement, the marker began to fall precipitously, back into the low hundreds.

After he underwent an MRI of the abdomen, I received a call from the radiologist, which is never a good thing. How can you be calling me with bad news? His marker is down and he feels well. How is this possible? To be honest, patients like him keep us oncologists going. Rising markers. This situation is most commonly encountered in prostate cancer, in which a rising PSA level may be detected years after surgery or radiation, and in ovarian cancer, in which a rising CA level may be detected some time after surgery and chemotherapy treatments.

If a rising tumor marker is detected, a recurrence of cancer is not a certainty. Furthermore, if a recurrence is destined to occur, it may take years for prostate cancer or months for ovarian cancer to declare itself. Whether to institute treatment based on the rising marker alone or to wait for clear evidence of a cancer recurrence depends on many factors.

For example, it is not uncommon to institute radiation or hormone therapy for a rising PSA in patients with a history of prostate cancer, but it is not common practice to reinstitute chemotherapy for a rising CA in a patient with a history of ovarian cancer. Establishing a regular schedule of doctor visits, blood draws to check the tumor marker, and surveillance testing to detect a possible recurrence at its earliest time can reduce this anxiety. It is, of course, devastating to learn that you or a loved one has a cancer that is not considered curable.

Yet such a diagnosis does not mean that the cancer is not treatable it nearly always is or that the affected person may not live for many years, as in the case of Mitch. Everyone reacts differently when diagnosed with a cancer that is not likely to be cured. Some people want to hear all the facts so that they can prepare for all possible outcomes. Others may not want to discuss the prognosis immediately and would rather wait for a time that enables them to face their situation or steel themselves to begin treatment; for some, coping means taking one step at a time.

Still others do not want to talk about prognosis or hear bad news at all. Patients should be able to convey to their caregivers their feelings, fears, and needs physical, practical, and emotional. They should, in time, come to believe that that their oncologist will fight tooth and nail for their survival and quality of life. Every means necessary should be employed to cope with this difficult situation.

Cancer Patient, Books

Psychiatrists, social workers, family therapists, nurses, spiritual advisers, and other profes- 43 Exposing Cancer sionals play critical roles in helping patients and their loved ones adjust to their new reality. This discussion is made all the more stressful when a patient insists on knowing how long he or she will survive. Certainly, an average survival estimate can be provided for any cancer.

Yet such a number is drawn from an analysis of groups of patients and must be qualified by the recognition that every patient is unique and reacts uniquely to cancer treatments. Patients whose cancers respond to treatment survive longer than those whose cancers fail to respond. But how a cancer will respond to treatment cannot be known before those treatments are administered. Furthermore, at the quickening pace of drug development today, it is possible that a promising new drug may come along that extends the lives of patients with a particular cancer.

For example, in the past few years alone, several new drugs have been approved for the treatment of colon cancer, such as irinotecan Camptosar , oxaliplatin Eloxatin , capecitabine Xeloda , bevacizumab Avastin , cetuximab Erbitux , and panitumomab Vectibix , after decades of having just one drug 5-FU to treat the disease. In addition, innovative combinations of new drugs with older ones are being introduced yearly, with each new combination extending life even further. For these reasons, prognosis is not easy to predict accurately and often takes time to determine.

The factors that oncologists use to try to estimate prognosis are discussed next. The first four are readily known, whereas the fifth is more difficult to ascertain and is of my creation drawn from the scientific work of many others. The five prognostic elements are: 1. As discussed earlier, these two elements are by far the most important in determining prognosis. For example, someone with an aggressive cancer who also has severe heart problems would have a difficult time tolerating strong chemotherapy or extensive surgery.

The chemotherapy doses would likely have to be lowered, and the surgery would have to be limited; these facts would diminish the chances that this person could beat the cancer.

Empowered to Participate in Your Care

Which genes the cell uses depends on its needs. This is because most people think of leukemia as being a rapidly fatal disease. Anny Hayon Brooklyn, NY. Frank ,. The gallbladder was removed, but Mitch awoke to devastating news. The restaurant will host musical events to raise funds for local charities that support breast cancer research.

In fact, some very infirm individuals may face a greater risk of dying from other medical conditions than from their cancer; it may be in their best interest not to treat the cancer in such a situation. Age is a consideration in determining prognosis because the older the person, the harder it is for their bodies to withstand strong anticancer treatments.

On the other hand, a seventy-year-old man in perfect physical condition may tolerate cancer treatments better than a forty-year-old man who has abused his body and health, so age itself is not blindly used to guide treatment recommendations. A prognostic factor element 4 represents some medical or scientific aspect of the cancer or the patient that aids in estimating prognosis. For example, a patient who has breast cancer that has spread to axillary lymph nodes would have a certain estimated prognosis based on the 45 Exposing Cancer stage TNM designation of the cancer.

Fortunately, however, an anticancer drug that specifically blocks the function of Her2, called Herceptin, has greatly improved the survival of Her2 positive breast cancer patients fig. Two other prognostic factors used in breast cancer are the estrogen receptor and progesterone receptor. The estrogen and progesterone receptors are proteins found in normal breast tissue, as well as in many breast cancers, that bind to the hormones estrogen and progesterone, respectively. Breast cancers that make these estrogen and progesterone receptors are generally less aggressive and have a better prognosis than those that do not.

