Chemotherapy and Radiation For Dummies E-Book

Alan P. Lyss

• Herausgeber: John Wiley & Sons
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 516

Veröffentlichungsjahr: 2011

Beschreibung

An informative, compassionate guide for cancer patients and their loved ones Each year, more than 1 million people get treated for cancer, and most of these will undergo chemotherapy, radiation therapy, or both. This reassuring, optimistic guide helps people get a handle on treatment options and explains in plain English how chemotherapy and radiation therapy really work. It offers detailed advice on how to alleviate and cope with side effects-which range from hair loss to nausea to anemia-and describes how good nutrition, meditation, support groups, and other techniques and resources can help in the recovery process.

Leseprobe

Chemotherapy and Radiation For Dummies®

by Alan P. Lyss, MD and Humberto M. Fagundes, MD with Patricia Corrigan

Chemotherapy and Radiation For Dummies®

Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com

Copyright © 2005 by Wiley Publishing, Inc., Indianapolis, Indiana

Published by Wiley Publishing, Inc., Indianapolis, Indiana

Published simultaneously in Canada

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Library of Congress Control Number: 2005921459

ISBN-13: 978-0-7645-7832-8

ISBN-10: 0-7645-7832-4

Manufactured in the United States of America

10 9 8 7 6 5 4 3 2

1B/QY/QU/QV/IN

About the Authors

Alan P. Lyss, MD: Dr. Lyss is the Medical Director of the Missouri Baptist Cancer Center and the Director of the Cancer Research Program of Missouri Baptist Medical Center in St. Louis, Missouri. He is Associate Professor of Clinical Medicine at Washington University School of Medicine and is the honoree of a distinguished Alumni Scholarship Award there. Dr. Lyss also is Associate Clinical Professor at the University of Missouri School of Medicine.

Dr. Lyss is the recipient of several research grants and currently has research funding from the National Cancer Institute. His clinical and research interests are directed toward finding improved treatments for patients with cancer, including improvements in supportive care and psychosocial support. He has been actively engaged in studies directed toward the prevention of common adult cancers and improving the distribution of innovative cancer care to underserved populations, especially to those who reside in rural areas.

Humberto Fagundes, MD: A radiation oncologist, Dr. Fagundes currently holds the position of Medical Director of Radiation Oncology at Missouri Baptist Medical Center in St. Louis, Missouri. He received his training in radiation oncology at Mallinckrodt Institute of Radiology from 1988 through 1992. He was then appointed Chief Resident/Fellow having completed his training in 1993. In the fall of that year he served as Assistant Professor of Radiation Therapy at Loyola University Medical Center in Chicago. Family ties brought him back to the St. Louis area in 1994. In 1999 he arrived at Missouri Baptist Medical Center and was named Medical Director in 2001.

Dr. Fagundes has introduced several innovations at Missouri Baptist, such as 3D Conformal Radiation Therapy, IMRT (Intensity Modulated Radiation Therapy), breast and prostate brachytherapy, as well as intra-operative brachytherapy. His particular interests are in the management of breast and prostate cancers. While in a community hospital, Dr. Fagundes continues to write and publish in the field.

Dr. Fagundes has also worked with the oncology communities in South America and India, where he has assisted in the introduction and implementation of new technologies and cutting-edge treatments in radiation oncology.

Patricia Corrigan: Ms. Corrigan, who holds a B.S. in health education from Lindenwood College, is a reporter for the St. Louis Post-Dispatch, where she writes often on health and fitness. She also is the author of 10 books, including Wild Things: Untold Tales from the First Century at The Saint Louis Zoo (Virginia Publishing Company), Convertible Dreams, a collection of her Post-Dispatch Saturday columns (Virginia Publishing Company), a guide for whale watchers and six nature books for children (NorthWord Press), and a dessert cookbook (Pocketbooks).

Ms. Corrigan has written freelance articles for numerous newspapers across the country and for national magazines such as More, Ms., BBW, Radiance, Lear’s, Family Fun, Cruise Travel, and Northwest Travel and Wildlife. A popular public speaker, she addresses conferences, civic organizations, women’s organizations, and school groups. A breast cancer survivor since 1995, she is especially happy to be associated with this book!

Dedication

We dedicate this book to everyone who undergoes chemotherapy and radiation.

Safe trip!

Authors’ Acknowledgments

We would like to acknowledge the many cheerleaders in our lives, especially our tolerant families.

Also, for their assistance and unflagging enthusiasm, we also want to thank Jeanne Hanson, Mikal Belicove, Joan Friedman, Ros Hofstein, Jean Roark, Carol Riley, Stephen P. Allen, MD, Gerry Puglisi, Susan Cuddihee, and Linda and Bill Gwyn.

We are grateful for the editorial participation of Martin Raber, MD, clinical professor in GI Medical Oncology at M.D. Anderson Cancer Center in Houston.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Joan Friedman

Acquisitions Editor: Mikal E. Belicove

Technical Editor: Martin Raber, MD

Editorial Manager: Michelle Hacker

Editorial Supervisor: Carmen Krikorian

Editorial Assistants: Courtney Allen, Nadine Bell

Cover Photos: © Getty Images/Photodisc Collection

Cartoons: Rich Tennant, www.the5thwave.com

Composition

Project Coordinators: Maridee Ennis, Emily Wichlinski

Layout and Graphics: Carl Byers, Andrea Dahl, Joyce Haughey, Stephanie D. Jumper, Barry Offringa

Special Art: Illustrations by Kathryn Born, MA

Proofreaders: Leeann Harney, Jessica Kramer, Carl William Pierce, Dwight Ramsey, TECHBOOKS Production Services

Indexer: TECHBOOKS Production Services

Publishing and Editorial for Consumer Dummies

Diane Graves Steele, Vice President and Publisher, Consumer Dummies

Joyce Pepple, Acquisitions Director, Consumer Dummies

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Kelly Regan, Editorial Director, Travel

