Do you see the half-full glass on that table over there? How about that half-empty one in the exact same location?
So much of what we are able to see and how we interpret it, depends on perspective. And our perspective depends on so many internal and external factors: our upbringing, our friends, our fears, our hopes, how much sleep we got, if we are hungry, if we are in pain, etc. Most of us can think of people we know who would see nearly every glass as half-full, and other people who would see nearly every glass as half-empty. Sometimes, our answers might even depend on the person who is asking the question. But I would be inclined to say that there are situations that can bring out the optimist or the pessimist in all of us.Perhaps the most significant factors are what the glass holds and how thirsty we are. If I were taking a seat at a lavish restaurant, I would be grateful for the half-full glass of wine set before me. And yet if I were approaching the rest station at mile 10 of my marathon, I might be quite disappointed to see a half-empty cup of Gatorade. It’s not always about the reality before you at the moment, but oftentimes it’s about what you have to lose, or gain, in the unpredictable future. When it comes to your health, it’s a game of balancing many different factors—some known and others unknown. And when it comes to cancer, the stakes are high. But you’re not playing alone.
The dreaded “c” word. Cancer. It is the same word whether you are trying to say it in English, Spanish, French, or Latin. But its impact is universal. Everybody knows somebody. And it may mean different things to different people, or even different things to the same person at different times. Being a cancer doctor, I get asked a lot of the same questions you may be thinking right now as you are reading this. Is there a cure for cancer? What causes cancer? Can we prevent cancer?
Cancer may only be one word, but there are countless ways to understand it. There is cancer that is localized in one place, and there is cancer that has spread (metastasized) to other sites. There are life-threatening cancers (most lung cancers), and there are cancers that can be safely observed without intervention for long periods of time (many prostate cancers). There are cancers in the brain, the eyes, the nose, the mouth, the tongue, the throat, the lungs, the esophagus, the stomach, the pancreas, the liver, the gallbladder, the kidneys, the colon, the bladder, the cervix, the prostate, the leg, the arm, the skin, the blood, etc. There are cancers that are more common in males, in females, in children, in adults, in families, in smokers, in people who have had certain chemical exposures in their lives, in people who eat certain foods. But probably every person who had cancer will say that it feels like it happened with absolutely no warning.
Cancer is a mystery, a war, a blessing, a curse, a hope, a fear, a test, a victory, and a challenge. It can be a mammogram, a CT scan, a PET, an MRI, a Pap smear, a PSA, an operation, radiation, or chemotherapy. It can feel like a lump, a headache, nausea, pain, trouble swallowing, weight loss, bloody stool, a cough, or fatigue. Or it can be completely silent. There is the cancer that affects the patient, and there is the cancer that affects everyone around them. It can make you weak, but it can also make you strong.
There is a lot of information out there about cancer. And often times, my patients tell me that all the facts, details, stories, and projections don’t actually serve to provide them with much clarity or comfort. This series of articles will hopefully serve as a navigation assistant for people who are currently on the battlefield, those who have beat their cancers, those who are close to people in any of these stages, or even those who have no personal connection to the disease but would just like to learn. Knowledge can be empowering. When should you see a doctor? What questions should you ask? What should you expect?
Interestingly, the number one reason people seek medical attention is pain. And unfortunately, most cancers are painless.
Ideally, we would be able to identify cancer when it is small and before it has had a chance to grow, cause symptoms, and spread to other places. With advances in biology, imaging, and technology, this is the ultimate goal. But where we stand now, we cannot detect the invisible nor can we predict the future.
More than 10 percent of women will get breast cancer in their lifetime.
Screening mammograms will not detect about 10 percent of them. These numbers can be shocking for most people who haven’t heard them. But with a change in perspective, the outlook can feel entirely different: nearly 90 percent of women will not get breast cancer in their lifetime and mammograms can catch nearly 90 percent of cancers. With research, time, and public awareness, we will make progress. We won’t need to rearrange our perspective to see things more positively. Hopefully, our vision can become the reality.
I will try to share with you a little bit about diagnosing cancer (imaging tests, blood tests, doctor’s visits), the different treatment options (surgery, chemotherapy, radiation), and the surveillance/follow-up that should continue after. We can learn about our successes in the past (earlier detection) that have led to the challenges of the present (destroying abnormal cancer cells without damaging healthy normal cells), and the possibilities of the future (personalized medicine).
The diagnosis of cancer can become an individual’s greatest personal challenge, but overcoming it requires a lot of participation from family, friends, doctors, nurses, pharmacists, social workers, neighbors, and even strangers.
Hopefully, this will help you understand why doctors emphasize the critical importance patients to get regular Pap smears or colonoscopies. It may inform you of how postmenopausal bleeding must be worked up, or how a painless growing mass in the side of your neck must be worked up. Maybe it will move you to walk in your local cancer fundraising benefit. It might even inspire you to drive someone you know to his/her radiation treatment one day. Or it might motivate you to throw out that pack of cigarettes, and not buy a new one. We can take this journey together, starting now.
In the word cancer, there is a race. There’s a beginning, an ending, and a whole lot of work in between. There’s the preparation for the race, the recovery, and the journey that continues long after.
In the word cancer, there is an element of care--both accepting it and giving it. Taking care of the disease with definitive treatments, but also caring for your other emotional, mental, physical, professional, and personal needs that don’t disappear just because of a diagnosis that has come into your life.
In the word cancer, there is a can. We can fight, we can share, we can learn, we can grow, we can make changes, we can move forward. And we will.