As described in chapter 1, blood tumor markers that relate to cancer growth are associated with numerous cancers, and sometimes they have prognostic importance. For example, among men diagnosed with prostate cancer, the higher the PSA at diagnosis, the lower the chances for cure; in testicular cancer, the higher the blood levels of AFP alphafetoprotein and HCG human chorionic gonadotropin , the more difficult it is to cure.

Some of the more commonly used models are for prostate cancer Partin Tables and several others , kidney cancer Memorial 46 Diagnosis, Staging, Curability Fig. Breast cancer and Her2 In panel A, a cancer cell is shown that lacks Her2 on its surface. In panel B, the cell contains Her2, resulting in activation of internal growth signals.

Helpful hint: Ask the oncologist whether a prognostic model exists for the cancer being treated and, if so, how the cancer ranks in the model. Perhaps the most advanced and widely used prognostic tool has been developed for early-stage stages I—III cancers of the breast, colon, and lung.

This tool is a computerized program called Adjuvant! Online, in which the oncologist enters clinical information about the patient age and overall health and cancer tumor size, grade, and number of lymph nodes involved and obtains a risk profile of that cancer. The oncologist can then choose a treatment option such as a particular chemotherapy regimen and the program will estimate the benefit of that treatment for the patient; the benefit relates to the reduction in the risk or chance that the cancer will return and the survival in years gained from the therapy.

The results can be printed in a patient-friendly graphical format, which the oncologist can share with the patient.

If a cancer is deemed to have aggressive features, then stronger treatments would be recommended to try to eradicate it and prevent it from returning; if it has less aggressive features, then strong treatments would not be necessary. This explains why cancer researchers and practitioners are so focused on identifying the behavior of a cancer before a patient starts treatment. No one wants to subject someone to strong therapies with powerful side effects if they are not truly indicated. If we can identify which cancers need strong therapies and which can be successfully treated with milder therapies, then each patient will receive the optimal and necessary treatment for his or her cancer.

This is a central goal of the field of cancer medicine. This brings us to the fifth and final factor that determines prognosis. It has no official name, but I call it the biological essence of the cancer. The biological essence comes from deep inside the cancer cell to dictate how heartily it grows, how well it resists apoptosis, and how invasively it spreads throughout the body.

All of the properties we have discussed thus far are mere surrogates for this biological essence; they all try to approximate it but fail to truly capture it. For example, how could it have been predicted that a fifty-year-old woman with an early-stage lung cancer stage I would ultimately die from lung cancer that returned more aggressively?

I'm an oncologist who got breast cancer. This is what I learned

And how could it have been predicted that a forty-two-year-old man with colon cancer that had spread to the liver and lungs stage IV could be cancer free five years after chemotherapy, when the average survival of such patients is under two years? Neither cancer type, stage, health of the patient, nor 48 Diagnosis, Staging, Curability prognostic factors could have predicted these outcomes. These cases highlight the reality that there is much that science cannot explain about the behavior of cancer. For example, why is pancreatic cancer so difficult to treat? Why is testicular cancer so often cured?

Its biological essence makes it melt away with chemotherapy or radiation. When a cancer patient lives much longer than could have been anticipated, the main reason is thought to be the favorable biological essence of that cancer: it grows slower or succumbs to treatment more easily than other cancers of its class. Certainly, in my oncology practice, I am continually amazed at how some people survive for many years with a cancer that has a dismal prognosis; the treatments worked incredibly well.

But beyond the treatments, do I think that some people have a special gift, have found a cure from a healer, or have prayed harder than those who succumbed to cancer? I have had the immensely humbling privilege of caring for some of the most courageous, health-conscious, and devout people that anyone could ever meet; many of these individuals faced an insurmountable enemy in a cancer that just could not be beaten down.

And whereas some individuals try to do all that they can to fight cancer, there are those who do not want to change their lives any more than they have to. These individuals accept the prescribed therapies but continue their life as uninterrupted as possible. This is also an important coping mechanism that must be respected.

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Other factors that may help a person survive include stopping smoking, eating a healthful diet, getting adequate rest and exercise, lowering stress, accepting love and emotional support, and having the will to live. But these cannot overcome an aggressive cancer for which modern medicine has no answer. On the contrary, I would not have been compelled to write this book if I did not believe that these uniquely human traits play a vital role in the healing of the human body.

Since we cannot predict this destiny for any cancer, any discussion of prognosis must be accompanied by the caveat that every person and every cancer is unique and that this uniqueness is poorly understood today. Our ability to provide a highly accurate prognosis to a newly diagnosed cancer patient will depend on advances in science that are able to capture the biological essence of a cancer. Incredibly, these advances are happening today, and we stand at the crossroads of a new era in the field of cancer medicine. Within the next ten years, the diagnosis, estimation of prognosis, and treatments used to battle cancer will all be much more precise than they are today.

