Cancer: Frequently Asked Questions
What is cancer?
Cancer is what happens when a group of cells grows uncontrollably and in an abnormal
and disorderly way. It is really a result of what happens when, for reasons that are
only partly understood, the normal growth-control mechanisms fail. Cancer cells have
two properties that make them dangerous: They can invade into neighboring tissues,
and they can spread to distant areas of the body, forming secondary tumors or metastases.
What causes cancer?
Two types of factors contribute to the cause of cancer.
One is a tendency or predisposition to develop cancer; the other is exposure to the
triggers that start it off (such as cigarettes, environmental toxins, sun exposure,
or liver damage, for example).
Why do some people get cancer and not others?
In a few cancers (such as retinoblastoma) and in a small proportion of the more common
cancers (such as a small proportion of breast and ovarian cancers), there seems to
be an inherited factor that we can (partly) identify. In most cancers, we assume that
a person’s cells have a low threshold for becoming malignant, and thus that he or
she will develop a cancer with relatively less prompting by a trigger (such as cigarettes
or the sun) than another person whose cells have a higher threshold and who may be
able to tolerate more exposure to a trigger without developing a cancer.
Is there an epidemic of cancer?
Cancer is common, but it's not really an epidemic. An epidemic means a very rapid
increase in the amount of the disease, and in most cancers there is no real change.
In some cancers (such as stomach) there has been a decrease, and in some cancers (such
as breast) there has been a small, steady increase, which may be partly accounted
for by better diagnosis. There is an epidemic of discussion and awareness (thank goodness),
so that at last people are talking about cancer, whereas until recently it had been
a taboo subject.
Do we get cancer from what we eat?
Yes and no! The high-fat, low-fiber diet common in developed countries may play a
role in about a third of all cancers (though we don’t know this for certain yet).
There are, however, no toxins or chemicals in modern foods that are proven to cause
cancer; in fact, the opposite is true. For example, the fact that cancer of the stomach
is becoming less common may be because of the way we preserve foods and prevent bacterial
decomposition of what we eat.
Are chemicals and pollutants causing cancer?
In a very small proportion of special cases only. In certain occupations, prolonged
exposure to a few identified chemicals may cause certain (rare) kinds of cancers.
Nowadays almost all of these substances have been identified and are regulated.
Does cigarette smoke really cause cancer?
Yes. Cigarettes cause the vast majority of cancers of the lung and are a major factor
in cancers of the bladder, pancreas, mouth, larynx, esophagus, and kidney.
Can cancer be prevented?
We think a lot of it can. The established preventive methods (including refraining
from smoking, avoiding sun damage, sensible sexual behavior, eating a high-fiber,
low-fat diet, having regular Pap tests) would reduce the incidence of cancer. It's
important to note that many people who develop cancer don't have any known risk factors. But
we could probably prevent more if we knew more, so research is very active in this
Why does the diagnosis seem to be so delayed in so many cases?
Cancer cells can multiply to produce literally billions of cells before a tumor becomes
big enough to detect. That is why prevention and some methods of screening are so
Why isn’t there a simple, universal test for cancer?
Because cancer cells are very similar to normal cells, and a cancer begins with a
very small number of cells. In a small number of cancers, certain tests can detect
early changes: the best example is cancer of the cervix (the Pap test).
Why do people with the same cancer get different treatment and have different problems?
A lot depends on the stage of the disease and on the particular individual. For instance,
in breast cancer with involved lymph nodes, if you are postmenopausal the best treatment
may be a hormone tablet; if you are premenopausal it may be chemotherapy.
Does conventional treatment work?
In many cases, yes. Surgery is an often successful conventional treatment, as are
radiotherapy (after or instead of surgery) and chemotherapy. In addition, conventional
treatment can produce remissions in a proportion of cases when cure is not possible.
So in some cases it works, and in other cases it does not. Your doctor will be able
to explain whether the chance of it working in your own case is high, low, or in-between.
That is why the discussions you have with your doctor about your particular case are
Why is the treatment so awful?
Many treatments are very well-tolerated, but treatment is often so awful mostly because
cancer cells are only slightly different from normal cells. In this respect, cancers
are totally different from, say, bacterial infections such as pneumonia or tuberculosis.
Because bacteria are completely different from our body’s cells, antibiotics can kill
them and not affect us very much. But because cancer cells are very like our normal
cells, in order to kill them we (usually) risk doing considerable damage to normal
cells or tissues.
Can fatigue be prevented?
Fatigue can't be prevented because the exact cause of fatigue is not always known.
However, you can decrease the effect of fatigue, such as conserving energy. If your
fatigue is related to anemia (low red blood cell count), there are ways to raise your
level and relieve fatigue. See the information in the fatigue topic zone, and talk
with your nurse or doctor so that he or she can help you to manage fatigue.