Publishing for Technology Dummies

Andy Cummings, Vice President and Publisher, Dummies Technology/General User

Composition Services

Gerry Fahey, Vice President of Production Services

Debbie Stailey, Director of Composition Services

Contents

Title

Introduction

About This Book

Conventions Used in This Book

What You Don’t Have to Read

Foolish Assumptions

How This Book Is Organized

Icons Used in This Book

Where to Go from Here

Part I : Your Journey Through Cancer Treatments: Preparing for the Trip

Chapter 1: Recognizing the Realities of Chemotherapy and Radiation

Making Peace with Your Diagnosis

Gathering Information

Shopping for Cancer Specialists

Considering Options

Exploring Virtual Chemotherapy

Trying on Radiation Therapy for Size

Sending for Help

Looking Beyond Cancer Treatments

Chapter 2: The Mutants Take Over: A Primer on Cancer

Demystifying the “C” Word

Watching the Immune System in Action

Discovering How Treatments Fight Back

Considering Risk Factors

Looking to the Future: Ongoing Research

Speaking of the “C” Word

Keeping Your Sense of Humor

Chapter 3: You Will Be Tested: What All Those Tests Show

Passing a Battery of Tests

Playing the Waiting Game

Setting the Stage for Treatment

Recognizing Symptoms of Cancer

Appreciating Early Detection

Part II : Your Choices along the Way: Making Good Ones

Chapter 4: Defining Chemotherapy: The Anticancer Drugs

Getting Some Chemotherapy Basics

Investigating Different Delivery Systems

Evaluating Your Oncologist’s Recommendation

Making the Best Choice for You

Chapter 5: Defining Radiation: A Burning Issue

Understanding Radiation Therapy

Evaluating Your Radiation Oncologist’s Recommendation

Making the Best Choice for You

Chapter 6: Setting New Standards: The Role of Clinical Trials

Grasping the Importance of Clinical Trials

Deciding Whether to Participate

Taking Part in a Clinical Trial

Feeling Good About Taking Part

Chapter 7: Getting a Second Chance: Bone Marrow Transplants

Demystifying Bone Marrow Transplants

Exploring the Types of Transplants

Searching for a Donor

Preparing for a Bone Marrow Transplant

Comparing Retrieval Methods

Undergoing the Rescue Process

Keeping an Eye Out for Post-Rescue Problems

Part III : Chemotherapy: What to Expect and How to Deal with Side Effects

Chapter 8: What to Expect During Chemotherapy: A Head-to-Toe Mouthwash

Your First Appointment: Getting the Toughest One Out of the Way

Continuing with Chemo

Asking for the Support You Need

Giving Yourself a Break

Chapter 9: Gimme a Boost: Immune and Bone Marrow Stimulants

Boning Up on Bone Marrow

Boosting the Immune System

Recognizing an Infection

Considering Supplements

Chapter 10: Coping with Serious Side Effects of Chemotherapy

Considering What’s to Come

Keeping an Eye on Kidney and Bladder Function

Combating Nausea

Facing Fatigue

Fighting Pain

Demystifying Depression

Confronting Infertility

Losing Your Hair

Chapter 11: Coping with Less Serious Side Effects of Chemotherapy

Considering What’s to Come

Battling Intestinal Disarray

Retaining Fluids

Experiencing Vision Problems

Fighting Fuzzy Thinking

Losing Interest in Food

Troubleshooting Skin and Nail Problems

Part IV : Radiation: What to Expect and How to Deal with Side Effects

Chapter 12: What to Expect During Radiation: Tattoos and Moisturizer

Your First Appointments: Getting the Toughest Ones Out of the Way

Experiencing the Real Thing

Soothing Your Skin

Making Wardrobe Adjustments

Seeking the Support You Need

Giving Yourself a Break

Chapter 13: Coping with Side Effects of Radiation Therapy

Considering What’s to Come

Fending Off Fatigue

Caring for Your Skin

Soothing Inflamed Mucous Membranes

Experiencing Diarrhea

Saying “No” to Nausea

Living with Lymphedema

Looking Out for Pneumonitis

Running to the Restroom

Watching Your White Blood Count

Dealing with Hair Loss

Recognizing Depression

Part V : Your Success Strategies: Assembling Your Support Team

Chapter 14: Your Health Professionals: Your Friends and Guides

Communicating with Your Doctors

Seeking Help from a Psychologist

Meeting Other Health Professionals

Chapter 15: Good Nutrition: Eating Right No Matter How You Feel

Welcoming New Members to the Team

Knowing When You Need Help

Catching Up on the Food Fights

Boning Up on the Benefits

Acknowledging the “A” List

Plumbing the Pitfalls of Poor Eating

Considering Problems that May Develop

Chapter 16: Meeting Spiritual Needs: Turning to Prayer and Meditation

Defining Distress

Tallying Up the Benefits of Faith

Talking about Spirituality with Your Doctors

Examining Prayer Practices

Accepting Prayers from Others

Assessing the Healing Power of Prayer

Listening to a Doctor on Spirituality

Squaring Faith with Cancer

Chapter 17: Finding a Support Group: Realizing You Are Not Alone

Determining Your Level of Interest

Defining “Group”