I thought my career as a doctor was over. It was the arts that saved me

Researchers are studying cancer fingerprints intensively for their ability to predict the behavior of a cancer. This field of study is called genomics because all the genes in a cell are collectively known as the genome. DNA is the genetic material that contains all the instructions a cell needs to function. A cell taps into only a small percentage of all the genes in the DNA warehouse at any time. Which genes the cell uses depends on its needs. For example, our skin cells can be thought of as being at rest most of the time, but if we are cut or burned, they become activated and hurl into action to repair the damage.

This repair process is orchestrated by genes that were dormant but became active on injury. Thus, skin cells at rest would be drawing on a different constellation of genes than those performing repairs. Similarly, a breast cell would use a different set of genes than a lung cell. To relate this to cancer, a breast cancer would use different genes than a lung cancer would because the two arise from different cell types. But even two breast cancers could employ different genes: a fast-growing breast cancer would use some genes that are distinct from those used by a slow-growing breast cancer genes that direct the cell to grow fast would be more highly used in the fast-growing cancer.

One can continue this line of thought down to the individual. Since no two people are alike, in personality or in DNA, no two cancers are genetically identical. Each cancer retains the genetic uniqueness of the affected person.

Consider It Pure Joy

So it merits repeating. We can rapidly analyze the many thousands of genes that exist in any cancer today. This incredible technology is enabling researchers to classify cancers by their genetic signatures and to determine which signatures portend a good prognosis and which indicate a significant chance that a cancer will return. Cancer signatures are also being developed to help guide the best and most effective treatment choices for any cancer.

The first clinically approved genomics test, called Oncotype DX, helps oncologists estimate the chances that an early stage, invasive breast cancer will relapse in another part of the body form metastases as well as which patients would benefit most from chemotherapy.

Breast cancers that do not involve axillary lymph nodes and that make the estrogen receptor or progesterone receptor are eligible for Oncotype DX testing. The recurrence score is also used to guide the choice of therapy, as follows: those in the low-risk range derive little benefit from chemotherapy and would typically be treated only with hormone therapy such as tamoxifen or an aromatose inhibitor, see chapter 7 , whereas those in the high-risk category derive great benefit from chemotherapy a 28 percent reduction in the risk of a cancer recurrence at ten years.

There is uncertainty, however, about how best to treat those with an intermediate risk score, which is why this group of patients is the subject of an ongoing clinical trial called TAILORx. In this study, patients with intermediate recurrence scores are randomized randomly chosen by a computer to receive either hormone therapy or chemotherapy plus hormone therapy. The goal is to determine whether chemotherapy prevents a cancer recurrence and improves survival compared to hormone therapy alone in this group of breast cancer patients.

Gene-based tests like Oncotype DX are being developed for nearly every type of cancer, with cancers of the lung, colon, and prostate furthest along. The future of cancer diagnosis will increasingly operate like 52 Diagnosis, Staging, Curability this: the pathologist will make the diagnosis, and the medical oncologist or surgeon will order genomics testing of the specimen to help determine both prognosis and the optimal treatment for that cancer.

The hope is that genomics testing will allow us to tailor cancer treatments specifically to each individual case. She has surgery to remove the mass, and the pathology shows a lymphoma. Her staging workup, treatment options, and prognosis will follow the principles established for lymphoma, not those for breast cancer. She will not have to undergo more surgery to test the lymph nodes in the armpit for cancer in a procedure termed axillary lymph node dissection; she will not need a bone scan to check for metastatic cancer affecting the bones.

These might have been done had Donna been diagnosed with breast cancer. Instead, she will undergo CT scans of the chest, abdomen, and pelvis, lymphoma-directed blood work, a bone marrow biopsy, and possibly a PET scan to stage the lymphoma fully and plan for its treatment. The type of cancer that develops depends on the specific cell type affected by the cancer process. Because every organ and gland in our body is made up of a variety of cell types, several kinds of cancer can occur in any region.

For most sites in the body, one type of cell is usually affected, resulting in the common 54 Understanding Specific Cancers types of cancer that are most often talked about. These principles will become clearer in the paragraphs that follow. Although there are hundreds of distinct types of cancer, I group them here into four main categories for ease of understanding: 1.

Carcinomas Hematologic malignancies blood and lymph cancers Sarcomas Brain tumors I encourage you to read about each type of cancer even though you may be interested in just one kind. The more you know about cancers and their properties, the better you will understand the specific cancer s you may encounter. Carcinomas Every organ in the human body is made up of a mixture of cells that cooperate to support the functions of that organ.

For example, the heart contains cardiac muscle cells that enable it to pump and nerve cells that transmit electrical signals that spark the muscle to pump in a rhythmic fashion. Another example is the breast or mammary gland, whose main function is the production of milk to sustain the newborn. Breast milk is produced by the glandular portions of the breast, composed of glandular or gland cells. The gland cells are surrounded by fatty tissue, which is made up of fat cells. The glands and fat are given structural support by fibrous tissue and are supplied with blood and nutrients by arteries, veins, and lymphatic vessels.

Normal cell diversity The diversity of cells that is present in each of our organs is represented here by the normal structure of the breast. The glands of the breast are composed of a branching system of ducts and lobules surrounded by fat.