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When It's Cancer: First Steps -- Part One

by Richard Frank, MD

If you are reading this blog entry, then either you or someone you know may have just been told that they have cancer. Hearing the diagnosis of “cancer” is quite simply a shock to the system.  The first reaction is often panic followed by a tidal wave of emotions: “How can this be?” “Why me?” “I’m scared and not able to handle this.” But handle it you must.

After the initial shock, the next reaction is to seek information. Many will talk to their family doctor, friends and family, and seek information on the internet or in book stores in order to learn as much as possible about the type of cancer they have and the best medical specialists to seek out. This is a very daunting task as few individuals are knowledgeable about cancer and its terminology or about what constitutes excellent cancer care.  Needless to say, the stress of the diagnosis makes it doubly hard to process information and make the best choices.

In order to give you some grounding during this initial phase of coping with cancer, I have prepared the following list of essential things that anyone newly diagnosed with cancer should know.

1.    Understand the diagnosis. There are many different types of cancer, even within the same broad category. For example, in non-small cell lung cancer, the most common types are adenocarcinoma and squamous cell carcinoma and they are treated differently. Breast cancer has three general categories: hormone receptor positive (for the estrogen and/or progesterone receptors), Her2 positive, and triple negative (hormone receptors and Her2 are negative or not present); the three types are often treated very differently.  Nearly every type of cancer has different sub-types and it is important to know which one you have.

2.    Do not jump the gun and think the worst. Not all cancers of the same type act the same. Some “bad” cancers may be curable. Get all the facts straight and get them only from the experts who treat the disease, not from physicians who are not cancer experts and not from well-meaning friends and family who “know someone with…”

3.    Meet first with local specialists. What other tests are needed to fully determine the stage or extent of the cancer in the body? Do you need surgery, chemotherapy and/or radiation? Have these questions answered first in your community, near where you live or work. Physicians that specialize in treating cancer have been highly trained whether they practice in a community setting or at a large medical center. Since cancer treatment may not be a one shot deal but can involve six months or more of therapy, it is important to make these treatments as convenient and safe as possible. Having a good cancer center close to home can make a world of difference.

4.    Consider a second opinion. The need for a second opinion depends on the quality of the first opinions you receive and on your preferences as a patient. Do not think that the grass is greener elsewhere and that an incurable cancer is curable at a more heavily advertised center. If the cancer specialists in your area have an excellent reputation and you like their approach to you and your cancer, then you may not feel that another opinion is necessary. On the other hand, if you feel that surgery is better performed at a high volume center, for example, or you just want the peace of mind that comes with confirmation of treatment recommendations, then a second opinion is right for you. The best doctors do not dissuade patients from seeking other opinions nor from receiving cancer care close to home when that is more convenient.

In Part Two of this post, I will discuss the importance of organization in helping cancer treatments go smoothly.

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