Locating a Group

Asking the Right Questions

Seeking One-on-One Support

Looking at the Benefits

Assessing the Risks

Helping Newcomers

Part VI : Your Future after Cancer Treatments: Looking Ahead

Chapter 18: Finishing Therapy: An End and a Beginning

Monitoring Your Health after Cancer

Coping with Long-Term Side Effects

Reducing Your Hormone Level

Working Out a Wellness Plan

Chapter 19: Dealing with Recurrence: Here We Go Again

Defining Recurrence

Redefining Survivor

Riding the Emotional Roller Coaster

Establishing a Treatment Plan

Considering Unconventional Treatments

Facing the Future, Whatever Comes

Chapter 20: Defining Yourself after Cancer: The New Normal

Looking at Life Through New Eyes

Making Semantic Decisions

Allowing for Negativity

Finding Inspiration in Amazing Recoveries

Looking at Time Differently

Protecting Yourself Emotionally

Defining Your Boundaries at Home and Work

Lightening Up

Part VII : The Part of Tens

Chapter 21: Ten Myths about Cancer

Myth #1: When You Get Cancer, You Die

Myth #2: If the Cancer Doesn’t Kill You, the Treatments Will

Myth #3: Cancer Treatments Are One-Size-Fits-All

Myth #4: You Can’t Work while You’re Having Cancer Treatments

Myth #5: It Takes Forever to Get Over Cancer Treatments

Myth #6: It’s Your Fault You Got Cancer

Myth #7: The Medical Community Suppresses Alternative Healing Methods

Myth #8: Now Your Family Will All Get Cancer

Myth #9: Cancer Always Comes Back

Myth #10: Nothing Is Ever the Same after Cancer

Chapter 22: Ten Ways for Family and Friends to Help You

Acknowledging That You Have Cancer

Giving You Time to Accept the Diagnosis

Holding You While You Cry

Making You Laugh

Seeking Help Coping from Someone Else

Asking for Specific Ways to Help You

Carrying Out Your Requests

Offering What You Are Reluctant to Ask For

Helping to Protect You

Celebrating with You

Chapter 23: Ten Things Beyond Your Control

Turning Back the Clock

Keeping the Diagnosis a Secret

Encountering an Alien Culture

Making New Friends

Experiencing Mood Swings

Facing Your Own Mortality

Suffering Power Outages

Missing Some Good Times

Choosing the Texture of Your New Hair

Receiving Help from Many Sources

Chapter 24: Ten Ways Life Will Be Better after Cancer

Cancer Goes Away

Treatments End

Fear Recedes

A Sense of Adventure Grows

Inner Strength Builds

People Matter More

Forgiveness Gains in Importance

Support Comes Naturally

The Tongue Loosens

Time Flies

Chapter 25: Ten Sources for More Information

Searching the Web

Coping with Cancer Magazine

Glossary

Introduction

You hold in your hands a cancer treatment book with bedside manner.

You can find here facts on chemotherapy and radiation — topics generally perceived as scary, and rightly so — presented in a straightforward manner and a conversational tone. We don’t overload you with medical jargon, but we do give you the information you need to have a fruitful conversation with your doctors.

Who are “we”? Fair question. “We” are a medical oncologist, a radiation oncologist, and a professional writer who just happens to be a cancer survivor. Among the three of us, we’ve accumulated quite a thorough understanding of cancer and its treatments. One of our goals is to provide you with plenty of inside information as you contemplate, begin, traverse, and end your cancer treatments.

Another of our goals is to remind you that even though you spend part of your life as a cancer patient, that part does not define who you are or restrict you as much as you may think.

About This Book

Chemotherapy and radiation are not simple topics, but this is not a dense, academic book. Instead, this is a book written in lay terms with all the material organized in an easy-to-read fashion. We cover one topic at a time in a logical sequence. You may want to start with Chapter 1 and proceed straight through the book in an orderly fashion, or you may want to skip around, reading whatever takes your fancy in any order that you choose.

If your doctor has recommended chemotherapy or radiation therapy, you may want to start with the overview of either, or go straight to a description of what each treatment may mean for you. You decide. Later, if you are curious about some other aspect of these cancer treatments, if you missed something, or if your treatment plan changes, everything you need to know will be waiting for you when you next pick up the book.

Here’s another advantage to this book: You can use it to complement the information that your doctors provide. If the details about a specific test, the description of a type of treatment, or a suggestion on how to manage a given side effect eludes you late one night or over the weekend, chances are this book can fill in the blanks until your doctor is back in the office.

Not all cancer treatment guides are created equal. On purpose, this one was developed and written to lead the pack — and to give you exactly the help you need.

Conventions Used in This Book

Some of the material in this book is a little technical and involves some medical terminology. Whenever a new word or phrase is introduced that needs to be defined, the word or phrase appears in italics and the definition is close at hand. You may think you don’t need to know these words and phrases, but your conversations with your doctors will go more smoothly if you are familiar with the terminology.

Also, all Web addresses in the text appear in a special font, called monofont, to set them apart from the rest of the text.

What You Don’t Have to Read

Text sitting next to the “Technical Stuff” icon is exactly that. You are welcome to move on if you think you already have plenty of information.

Here’s another tip: When you run across any material printed in a gray box, this is material that you may find interesting, but it’s not crucial, especially if you are a reader who prefers just the facts about chemotherapy and radiation. Skipping the sidebars will not cause you any trouble in terms of following the rest of the text.

Foolish Assumptions

We have boldly assumed that you are not a medical student, a physician, or a person considering seeking advanced training in oncology or radiation oncology. We also figure you’re probably not a contestant preparing for a TV quiz show.

No — we think you have been diagnosed with cancer and are preparing to begin either chemotherapy or radiation, or maybe both. Having cancer ushers you into a whole new world with a whole new language, so we have done our best to explain the culture and define the terms that you are likely to encounter.

On the other hand, you may be shopping for a good reference book to give to a family member or close friend facing cancer treatments. When you hand that person this book, be sure to say we think he or she is lucky to have the support of such a thoughtful person.

How This Book Is Organized

This book is divided into seven parts to help you make your way through cancer treatments.

Part I: Your Journey Through Cancer Treatments: Preparing for the Trip

This is a suggested packing list, as it were, to ease your experience as you head off to cancer treatments. Here, you find suggestions to help you choose your doctors, a brief refresher course in simple cell biology from your days in science class, and information on some of the tests you may need to schedule to help determine which treatment would be best for you.