I am going to start radiation next week. What should I expect, and what can I do to
decrease the fatigue?
Fatigue related to radiation treatments usually starts about the second or third week
of treatment, and may continue for up to three months or longer afterwards. It is
important to take good care of yourself. This means eating a well-balanced diet, drinking
lots of fluid, sleeping well at night, and doing exercise as tolerated, such as walking
regularly. Once you start feeling fatigued, then you should match your activity to
how you feel. You should identify the activities or tasks that you have to do, and
ask someone else to do the other tasks.
First, if you are driving yourself to your radiation treatments, see if someone else
can drive you to your radiation treatments when you start feeling tired.
Second, try keeping a diary of how you feel, what makes you feel more energetic, what
makes you feel more tired, and avoid the more tiring activities. Rate the activities
using a simple scale, such as on a scale of 0 (full of energy) to 10 (absolutely exhausted,
Third, talk with your doctor or nurse about problems that arise, or if your fatigue
How does fatigue affect a person?
Fatigue affects people differently. In addition, there are various degrees of fatigue.
Some people may find that they are unable to do simple things that they used to do,
such as climbing stairs without stopping or holding onto the handrail. Others may
have trouble standing up in the shower, and get too tired, so a shower chair is helpful.
Changes in mental processes can happen, and cause “fuzzy thinking.” It may be hard
to concentrate or focus on things, such as reading or watching television. Visiting
with family, cooking, or other activities that you used to enjoy before starting cancer
treatment may now be too exhausting. However, there are tips to help conserve your
energy for the activities that are important to you.
How can I ask my family to help me?
This may be one of the hardest things to do. Most family members want to help and
are just waiting to do something. Often they feel helpless, and afraid to ask if they
can help. By being very specific about what you would like them to do, it will make
it much easier for them to help. Sometimes, a family meeting is a good way to tell
family what is going on, and to organize the tasks and activities. A family meeting
may also be helpful when family members may not understand that fatigue is a real
problem related to cancer and its treatment. Your doctor, nurse, or a social worker
can help with this, too.
I’m taking interferon therapy, and am so tired. What can I do?
Fatigue is very common with interferon alfa treatment as well as from cancer. Usually
a full assessment is done to make sure that other treatable causes aren’t overlooked,
like hypothyroidism (too little thyroid hormone), anemia (decreased red blood cell
count), depression, hypoglycemia (low blood sugar) or dehydration (having too little
fluid in the body). Things that have helped other people receiving interferon who
get fatigue: distraction (daydreaming, laughter, meditation, prayer, reading, soft
music, soaking in the tub, watching TV, writing); saving energy (avoiding exertion,
getting extra sleep or taking a quick nap, relaxing, resting or sitting quietly, planning
activities, slowing down); using energy (exercise, swimming, walking); medical treatments
(blood transfusion, pain control); other (eating food and drinking ice water).
When should I call the nurse or doctor about my fatigue?
You should call your nurse or doctor if any of the following occur:
Lose your balance
Have trouble sitting, standing, or walking
Sleep all the time
Can’t sleep at night
All of a sudden feel much more fatigued
Need help talking with your family about your feelings or needs
Any new problem that you need help with
Is fatigue a real symptom?
Yes, fatigue is a real symptom. Fatigue can lead to a decrease in quality of life.
Factors, such as treatment, anemia (low red blood cell count), stress, difficulty
sleeping, and poor nutrition can all add to fatigue. Still, since no one else can
see your fatigue, it's common to question yourself about it. Don't. Fatigue is often
a real part of cancer and its treatment.
How can I get the best from my doctor?
Doctor-patient relationships are similar in some respects to marriages: some are good
and some are bad, and a lot depends on the people involved. The key to getting the
best from your medical team is to present your problems as clearly and accurately
as you can and clarify exactly what it is you want to know and what you need.
Why are we all so frightened of cancer?
Probably because so many of the other major threats to our health have faded somewhat.
Until the 1940s we used to be afraid of syphilis and tuberculosis; before that it
was cholera and smallpox. Currently, cancer and infectious diseases are occupying
the roles of humankind’s bogeyman diseases. Cancer has not changed very much, but
our perception of it has. In fact, the prevention and treatment of cancer has never
been as promising as it is today.
Can attitudes or stress cause cancer?
Not as far as we know. In fact, the idea that the cancer “personality” or a bad attitude
contributes to the cause of cancer may be part of the ancient human habit of blaming
the patient for the disease.
Can a change in diet alter the course of cancer?
Again, not as far as we know. Many cancer centers are currently involved in finding
out whether a certain diet can alter the course of cancer in some selected early cases.
There is no evidence, however, that diet supplements, vitamins, minerals, or special
diets actually change the course of a cancer once it has developed.
