Cancer – there its out, that big scary word that stops most people from hearing anything else a doctor says. As a working family doctor, I have dealt with many faces of this disease. From young to old, it takes all comers without any prejudice. But what has really gotten me thinking about this blog is how few of my patients, or even family members for that matter, have any kind of true understanding to what “Cancer” is…
So in a nutshell…
People are made of organs and organs are made of cells. Those cells have a certain lifespan programmed into them, and when something happens either from external stimulus i.e.smoking/radiation/asbestosis exposure or internal cell reasons i.e genetics any cell in your body can forget how to die. Basically, anything that may cause a normal body cell to develop abnormally potentially can cause cancer. When this preprogrammed cell death fails to happen a cancer cell is made. Now this is actually thought to happen all the time in our bodies, so why don’t more people have cancer? Because our body has immune cells that go around and fight off these altered cells. When the cancer cells (the cells that have forgotten when to die) overtake the immune system and keep growing, those growing groups of cells are now a a cancerous tumor.
There are many terms that doctors use to describe cancer and tumors: carcinoma, sarcoma, leukemia, malignent, metastatic… and each one has a very different meaning.
Carcinoma: Cancer that begins in the skin or in tissues that line or cover body organs
Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue
Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood
Lymphoma/Myeloma: Cancers that begin in the cells of the immune system
Metastatic: Cancer that has sread either by lymph nodes or blood from its original site
Malignent: Another medical word for cancer
The most commen question I get in the office is – “Doc, I want a blood test to tell me if I have cancer…” Given the about explaination you can see the problem in this. There is no one blood test for eye cells, brain cells, liver cells, and gut cells. There are certain tumor markers for certain types of cancer, like CEA (Carcinoembryonic Antigen) which is present in Large Colon Cancers, some ovarian cancers, some pancreatic cancers, some breast cancers, and some lung cancers. But this test would be negative in a patient with Melanoma (an aggressive form of skin cancer).
So, what are the most commen types of cancers that affect us here in the U.S.?
Cancer type Estimated new cases Estimated deaths
Bladder 70,530 14,680
Breast 207,090 39,840
Breast(male) 1,970 390
Colon&rectal 142,570 51,370
Endometrial 43,470 7,950
Kidney 53,581 11,997
Leukemia 43,050 21,840
Lung 222,520 157,300
Melanoma 68,130 8,700
Non-Hodgkin lymphoma 65,540 20,210
Pancreatic 43,140 36,800
Prostate 217,730 32,050
Thyroid 44,670 1,690
The three most common cancers in men, women and children in the U.S. are as follows:
•Men: Prostate, lung, and colorectal
•Women: Breast, colorectal, and lung
•Children: Leukemia, brain tumors, and lymphoma
Cancer affects us all. It has no preferance to race, sex, or age. It will affect, sicken, and sometimes kill the very young to the very old. I have seen it do all this and more.
What I hoped to provide in this article is simple commen sense terms to exlpain what is often a scarey and life altering diagnosis.
If you don’t understand what your doctor told you, ask again, and keep asking until you do. Don’t agree to test you don’t understand. It is your body and you need to know what the risk is and potential benifit from each and every test or treatment that anyone wants to run on you.
And lastly, sometimes it is the bitter truth that Cancer kills. Don’t be afraid to ask for help with spritual counseling whatever your faith may be. Make sure you understand what kind of treatment odds you are dealing with from the doctors. So many times as a family doctor, I get the letter from the Oncologist explaining the palliative therapy (therapy to just make symptoms better not to treat or cure the disease) that my patient is in, and then will see that patient who tells me that the cancer doc says it looks good for them. I don’t think anyone is telling falsehoods, I think that there is a lot of selective hearing that goes on when talking about cancer. And even more selective hearing happens, when a doctor starts talking about potential end of life.
Never ever be afraid of big medical terms, sometimes you may find that the doctor is just as uncomfortable with talking about cancer as you are. My personal losses with this disease are two of the best grandparents you could ever have, and watching them face this illness in two very different ways and still die still hurts. I can see the faces of the patients that I have lost to this illness, and it makes me angry, but then it also makes me want to make sure that my patients understand to the best of their ability what they are facing.
Overall, I think one of the biggest downfalls of my profession is doctors spend 8 years or more learning to talk in arcacic terms and in language way above the average patients understanding. Then, when we as MD’s are out of school, we forget that not everyone talks like we do.
Case in point… I was giving a community talk on heart disease and the Cardiolgist that was talking with me got ask to explain Congestive Heart Failure. He looked at his watch and said there is no possible way to explain that in the 5 minutes we have left and ask for the next question. Seeing the womens crestfallen face, I ask the cardiologist if I could try to explain heart failure to her. He looked at me funny and said to try. I did it in 4 words… “your pump (heart) don’t work”. He was astounded and she understood. The Cardiologist later told me that he never thought to take such a simple approach to the explaination.
So, if God forbid, you or a love one ever face this terrible disease in any form, I hope this will help. Remember that it is OK to be overwhelmed when you are first told and your doctor should realize that you may need to hear this shocking news more than once. Make sure you understand what you are risking and gaining by various test and treatments, and make sure that you understand what your doctors treatment goal is. Often doctors and patients are worlds apart on this, i.e treating for a cure verses treating for remission of symptoms (palliation). Make sure you understand the diagnosis, write it down if you have to. And lastly, remember that your doctor brings their past into this as well, and may have as hard of time with this diagnosis as you do.