Part II: Your Choices along the Way: Making Good Ones

When you have been diagnosed with cancer, you make a lot of important decisions in a short time after you talk with your doctor about which treatments are most likely to stop the cancer. In this part, you get an overview of chemotherapy and radiation therapy — the gold standards today in cancer treatment. Also in this part are many of the answers to questions you may have about clinical trials. And this is where you find detailed information about bone marrow and stem cell transplants.

Part III: Chemotherapy: What to Expect and How to Deal with Side Effects

We can’t literally accompany you to your first chemotherapy appointment, but we have been where you are going, and we can tell you what to expect on that day and in the days to come. You’ve probably heard about the side effects of anticancer drugs. Here, you find them described in detail, one at a time, along with practical suggestions to help you manage those that affect you.

Part IV: Radiation: What to Expect and How to Deal with Side Effects

Preparing to begin radiation therapy? In this part, we take you step by step through your setup appointment, your first dose of radiation, and the remainder of your treatment. This is also the place to look for strategies to help you manage side effects throughout treatments.

Part V: Your Success Strategies: Assembling Your Support Team

We are big fans of the idea of building a support team to call on as you go through cancer treatments. In this part, you find suggestions on how to build good relationships with medical practitioners involved in your care, as well as others you may want to add to the team, including yoga instructors, massage therapists, tai chi practitioners, fitness experts, nutritionists, and spiritual leaders. Here, too, you can decide whether a support group is right for you — and, if so, discover how to find one.

Part VI: Your Future after Cancer Treatments: Looking Ahead

Is there life after cancer? Of course, but don’t expect everything to be the same as it was before. In this part, you find an assessment of some of the long-term physical changes that may affect you, a frank discussion on recurrence, and discussions of emotional “potholes” that may exist on the road to your future. You also discover some ideas on how to make the most of every day.

Part VII: The Part of Tens

You’ve probably heard a lot about cancer, and some of what you heard may even be true! In this part, you discover the real story behind some of the myths of cancer. We also suggest ten specific things people can do to help you as you go through treatment; identify ten matters completely beyond your control; and present what we consider ten gifts from cancer, each of which will make your life after cancer more rewarding. Last of all, look for ten sources for more information about cancer.

Appendix

Cancer comes with its own vocabulary, so look here for a list of words you’re likely to hear as you go through cancer treatments.

Icons Used in This Book

Icons used throughout this book call your attention to material that may be of particular use to you.

This is the “helpful hint” icon, and many of the tips provided can save you time and energy, both physical and mental.

How can anybody possibly remember everything there is to know about cancer? This icon serves to remind you of particularly important information.

This icon is intended to set off an alarm — carefully heed any information next to it.

Sometimes, you want to know it all, and sometimes you would just as soon skip the technical stuff. Depending on where you stand, this icon will either flag you down or wave you on.

Where to Go from Here

Our foremost hope is that you go on to live a long and happy life after cancer.

This is your book — take what you need, and may it serve you well.

Part I

Your Journey Through Cancer Treatments: Preparing for the Trip

In this part . . .

Starting with a look at the new world you are entering, we provide tips on what to expect and offer suggestions on how to choose the medical professionals who will accompany you on your journey through cancer treatments. This part also brings you up to speed on what cancer is, how it attacks the body, and what tests are available to help determine the best treatment for you.

Chapter 1

Recognizing the Realities of Chemotherapy and Radiation

In This Chapter

Taking time to absorb the news

Finding your way in a new culture

Sorting out treatments and side effects

Building a support team

Changing to reflect a new perspective

You’ve been told that you have cancer. You may have seen it coming, but more likely this news came out of nowhere to frighten you and shake up your world.

Cancer! How can that be?

Here’s how: The Centers for Disease Control reports that more than 18 million new cases of cancer have been diagnosed since 1990, and the government agency estimates that at least 1.3 million new cases will be diagnosed in 2005. One out of every four Americans dies of cancer. In fact, the American Cancer Society announced in January of 2005 that cancer has surpassed heart disease as the leading cause of death for people under 85 in the United States.

On the other hand, more than ever before the words cancer and death do not necessarily belong in the same sentence. Each day brings news of improvements in screening tests and in treatments. And, happily, survival rates for cancer are at an all-time high in the United States. So, instead of spending time and energy asking “Why me?”, we encourage you to take a deep breath and get ready to begin your journey through cancer treatments.

In this chapter, we talk first about taking time to come to grips with your diagnosis. Then we offer suggestions on how to choose a doctor. Next, we present a road map of the rest of this book, where every twist and turn on your journey is clearly marked.

Making Peace with Your Diagnosis

The longest journey begins with a single step, or so an ancient Chinese proverb tells us. You have many steps in store as you make your way through the coming months. But before you take the first step, you have an important task.

Registering your emotions

“First,” says one woman we know who was diagnosed with cancer in 1997, “you scream.” She is right, even if that scream is silent. This is a logical emotional response. After all, you have never before heard the words, “You have cancer.” When you do hear these terrifying words, you may have to ask that the doctor repeat the bad news. Some people recall that on first hearing them, these words sound dim and far away. Others report that their bodies begin to tremble involuntarily. And others appear to remain stonily silent, even as their minds race. Whatever your first reaction, you need time to make peace with your diagnosis.

Taking time to process the news

More likely than not, you won’t be thinking clearly at first. You may start to tally up the people you know who have died of cancer, and you probably will wonder if you’re going to die, too. At this point, you simply don’t have enough information to know what the future holds. You may find yourself totally focused on the diagnosis, but that focus may be chaotic, with hope and fear fighting for your attention even as you try to frame important questions for your doctor.

Give yourself a break. Adjusting to the news that you have cancer takes time. Complete acceptance — if there is such a thing — won’t come in a day or a week or even a month, but gradually, you will adjust to the diagnosis. Long before that happens, you may find yourself heading into the operating room for cancer surgery or preparing for your first chemotherapy or radiation appointment. Don’t be surprised if, from time to time, you experience the same shock and fear all over again that you felt when you first heard the news.