With so many advances, how come there’s no progress?
We have made tremendous—and increasing—progress in our understanding of cancer, but
the gap between understanding and treatment (between laboratory and bedside) is a
wide one. Because stories about cancer research are often reported in the media as
if that gap were small, people tend to expect big changes in treatment. This tendency
is partly responsible for the widespread feeling of disappointment with the impact
of cancer research.
Will there ever be a cure for cancer?
Many cancers ARE cured. Since every cancer is different, finding a single universal
cure is unlikely (similar to there not being a single antibiotic that cures all infections).
It is quite likely that we will make some further advances in some cancers. The biggest
changes in cancer may come from prevention or from other directions, such as treatments
or vaccines to prevent spread after the primary cancer has been removed. Obviously
nobody knows what is going to happen, but a single, sudden breakthrough that produces
a universal miracle cure is very unlikely.
Can our species ever be free of cancer?
Probably not. It is likely that our human species evolved with a design that was quite
satisfactory if the individual lived for three, four, or perhaps five decades. Our
problem, so to speak, is that we are now quite good at dealing with the forces that,
centuries ago, used to kill us off before we were 60. Now that many more of us are
living into our 60s, 70s, and beyond, cancer is a flaw that appears with increasing
frequency as cells do more and more multiplying and get older. It is possible that
we can devise ways of stopping this flaw from appearing, but it is equally possible
that cancer is not eradicable in the way smallpox was.
Will my hair grow back?
Yes, hair loss from chemotherapy is temporary. It will grow back, usually after therapy
is finished. In some cases, hair can grow back during therapy. Usually the texture
of the hair is different for the first year. Then, after a year or so, it usually
goes back to how it was before you took chemotherapy. Hair loss from radiation therapy
may be irreversible.
If I have a lot of side effects does that mean the chemotherapy is working?
No. The side effects occur because the chemotherapy hurts normal cells that divide
frequently, as well as the cancer cells. There is much that can be done to prevent
or lessen the side effects that a person gets after chemotherapy.
Are the side effects of chemotherapy worse than the cancer?
Nausea and vomiting, which to many are the worst of the side effects, can be controlled
for most people. Fatigue is finally getting the attention it deserves, and there are
many self-care tips that can help. Anemia, which can cause fatigue, can also be prevented
or treated in many cases.
Does everyone with cancer get anemia?
No. Anemia is a common condition that can be caused by benign conditions. Some cancers
can suppress the body's ability to efficiently make blood. Some cancer treatments
can cause anemia. Many cancer patients will never have anemia; and many people without
cancer can develop anemia for other reasons.
What effect does alcohol have?
There are many different types and causes of anemia. Alcohol can cause anemia by suppressing
the body's ability to make blood efficiently. Alcohol use can also lead to conditions
that increase the risk of bleeding, poor nutrition, and chronic disease that leads
Why don’t I get anemia right after my chemotherapy?
The red blood cells in the body live for about 120 days, or 3 months. Chemotherapy
doesn’t hurt the red blood cells that are already made and circulating in the blood.
Chemotherapy injures the cells in the bone marrow that make the red blood cells. The
chemotherapy prevents these cells from replacing the normal red blood cells when they
are used up. That is why the anemia may not develop for a while after the chemotherapy
How is anemia treated?
This depends on the cause of the anemia. If the anemia is caused by not enough building
blocks in the body, like iron, folic acid, or vitamin B12, the treatment includes
adding these back to the body. Red blood cells can then be made, and the blood values
return to normal. If the cause is chemotherapy, or sometimes radiation, then red blood
cell transfusions or injections of erythropoietin can be given in some cases. Erythropoietin
is a natural hormone made by the kidneys that tells the bone marrow to make more red
Should everyone get a second opinion?
Many people with cancer get a second opinion from another doctor. There are many reasons
to get a second opinion, including if the person is not comfortable with the treatment
decision, if the type of cancer is rare, if there are different ways to treat the
cancer, or if the person is not able to see a cancer expert. In addition, some health
insurance companies require a second opinion before treatment begins. A second opinion
can help a patient have more confidence in the cancer diagnosis, treatment plan, or
How can someone get a second opinion?
There are many ways to get a second opinion:
The person’s primary doctor may be able to recommend a specialist, such as a surgeon,
medical oncologist, or radiation oncologist. Sometimes these doctors work together
at cancer centers or programs.
The contact information for the Cancer Information Service is 1-800-4-CANCER (1-800-422-6237).
This service informs callers about treatment facilities, including cancer centers
and other programs supported by the National Cancer Institute.
Patients can get names of doctors from their local medical society, a nearby hospital,
a medical school, or local cancer advocacy groups, as well as from other people who
have had that type of cancer.