>IF you have just been diagnosed in the last fortnight or so as having cancer, have a good cry. And why not. It is sad and frightening news; there is so much uncertainty; there are many unanswered questions. Thoughts of death flit through your mind.
Let the tears flow. Then wipe your tears and regain your composure for the hard thinking is about to start. Here's a guide on what to do next.
No rush
The cancer has been growing in your body for decades. It takes 10 to 20 years for the first cancer cell to be transformed into a mass of detectable and diagnosable cancer. Take at least two weeks to a month to work things out. Do not embark on any treatment (surgery, radiotherapy and chemotherapy) until most of your questions are answered.
The pathological review
In all probability, the diagnosis of cancer was confirmed after tissue from a certain part of your body was examined in the laboratory.
Ask for a pathological review (polite term for second opinion) of your biopsy or surgical specimen if there is uncertainty as to the type of cancer. At other times, the initial pathological study is not detailed enough.
If you have been diagnosed with breast cancer, the pathological information should include the size of the tumour, the number of lymph nodes involved, the grade, the estrogen receptor status, the progesterone receptor status, the presence of lymphovascular invasion and the HER2 status. The last is an indication of how aggressive the tumour is and whether your tumour will respond to a certain drug.
Many pathology reports do not include all this information.
The stage of the cancer
It is important to know the stage of your tumour - how far the cancer has spread. First, it is to avoid unnecessary surgery if the cancer is at an advanced stage.
For example, take lung cancer. If surgery is contemplated, we do a positron emission tomography scan (a PET/CT scan). This scan will show if the cancer has spread extensively to the lymph nodes in the vicinity or to a distant site in the body. Surgery is then not warranted.
If the PET scan shows a localised potentially operable tumour, the next step is to insert an ultrasound probe into the large air passages and determine if the tissues behind your breastbone are involved with cancer. If the answer is yes, surgery is out.
Second, the stage will determine the type and number of cancer drugs to be used. For instance, in stage II colon cancer, we usually use two drugs and in high-risk stage II and stage III, we use three drugs.
The doctors
Never be pushed to see any doctor against your wish. Choose your surgeon wisely. You should also choose your radiologist (the doctor who undertakes and studies X-rays and scans) and your pathologist. Needless to say, you choose your oncologist. All these specialist doctors will work in concert to look after you.
Your friends and counsellors
Whether to share this painful news with your loved ones is entirely up to you. After all, cancer (or any illness for that matter) is a very private matter. You can keep it all to yourself (and there is much to say for this) or share it with the world.
The danger of too many people knowing about your cancer is obvious. Purveyors of alternative medicine won't leave you alone. Multilevel marketers of food supplements and fruit juices will assail you with their latest cure-alls and "boosters of the immune system". Religious zealots will make a beeline to your home to save your soul. At such a time, you really don't need all this mumbo-jumbo.
Be thorough, systematic and punctilious
Start a folder for all your medical, laboratory and X-ray reports, and all bills and correspondence with insurance companies, too. Ask for written information each time you see a doctor: this goes into your folder as well.
All these notes will help you help your oncologist immensely. You will also feel "in charge" to some extent and this will boost your morale.
The second opinion
Not only is the second opinion important, perhaps a third or a fourth may be necessary. You can then weigh the wisdom against the folly of each opinion you get.
However, be warned of two pitfalls. The first is: be clear that you are not seeking a second opinion just to hear what you want to hear. Scientific medicine is not a popularity contest. Nine doctors out of 10 concur on a certain treatment approach. This does not necessarily mean that one dissenting voice is wrong.
The second is this: four opinions should not mean having four oncologists treating you at the same time.
Four ways of flying an aircraft does not mean four pilots grappling with the controls during the flight. Change your attending oncologist by all means if you are not satisfied with him. But give him at least two months (equal to three cycles of chemotherapy) exclusively at the helm before you make that change.
The crying may start again. And it is all right. Steel your heart, calm your nerves and boot up your brain. You will be the better to fight your cancer.