Experiencing a range of emotions

About that recurring shock and fear: These are completely normal emotions. In fact, you likely will go through repeated periods of denial, anger, bargaining, depression, and acceptance. You may recognize these as the stages that people experience when confronting death. In this instance, you are experiencing the loss of life as you know it, the loss of good health, and the loss of feelings of immortality, so it makes sense that you experience these stages, even if you have treatable cancer.

Expect to take more than one ride on the emotional roller coaster as you move back and forth between a range of feelings. This process definitely involves taking two steps forward and one back.

Over time, you will come to recognize when your emotional well-being is at risk, and you will take comfort in knowing that a period of emotional upset most likely will be followed by a period of calm.

Telling family and friends

Early on, after you have processed the news about your diagnosis and are ready to talk about it, you likely will want to tell family members and close friends so they can make themselves available to provide emotional support — and practical help as well. Many people who are newly diagnosed also want to speak with someone who has had cancer, someone who already has been through treatments and lived to tell the tale. In fact, you may find yourself having an exceptionally keen interest in hearing these tales! If you don’t know who to call, you may want to ask your doctor if she can have a survivor get in touch with you.

This is a good time, as you begin to gather information about your diagnosis and potential treatments, to talk with someone who has been there. That said, every individual — for a variety of reasons — experiences cancer and the treatments differently, so remember that the details of someone else’s story may not apply to you at all.

You also may want to speak with your boss, as your work schedule and obligations may be directly affected by your treatments. Who else needs to know? That depends on what type of person you are: The type who needs to tell as many people as possible, or the type who wants to tell as few people as possible. You know yourself best and will act accordingly.

Gathering Information

Knowledge is power! In Part I of this book, we help you get acquainted with the facts about cancer — which actually is more than 100 different diseases — and we describe the tests available to help determine the best treatment for you.

Up until the moment of your diagnosis, you may not have known much about cancer — what it is or how it works (which we discuss in Chapter 2). Now, of course, you want to find out more so you can have an idea about what the coming year holds for you. That’s a good, positive approach. A poster passed among people going through cancer treatments reads, “When you know the facts, you can make a plan.”

Before you make your plan, your doctor will provide you with specific information about your cancer and recommend appropriate treatments. A number of sources can supply general information, including

This book

Other books

Free booklets published by health agencies

Web sites (see Chapter 25 for some recommendations)

Newspaper and magazine articles

Some people whip through every bit of reading material available on the type of cancer that they have. Others confine their reading to material that specifically relates to the immediate situation. (We think the latter is a wiser approach.)

You don’t have to learn enough to earn a degree in cancer, and you don’t have to mold yourself into the perfect patient. Your job is to educate yourself about your specific cancer, get through your treatment, and get on with your life.

Shopping for Cancer Specialists

When we say that it is your job to educate yourself about your cancer and your treatments, please don’t think that the responsibility rests entirely on your shoulders. You will have help — a lot of it. Some people first learn that they have cancer from a surgeon or another specialist. When it comes time to do the tests that determine the extent of the cancer — and you can read more about these tests and how to assess your results in Chapter 3 — you need to see a medical oncologist, a medical specialist who treats cancer. If radiation therapy is recommended for you, your medical oncologist will refer you to a radiation oncologist, a medical specialist who treats cancer patients with radiation therapy.

Finding good doctors

These cancer specialists and other doctors along the way will direct your care and serve as important members of your support team. In Chapter 14, we offer some suggestions for building good relationships with your doctors. Of course, before you can build relationships, you have to choose the doctors. A number of factors come into play, including

The type of cancer you have

Your age

Your general health

The number of doctors or medical centers available where you live

Your insurance coverage — or lack of it

Obviously, you want the best care that you can get. Given the state of healthcare today, some choices will be up to you and some will not, no matter what your specific circumstances. In any case, you most likely don’t want to choose a doctor simply by opening the telephone book and picking one with an office close to your home.

Here are some sources to help you choose your cancer doctors:

Your primary care doctor (internist or family doctor) or surgeon

The referral department of a large medical center

Your local medical society

Professional medical associations

A relative or friend who has personal experience with cancer

When you have a name or two in hand, make an appointment for a consultation. Ask the receptionist what you need to do to make any test results, x-rays, or surgical reports available to the doctor. After that information is gathered, sit down with the doctor and hear what he has to say.

If you have a friend or family member who can accompany you for your first visit to the oncologist, take advantage of that help. Another pair of oars could be helpful as you navigate these unfamiliar waters!

Afterwards, think about what you heard. Think about how you felt while you were hearing it. Think about spending the next several months carrying out a treatment plan under the direction of this particular doctor. If you have found a good fit for you, then proceed.

If for any reason you’re not satisfied with what you hear, or you are uncomfortable about how you feel, make an appointment with the next doctor on your list.

Second opinions are common in oncology, and most oncologists expect and encourage you to seek one, just so you are comfortable as you proceed with your treatment. A good closing question with the oncologist is “Who would you go to see if you were me and you wanted to be sure that you were on the right path?” If you think that the doctor is uncomfortable with this question, move on!

Preparing to embrace a new culture

After you have chosen a doctor, you quickly will become aware that not only are you in the hands of a new medical professional, but you are entering what may seem like an entirely new culture full of people who speak a new language. (For a crash course in the language, see the glossary in the appendix.) There is much to learn about your particular cancer, of course, but that is just the beginning.

What’s next?

Tests to take

Treatments to undergo

Side effects to endure

Strategies to implement to manage those side effects

More specifically, just to give you a few examples, you will find yourself wondering about the following:

Your blood cell count

Survival statistics

How radiation works

Long-term effects of chemotherapy

How to avoid nausea

Where to buy a wig

Long-term effects of radiation

How to care for your skin

Clinical trials of new and (potentially) better treatments

And that’s just part of your new culture!

Sound confusing? That’s why you have this book. We walk you through every step. But first, we have some advice. While you are learning the new language and sorting out your place in the new culture, you also want to keep your eye on the future.

