Q: What is cancer?
A: 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.
Q: What causes cancer?
A: 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).
Q: Why do some people get cancer and not others?
A: 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.
Q: Is there an epidemic of cancer?
A: 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.
Q: Do we get cancer from what we eat?
A: 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.
Q: Are chemicals and pollutants causing cancer?
A: 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.
Q: Does cigarette smoke really cause cancer?
A: 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.
Q: Can cancer be prevented?
A: 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 field.
Q: Why does the diagnosis seem to be so delayed in so many cases?
A: 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 important.
Q: Why isn’t there a simple, universal test for cancer?
A: 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).
Q: Why do people with the same cancer get different treatment and have different problems?
A: 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.
Q: Does conventional treatment work?
A: 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 so important.
Q: Why is the treatment so awful?
A: 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.
Q: Can fatigue be prevented?
A: 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.
Q: I am going to start radiation next week. What should I expect, and what can I do to decrease the fatigue?
A: 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, no energy).
Third, talk with your doctor or nurse about problems that arise, or if your fatigue is severe.
Q: How does fatigue affect a person?
A: 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.
Q: How can I ask my family to help me?
A: 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 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.
Q: I’m taking interferon therapy, and am so tired. What can I do?
A: 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).
Q: When should I call the nurse or doctor about my fatigue?
A: 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
Q: Is fatigue a real symptom?
A: 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.
Q: How can I get the best from my doctor?
A: 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.
Q: Why are we all so frightened of cancer?
A: 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.
Q: Can attitudes or stress cause cancer?
A: 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.
Q: Can a change in diet alter the course of cancer?
A: 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.
Q: With so many advances, how come there’s no progress?
A: 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.
Q: Will there ever be a cure for cancer?
A: Probably not a cure. 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.
Q: Can our species ever be free of cancer?
A: 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 sixty. Now that many more of us are living into our sixties, seventies, 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.
Q: Will my hair grow back?
A: 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.
Q: If I have a lot of side effects does that mean the chemotherapy is working?
A: 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.
Q: Are the side effects of chemotherapy worse than the cancer?
A: 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.
Q: Does everyone with cancer get anemia?
A: No. Some cancers are linked with anemia, like multiple myeloma or leukemia. Other cancers are associated with an anemia called anemia of chronic disease. Anemia of chronic disease can also occur with diseases like rheumatoid arthritis. Treatment, such as chemotherapy or radiation therapy, can also cause anemia.
Finally, if the body doesn’t have enough nutrients to make red blood cells, a person can get anemia. For example, if you have bleeding from the intestine and lose red blood cells, you can lose a lot of iron. This is called iron deficiency anemia.
Q: What effect does alcohol have?
A: There are many different types and causes of anemia. Often people who drink a lot of alcohol don’t eat right. That, together with the alcohol itself, leads to a decreased supply of folic acid in the body. The body can’t store much folic acid, so it has to be taken in daily, through food or a pill. The body needs folic acid (folate) in order to make the red blood cells. If there isn’t enough, then the person gets anemia. People with this type of anemia can also get other types of anemia too.
Q: Why don’t I get anemia right after my chemotherapy?
A: 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 starts — usually about 3 months of circulating around the body in the bloodstream.
Q: How is anemia treated?
A: 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 epoetin alfa can be given in some cases. Erythropoietin is a natural hormone made by the kidneys that tells the bone marrow to make more red blood cells.
Q: Should everyone get a second opinion?
A: 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.
Q: How can someone get a second opinion?
A: 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 Cancer Information Service (800-4-CANCER) 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.
- Foster, Sara, RN, MPH
- MMI board-certified, academically affiliated clinician