(Part 1 - Diagnosis)
Written by Steven Burns
From his column To Your Health
You’ve just been to the doctor. You were already worried, because she had ordered tests, and you didn’t get the “all clear” phone call. When you arrived, her face was kind but serious, and you heard the words no one wants to hear: “You have cancer.”
I have seen many reactions to the news over my decades in practice. The most common is emotional shock. Some patients are sad, some angry, some resigned. A few exhibit a sense of relief, finally knowing the answer to their long quest for a diagnosis. Universally, they ask, “Okay, what do I do now?”
In 2018 in the USA, about 1,735,000 new cases of cancer were diagnosed, and nearly 610,000 died of the disease. These numbers do not include the very frequent low-grade skin cancers (basal cell and squamous cell carcinomas). About 38.4% of individuals will be diagnosed with cancer in their lifetimes. Worldwide, in 2012 (the latest date for world figures), there were 14.1 million new cases, and 8.2 million deaths from cancer. So, more than a third of us can expect to get cancer at some point in our lives.
After appointments with specialists and before treatment begins, many of my patients come to me with questions they forgot to ask the specialists. Commonly, I hear: “Should I get a second opinion?” Some are concerned that the specialist will be offended if they seek another opinion. I reassure them that specialists who treat cancer usually encourage patients to get additional opinions, and that they are not offended when patients do so. In some cases, I recommend patients go to a nationally known cancer center for an opinion. I usually do this when the patient has a rare or complicated cancer, or when there is a study about newer or experimental treatments.
Interestingly, most of my patients decline additional opinions after our discussion. They just want to know they have options. I believe it is important to have physicians in whom you have confidence. Your primary care physician should be able to explain treatments and symptoms in a way that you can understand, or you may need a different primary care physician.
After diagnosis, the next steps are based on the type of cancer you have. Some are treated surgically (breast, colon, prostate, melanoma, for instance). Some are treated with chemotherapy (leukemias, lymphomas, various inoperable cancers). Some are treated with radiation (most brain tumors, certain lung cancers). These treatments may be used in combination for many types of cancer.
Ideally, your doctor will have a proposed treatment plan in place when she tells you the diagnosis. In my practice, I try to talk to the surgeon or oncologist before my patient comes in to discuss the diagnosis. Where possible, my patient will already have appointments with relevant specialists by the time I see them.
Following initial diagnosis and planning, patients start asking the hard questions. “Why did this happen to me? I’ve never smoked, I take care of myself. Was there something in my diet, or medicine, or toxins in the environment that caused this?” While we can talk about risks in the environment and lifestyle for populations, there is no way to answer these questions. I have had lung cancer patients who never smoked, colon and breast cancer patients with no family history, and melanoma patients who never spent extra time in the sun.
The most difficult reason for us to accept is that cancers happen as we grow older. With time, the immune system becomes less adept at recognizing and destroying the abnormal cells our bodies make, and the cells then grow and invade the tissues around them. As much as we would like to have control over every aspect of our biology, that is just not how God made us. The best biological reason is the immunological one—things wear out. The best theological reason is that we live in an imperfect world.
Next time: Living with Cancer
Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.