When you have a treatment plan in place, grab a calendar and mark on it the proposed schedule for your chemotherapy and/or radiation treatments. Seeing exactly how long all this will take also allows you to see all those dates left on the calendar after treatment, when your life will once again be your own.

Considering Options

Part II of this book is all about options — treatment options, choices regarding delivery of treatments, and the possibility of participating in a clinical trial. Here too you can find complete information on bone marrow and stem cell transplants.

Understanding chemotherapy and radiation

Medical science is currently learning about and testing some ways to turn off the misguided cells that undergo a mutation and get busy transforming into cancer cells that attack the body. Today, chemotherapy and radiation are the time-tested standard treatments for most cancers. Many people diagnosed with cancer have both treatments, sometimes concurrently and sometimes one after the other. Some people have just one.

Basically, most chemotherapy is systemic; it involves any number of anticancer drugs that sweep through every cell in the body. In contrast, most radiation therapy is local or regional, meaning treatments are aimed specifically at the site of a tumor or at nearby places the tumor may have spread.

How do these two treatments work? Check out Chapter 4 for details on chemotherapy. We discuss more than half a dozen different types of anticancer drugs. Also, though most chemotherapy drugs are delivered directly into a vein, some are injected into a muscle or a tumor. Some chemotherapy drugs even come in pill form. Who knew? Well, if you didn’t, see Chapter 4.

Looking for the inside story on radiation therapy? In Chapter 5, you find out about the two main types of radiation therapy — external beam radiation and brachytherapy — as well as some additional types of treatment.

Sometimes your doctors provide you with information and allow you to decide which treatment to pursue. Don’t hesitate to ask what choice the doctor would make for a family member, as that may help you with your decision.

In any case, carefully evaluate the benefits and risks of all your treatment options. The decisions you make today may well affect the rest of your life.

Treatments for life-threatening diseases often carry long-term physical costs, such as decreased organ function now or increased risk for other diseases ten years down the road. Paying the price is always easier if you are well-informed before you begin treatments.

Looking into clinical trials

One important option to consider is whether to participate in a clinical trial. These trials, or tests, of new treatments or new combinations of tested treatments lead the way in cancer research. That means the participants in clinical trials are on the cutting edge of medical science. We spell out the pros and cons in Chapter 6, where you also find questions you may want to ask your doctors, as well as reports from participants who have chosen to be part of clinical trials.

Taking a chance on a transplant

Sometimes, in cases where cancer does not respond completely and permanently to standard treatments, doctors recommend bone marrow and stem cell transplants. This is serious stuff, medical miracles of the first order — or so we hear from individuals whose lives have been saved as a result of a transplant. Chapter 7 tells you everything you need to know about the purpose of transplants, the different types, how transplants are done, what to expect afterwards, and how to prepare yourself emotionally.

Exploring Virtual Chemotherapy

There is nothing like the real thing, of course, but in Part III of this book, you come as close to experiencing chemotherapy and all the side effects as you can without actually feeling the powerful anticancer drugs drip into your body.

Getting started on chemo

That first day of chemo, as fearful as it seems in the anticipation, most often doesn’t turn out to be as bad as you may expect. In Chapter 8, we take you step by step through your first appointment. In this book, we say repeatedly that you don’t have to go through cancer treatments alone. Here, we go so far as to recommend what to eat for breakfast and what to wear! Later in the chapter, we clear up any misconceptions about when to take anti-nausea medication. You also find suggestions on how to get the support you need from family and friends as you go through treatments.

Taking care of your immune system

Because anticancer drugs kill healthy cells as well as diseased cells, you are particularly prone to infection while undergoing chemotherapy. That’s bad, because you simply won’t have the resources to fight off bacteria that means to do you harm. The good news is that doctors can prescribe immune and bone marrow stimulants to help boost your immune system and help your body fend off infections. In addition to medical interventions, there are plenty of preventative measures that you can take to help protect yourself. Read all about it in Chapter 9.

Signing up for side effects

Even people who have never known anyone diagnosed with cancer seem to know a complete litany of the side effects that accompany this powerful head-to-toe therapy. Never mind that many people taking anticancer drugs are troubled by just a few side effects — and some of those to a limited degree. Everybody wants to get into the act!

In Chapters 10 and 11, you can find details about the serious and not-so- serious side effects of chemotherapy. Here are just some of the side effects we cover:

Nausea

Fatigue

Neuropathy (nerve damage)

Mouth and throat sores

Depression

Infertility

Temporary hair loss

Before you panic and assume that you will experience every possible side effect known to result from chemotherapy, we want to say something that we say often in this book, simply because it’s comforting to hear.

Every person experiences cancer treatments differently, but no one person is likely to be troubled with every side effect from any one treatment.

No matter which specific side effects you must endure, in this book you find plenty of practical suggestions on how to manage them.

Trying on Radiation Therapy for Size

True to the title of this book, detailed information on what to expect from radiation therapy follows just after we inform you about what to expect from chemotherapy. That’s what Part IV is for.

Getting set up for the first treatment

Ask about your first treatment — and in Chapter 12, we answer. You can read all about how radiation therapy is devised specifically for your body. You discover that undressing for the therapy takes longer than the therapy itself. And, we make suggestions about how to care for your skin. If you are looking for ideas on how to get the support you need from family and friends, we provide them here.

Managing side effects

Contrary to popular opinion, people who undergo radiation therapy are every bit as subject to side effects as people who undergo chemotherapy.

Just because Chapter 13 provides details on a long list of side effects, this does not mean that you will experience every last one.

Here are some of the typical side effects from radiation therapy that are described in this chapter:

Fatigue

Reddened skin

Inflamed mucous membranes

Diarrhea

Nausea

Lymphedema (swelling of an arm or leg because of fluid accumulation)

Permanent hair loss

Depression

We don’t simply list possible side effects and then leave you wondering what to do. Plenty of practical suggestions on how to manage those side effects also are included in Chapter 13.

