(ANN) Dr.Ang Peng Tiam
Shock burn memories into our brains. Years later, most patients can vividly recall how they felt when the doctor first confirmed that they had cancer.
People respond differently to the diagnosis of cancer. Some go into denial. Others get angry. I remember a Caucasian lady who took her angry out of me when I told her she had an aggressive brain cancer called glioblastoma multiforme.
She kept telling me that she “lived a very healthy life – eating lots of fruits and vegetables, exercising everyday and drinking lots lof water”. She felt that her doctors (a neurologist, the neurosurgeon the pathologist, the radiologist and I) were simply incompetent.
There are those who accept it as a matter of fact and begin focusingon what needs to be done. I remember a man, whom I diagnosed with colon cancer. He smiled at his wife and said: “see, I told you so!”.
When told that you have cancer, do not panic! Listen what the Doctor has to say. Ask a friend or a relative to come and be with you. Take your time – ask as many questions as you like. Most doctors are very happy to spend as much time as the patients need to help him/her understand what needs to be done.
What type of cancer is it?
The diagnosis should always be backed by tissue proof of cancer. This is a critical step which must not go wrong. A good pathologist is responsible not only for making the diagnosis but also for providing as much as information as possible on the type of cancer, For example, in breast cancer, we need to know the size of the tumor and the number of lymph nodes involved to know if there is a risk of cancer returning.
If the diagnosis is in question, review of the pathology by an external pathologist is useful. The patient (and the doctor) has a right to ask for the pathology blocks and slides to be sent to another pathologist to confirm the diagnosis.
What is the stage of cancer?
The more advanced the stage, the poorer the overall outlook for the patient.
Whenever, cancer is suspected, it is important to proceed with a full staging to establish of the cancer has spread. These days, there is a range of radiological investigations that can be used – plain X-ray films, ultrasound imaging, computer-tomograms (CT scans), magnetic resonance imaging (MRI)and nuclear imaging.
The latest and most sophisticated machine to aid in the diagnosis and staging of cancer is the PET-CT scan (positron emission tomogram).
The big difference between a PET CT scan and all the other imaging techniques is that it combines a metabolic scan with an anatomic scan. In PET-CT scan, a tiny amount of radioactive labeled glucose is injected into the blood stream.
Cancer are like sugar. As such, the glucose is preferentially taken up by the cancer cells and the radioactive substance “lights up” to identify the location, size and activity of the cancer. The CT part of the PET allows us to accurately locate the place the cancer is hiding.
A PET-CT scan has helped us to reduce unnecessary surgery because it can pick up cancer that spread which some of the other imaging studies may miss. There are research papers that suggest that no patient should go for a lung cancer operation without first going for a PET-CT scan. This method has been shown to cut down “futile surgery” (surgery that need not be done) by half in patients with lung cancer.
How Should the cancer be treated?
The three main ways of treating cancer are surgery radiotherapy and chemotherapy. For a cancer patient to be cured, we must get rid of the cancer and ensure that it never comes back. So to achieve “cure” means that there is no recurrence on and around the place the cancer was originally found (no local or regional recurrence) and no recurrence in distant sites (no systemic recurrence).
Surgery and radiotherapy work hand in hand to ensure that the local site is “thoroughly sterilized”. Surgery has to be aggressive to ensure that all the cancer that can be seen is removed. Radiotherapy is added to kill any cancer cells that may be left in the area.
Chemotherapy is different in that it treats cancer cells which may have escaped from the local site and are “hiding” in other parts of the body like the bones, liver or lungs. These microscopic cells are too small and cannot be detected by all the imaging modalities. Chemotherapy can be taken orally or injected into the bloodstream and taken up by the cancer cells which they kill to prevent distant spread (metastases).
Is there need ofr a second opinion? It all depends on how confident you are with your doctor.
If you want one, consider seeking an opinion at a facility which offers multi-disciplinary cancer care. A second opinion can be very important because specialties may have their own preferences in approach.
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