Sending for Help

A recurrent theme in this book is the importance of putting together a support team to help you get through cancer treatments. Some teams are small — tight circles of medical professionals and family members. Other teams may be much larger and include all manner of healthcare professionals, spiritual advisors, and members of support groups. We take a look at all these possibilities in detail in Part V. Regardless of the size of your team or whether you all choose to wear matching T-shirts or baseball caps, having a support team is an important success strategy.

Making room on the team bus

We suggest in Chapter 14 that you let the doctors sit at the front of the team bus, right behind your immediate family and dearest friends. Who comes next? Perhaps a psychologist, if you think you would benefit from that type of help. Next, we propose that you consider looking at a number of complementary therapies that may help you reduce stress as you go through treatments. Practitioners who provide these therapies include

Massage therapists

Yoga teachers

Reiki practitioners

Tai chi instructors

Meditation instructors

Fitness experts

Now, you may be interested in working with only one or two of these individuals — you may not have the time, energy, or funds to take on any more. We encourage you to do that.

Let’s face it: Cancer increases stress at both emotional and physical levels. Sometimes, a little body work from a certified practitioner is just what the doctor ordered.

Practicing good nutrition

Both chemotherapy and radiation therapy can cause changes in your eating habits, for a variety of reasons. In some cases, the treatment itself is responsible. In others, fatigue from the treatments can leave you too tired to eat. That’s bad, because good nutrition is especially important during cancer treatments. Here are some reasons why:

Eating well helps you keep your energy up.

Good nutrition helps you manage side effects.

A healthy diet can help your body fend off infection.

In Chapter 15, we talk about the importance of good nutrition and even suggest that you may want to add a registered dietitian to your support team.

If you opt not to do that, we make recommendations for a nutritious diet and bring you up to speed on the latest scientific thinking on protein, carbohydrates, fats, vitamins, minerals, and fluids — at least in regard to nutrition during cancer treatments. We also outline for you exactly what nutritional effects specific cancer treatments may have on your body.

Tending to your spirit

Making room in your life for a cancer diagnosis almost always also means asking yourself some of the really big questions — questions most often left to philosophers and spiritual leaders. Some of these questions include

Who am I?

Why am I here?

What is my purpose?

Why did I get cancer?

Will cancer kill me?

What is the point of living in a world where there is cancer?

These questions can lead to a great deal of stress, which can evolve into losing the will to go on or even to a complete loss of faith in the future. This is known as spiritual distress.

Who do you call in this situation? In Chapter 16, we talk about faith and make suggestions on how to bring up this topic with your doctors. We also talk about prayer and meditation as ways to reduce spiritual distress. And we recommend that you add a spiritual leader to your support team if you are so inclined.

Finding support from strangers

Sometimes, people going through cancer treatments find that their daily concerns, complaints, and fears may wear out some of the “inner circle” members of the support team. Sometimes, you can find a certain freedom and acceptance from a support group that can’t be found anywhere else. Is a support group right for you? Have a look at Chapter 17, where we can help you decide.

In that same chapter, you discover that support can come from many or one, and that you can meet at a hospital, in a church, in a freestanding community center — or in your own home, sitting at your computer. We also review the benefits of being part of a support group, as well as the risks.

Looking Beyond Cancer Treatments

When you’re in the middle of chemotherapy or radiation treatments, sometimes it seems that this particular journey will never end. It will, of course, and in Part VI, you discover what to expect when that happens. As at the end of any meaningful road, you’re likely to find several forks. In this case, you may want to explore lingering physical side effects of cancer treatments, the possibility of recurrence, and some emotional adjustments that are often required after treatments are complete.

Beginning anew

Don’t for a minute expect that you never need darken your doctor’s door after the last of your cancer treatments. On the contrary, you will be carefully monitored for years to come. In time, you’ll even appreciate that fact.

In Chapter 18, you find out what to expect in terms of follow-up care — regular checkups and periodic screening tests — and you can look over a list of long-term side effects that may or may not trouble you. That list includes such physical problems as the following:

Fatigue

Pain

Lymphedema

Oral problems

Bladder and bowel problems

Early menopause

Infertility or impotence

Also in Chapter 18, we propose that you craft a personal wellness plan to see you through the years to come.

Returning to square one

Some people finish cancer treatments and never have to confront this particular disease again. In Chapter 19, you get an idea of what to expect if that’s not the case — if cancer recurs months or years after treatments end. If you’re tempted to avoid this chapter because you expect only the worst, think again.

In many cases, a recurrence can be treated as a flare-up, and cancer can be considered as a chronic disease.

We lay out a plan of action in Chapter 19, should your cancer recur, and we also explain several reasons why the second time around may not be as trying as the first. If recurrence is as bad, or even worse, look here for information on palliative care and an explanation of the mission of hospice.

Making peace with a new you

After cancer, nothing is ever really the same again. Even if you are not troubled with long-term physical side effects as a result of treatment and even if your cancer never comes back, you’ll likely find that you are different emotionally and that your standard mode of operating in the world has changed. Read all about that fact in Chapter 20, where we endeavor to help you define yourself anew after cancer.

This is the time that you get to decide all over again who to be, what to say about yourself, and how to make changes in your life that reflect your new perspective on the gift of time. Here, too, are tips on how to protect yourself as you head boldly into your brave new world.

Chapter 2

The Mutants Take Over: A Primer on Cancer

In This Chapter

Acknowledging the power of the word cancer

Gaining a basic understanding of cancer

Discovering how cancer works in the body

Recognizing risk factors for cancer

Talking about your cancer

Cancer is a loaded word if ever there was one — a word incapable of tiptoeing into a conversation. Instead, the word cancer storms in, attracting attention much like an oversized neon sign, every letter blinking in brightest red. No doubt about it, cancer is a word that, when spoken aloud, most often overrides just about any other topic.

The word sounds even more urgent if the cancer is yours. When confronted on a personal basis, cancer most often evokes fear. That fear is completely normal. But understand that cancer is not some vicious, drooling alien life form or an enraged, badly dressed ogre in seven-league boots tromping through the countryside of your life.

Cancer is a disease — more accurately, a group of diseases — and every person’s body carries within it the possibility of developing cancer.

Cancer also is a disease on the run. Due to the development of more sophisticated detection methods and improved courses of treatment, the number of people surviving cancer in the United States has more than tripled over the past 30 years — so says the National Cancer Institute and the Centers for Disease Control and Prevention (see Figure 2-1).

Figure 2-1: People today are living longer than ever after a diagnosis of cancer.

Source: National Cancer Institute and the Centers for Disease Control and Prevention

You can say so, too — it will make you feel better.

In this chapter, you find out what cancer is, what it isn’t, and how chemo-therapy and radiation work to defeat cancer.

Demystifying the “C” Word

The origin of the word cancer is as comical as the connotation is scary.

Studying cancers of the breast, uterus, stomach, and skin in the fifth century, Hippocrates observed that a cancerous tumor (see Figure 2-2) has a hard center with “claw-like projections” — a shape similar to a common crustacean. The good doctor named the disease karkinos or karkinoma, the Greek word for crab, giving us carcinoma. The Latin version of the Greek word is cancer.

No wonder cancer makes people crabby!

Hippocrates is, of course, the same Greek physician who gave his name to that famous oath that physicians take upon graduation from medical school.

Figure 2-2: A cancer cell models its “claw-like” projections.

Understanding how cancer develops

Just what is cancer?

The disease originates at the cellular level. Cells, you may recall from biology class, grow and divide to make sure that you have all the cells you need when you need them to maintain a healthy body. As you read this, some 10 million of your cells are busy dividing. This is normal.

Usually, cell division is an orderly process, with cells growing, maturing, and then dying off as new cells take their place. Sometimes, for reasons not entirely understood, this routine is interrupted. A single cell that has undergone a mutation — either a spontaneous change as a result of a natural incident or one resulting from exposure to a carcinogen, or cancer-causing agent — begins to reproduce and keeps at it, without stopping. These new cells, which never reach maturity, form a growth or mass of tissue, and that mass is called a tumor.

Tumors come in two types: benign (noncancerous) and malignant:

Generally, benign tumors stay put and do not spread to other parts of the body. If a benign tumor is surgically removed, it usually does not come back.

Malignant tumors, on the other hand, contain abnormal cells that continue to divide. Sometimes these cells invade tissue or organs nearby and try to destroy the healthy cells. Sometimes cancerous cells enter the bloodstream or the lymphatic system. When that happens, the cancer cells can spread to sites in the body distant from the site at which the cancer originated. If it spreads, the cancer is termed metastatic — more about this topic in the upcoming section “Differentiating among tumors.”

What causes cancer?

If only we knew!

Well, actually we know the culprit for some people: genes. As we discuss later in this chapter (see the section “Considering Risk Factors”), about 10 percent of the people who get cancer get it because of abnormalities in their genes. Lots of research is underway to try to pinpoint these abnormalities and find ways to deal with them even before cancer develops.

But unless late-breaking news (reported just after this book went to press) has revealed precisely what it is in our genes that causes cell division to go out of control, for the majority of cancers, no one yet knows exactly why the switch gets stuck when a particular cell turns “on.”

Over time, plenty of factors have taken the blame. Some of them, considered identified risk factors, include smoking, an unhealthy diet, and unprotected exposure to the sun’s rays. We talk more about these factors later in this chapter. Electromagnetic fields (think cellphones) also have taken the rap, but to date, no conclusive scientific evidence supports the claim. Some rumors about things that cause cancer, such as tight underwired bras and antiperspirants, are just funny. These rumors have no basis in fact, much like the old myths that claimed illness was caused by the brisk night air or excessive personal hygiene.

No one would dispute that having cancer causes stress, but to date there is no evidence that stress is directly responsible for causing cancer. The National Cancer Institute reports that scientists do know that “many types of stress activate the body’s endocrine (hormone) system, which in turn can cause changes in the immune system, the body’s defense against infection and disease (including cancer).” However, there is no scientific proof that stress-induced changes in the immune system directly cause cancer.

In seeking a place to lay blame for cancer, some people have come to believe that the tragic loss of a spouse or loved one may cause the disease. Not so, says the National Cancer Institute: “Most cancers have been developing for many years and are diagnosed only after they have been growing in the body for a long time (from 2 to 30 years). This fact argues against an association between the death of a loved one and the triggering of cancer.” Again, the Institute reports that “although studies have shown that stress factors alter the way the immune system functions, they have not provided scientific evidence of a direct cause-and-effect relationship between these immune system changes and the development of cancer.”

Research, of course, continues.

Listing the types of cancer

Doctors do know that cancer actually is many different diseases, each one complex in its own way. Here, with a nod to the order preferred by the Abramson Cancer Center at the University of Pennsylvania, is a list of some of the different types of cancer. Keep in mind that each type of cancer also has subtypes.

Bone cancers

Brain tumors

Breast cancers

Endocrine system cancers

Gastrointestinal cancers

Gynecologic cancers

Head and neck cancers

Leukemia

Lung cancers

Lymphomas

Multiple myeloma

Pediatric cancers

Penile cancer

Prostate cancer

Sarcomas

Skin cancers

Testicular cancer

Thyroid cancer

Urinary tract cancers

Here’s something else that doctors know for certain: Cancer is not contagious. You didn’t “catch” it from anyone else, and your family and friends can’t get it from you.

Differentiating among tumors

The types of cancer listed in the previous section are named for common sites where various cancers originate. Many of these cancers may spread to other sites — they may metastasize or disseminate to other organs. For example, a breast cancer may spread to the lungs, bones, or brain.

If several organs are affected by cancer when you are diagnosed, a pathologist